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Anthropogenic aerosols play a major role in the Earth–atmosphere system by influencing the Earth's radiative budget and precipitation and consequently the climate. The perturbation induced by changes in anthropogenic aerosols on the Earth's energy balance is quantified in terms of the effective radiative forcing (ERF). In this work, the present-day shortwave (SW), longwave (LW), and total (i.e., SW plus LW) ERF of anthropogenic aerosols is quantified using two different sets of experiments with prescribed sea surface temperatures (SSTs) from Earth system models (ESMs) participating in the Coupled Model Intercomparison Project Phase 6 (CMIP6): (a) time-slice pre-industrial perturbation simulations with fixed SSTs (piClim) and (b) transient historical simulations with time-evolving SSTs (histSST) over the historical period (1850–2014). ERF is decomposed into three components for both piClim and histSST experiments: (a) ERFARI, representing aerosol–radiation interactions; (b) ERFACI, accounting for aerosol–cloud interactions (including the semi-direct effect); and (c) ERFALB, which is due to temperature, humidity, and surface albedo changes caused by anthropogenic aerosols. We present spatial patterns at the top-of-atmosphere (TOA) and global weighted field means along with inter-model variability (1 standard deviation) for all SW, LW, and total ERF components (ERFARI, ERFACI, and ERFALB) and for every experiment used in this study. Moreover, the inter-model agreement and the robustness of our results are assessed using a comprehensive method as utilized in the IPCC Sixth Assessment Report. Based on piClim experiments, the total present-day (2014) ERF from anthropogenic aerosol and precursor emissions is estimated to be −1.11 ± 0.26 W m−2, mostly due to the large contribution of ERFACI to the global mean and to the inter-model variability. Based on the histSST experiments for the present-day period (1995–2014), similar results are derived, with a global mean total aerosol ERF of −1.28 ± 0.37 W m−2 and dominating contributions from ERFACI. The spatial patterns for total ERF and its components are similar in both the piClim and histSST experiments. Furthermore, implementing a novel approach to determine geographically the driving factor of ERF, we show that ERFACI dominates over the largest part of the Earth and that ERFALB dominates mainly over the poles, while ERFARI dominates over certain reflective surfaces. Analysis of the inter-model variability in total aerosol ERF shows that SW ERFACI is the main source of uncertainty predominantly over land regions with significant changes in aerosol optical depth (AOD), with eastern Asia contributing mostly to the inter-model spread of both ERFARI and ERFACI. The global spatial patterns of total ERF and its components from individual aerosol species, such as sulfates, organic carbon (OC), and black carbon (BC), are also calculated based on piClim experiments. The total ERF caused by sulfates (piClim-SO2) is estimated at −1.11 ± 0.31 W m−2, and the OC ERF (piClim-OC) is −0.35 ± 0.21 W m−2, while the ERF due to BC (piClim-BC) is 0.19 ± 0.18 W m−2. For sulfates and OC perturbation experiments, ERFACI dominates over the globe, whereas for BC perturbation experiments ERFARI dominates over land in the Northern Hemisphere and especially in the Arctic. Generally, sulfates dominate ERF spatial patterns, exerting a strongly negative ERF especially over industrialized regions of the Northern Hemisphere (NH), such as North America, Europe, and eastern and southern Asia. Our analysis of the temporal evolution of ERF over the historical period (1850–2014) reveals that ERFACI clearly dominates over ERFARI and ERFALB for driving the total ERF temporal evolution. Moreover, since the mid-1980s, total ERF has become less negative over eastern North America and western and central Europe, while over eastern and southern Asia there is a steady increase in ERF magnitude towards more negative values until 2014.

Cultural heritage (CH) sites are frequently exposed to natural elements, and their exposure becomes particularly precarious with the onset of climate change. This increased vulnerability places these sites at risk of deterioration or complete destruction. Risks such as land deformation, floods, acid rain, and erosion significantly threaten historic monuments, while water-related hazards, significantly influenced by both climate change and human activities, present a particularly grave risk to these invaluable sites. Considerable research efforts have focused on safeguarding CH sites. However, there remains a deficiency in systemic approaches towards identifying and mitigating risks for CH sites. The TRIQUETRA project proposes a technological toolbox and a methodological framework for tackling climate change risks and natural hazards threatening CH in the most efficient way possible. It aims at creating an evidence-based assessment platform allowing precise risk stratification as well as a database of available mitigation measures and strategies, acting as a Decision Support System (DSS) towards efficient risk mitigation and site remediation. TRIQUETRA is a European project that brings together a diverse group of researchers with varied expertise, encompassing university research groups, research institutes, public entities, as well as small and medium-sized enterprises. In this article, TRIQUETRAs overall methodology is presented, and preliminary results concerning risk identification, TRIQUETRAs knowledge base, as well as novel sensors and coatings, are discussed.

Objective and rationale: Chronic endometritis (CE) has recently been associated with unexplained infertility and recurrent miscarriages. The current gold standard for CE detection is histopathological examination. However, office hysteroscopy and endometrial cultures are also significant, due to the possible link between CE and various microorganisms. Bacterial colonization of the endometrium has been associated with reduced success rates of in vitro fertilisation embryo transfer. Few studies have tried to correlate CE hysteroscopy findings with pathogenic microorganisms. This prospective cohort study sought to establish whether hysteroscopic diagnostic lesions correlate with specific microbial species. Methods: The study encompassed women undergoing diagnostic tests for a range of subfertility health issues. 189 women completed the standard office diagnostic hysteroscopy (DH). 181 had also endometrial samples taken for microbial culture investigation. Correlation analysis (χ2 and Fisher's exact test) between hysteroscopic findings suggestive of CE and endometrial cultures was carried out. Logistic regression models were also fitted to measure whether a positive endometrial culture could affect CE conditions. Results: A significant association of E. coli was observed between the hysteroscopically characterized CE + group with focal hyperplasia, when compared to the non–CE group. Logistic regression analysis revealed that women positive for E. coli were 4.423 times more likely to have focal endometrial hyperplasia. No other significant correlations were identified between DH and positive endometrial cultures. Conclusions: The presence of E. coli in the endometrium was significantly correlated with focal hyperplasia findings from hysteroscopy, emphasizing the importance of microbial cultures in the diagnosis and targeted treatment of CE in women with subfertility.

The Mediterranean, and particularly its Eastern basin, is a crossroad of air masses advected from Europe, Asia and Africa. Anthropogenic emissions from its megacities meet over the Eastern Mediterranean, with natural emissions from the Saharan and Middle East deserts, smoke from frequent forest fires, background marine and pollen particles emitted from ocean and vegetation, respectively. This mixture of natural aerosols and gaseous precursors (Short-Lived Climate Forcers—SLCFs in IPCC has short atmospheric residence times but strongly affects radiation and cloud formation, contributing the largest uncertainty to estimates and interpretations of the changing cloud and precipitation patterns across the basin. The SLCFs’ global forcing is comparable in magnitude to that of the long-lived greenhouse gases; however, the local forcing by SLCFs can far exceed those of the long-lived gases, according to the Intergovernmental Panel on Climate Change (IPCC). Monitoring the spatiotemporal distribution of SLCFs using remote sensing techniques is important for understanding their properties along with aging processes and impacts on radiation, clouds, weather and climate. This article reviews the current state of scientific know-how on the properties and trends of SLCFs in the Eastern Mediterranean along with their regional interactions and impacts, depicted by ground- and space-based remote sensing techniques.

An assessment of the projected changes in precipitation extremes for the 21st century is presented here for Greece and its individual administrative regions. The analysis relies on an ensemble of high-resolution Regional Climate Model (RCM) simulations following various Representative Concentration Pathways (RCP2.6, RCP4.5, and RCP8.5). The simulated changes in future annual total precipitation (PRTOT) under the examined scenarios are generally negative but statistically non-robust, except towards the end of the century (2071–2100) over high-altitude mountainous regions in Western Greece, Peloponnese, and Crete under RCP8.5. The pattern of change in the number of very heavy precipitation days (R20) is linked to the respective pattern of the PRTOT change with a statistically robust decrease of up to −5 days per year only over parts of the high-altitude mountainous regions in Western Greece, Peloponnese, and Crete for 2071–2100 under RCP8.5. Contrasting the future tendency for decrease in total precipitation and R20, the changes in the intensity of precipitation extremes show a tendency for intensification. However, these change patterns are non-robust for all periods and scenarios. Statistical significance is indicated for the highest 1-day precipitation amount in a year (Rx1day) for the administrative regions of Thessaly, Central Greece, Ionian Islands, and North Aegean under RCP8.5 in 2071–2100. The changes in the contribution of the wettest day per year to the annual total precipitation (RxTratio) are mainly positive but non-robust for most of Greece and all scenarios in the period 2021–2050, becoming more positive and robust in 2071–2100 for RCP8.5. This work highlights the necessity of taking into consideration high-resolution multi-model RCM estimates in future precipitation extremes with various scenarios, for assessing their potential impact on flood episodes and the strategic planning of structure resilience at national and regional level under the anticipated human-induced future climate change.

CXCR4, JUNB and PD-L1 are implicated in cancer progression and metastasis. The current study investigated these biomarkers in CTCs isolated from metastatic prostate cancer (mPCa) patients at the RNA and protein levels. CTCs were isolated from 48 mPCa patients using the Ficoll density gradient and ISET system (17 out of 48). The (CK/PD-L1/CD45) and (CK/CXCR4/JUNB) phenotypes were identified using two triple immunofluorescence stainings followed by VyCAP platform analysis. Molecular analysis was conducted with an EpCAM-dependent method for 25/48 patients. CK-8, CK-18, CK-19, JUNB, CXCR4, PD-L1, and B2M (reference gene) were analyzed with RT-qPCR. The (CK+/PD-L1+/CD45-) and the (CK+/CXCR4+/JUNB+) were the most frequent phenotypes (61.1% and 62.5%, respectively). Furthermore, the (CK+/CXCR4+/JUNB-) phenotype was correlated with poorer progression-free survival [(PFS), HR: 2.5, p = 0.049], while the (CK+/PD-L1+/CD45-) phenotype was linked to decreased overall survival [(OS), HR: 262.7, p = 0.007]. Molecular analysis revealed that 76.0% of the samples were positive for CK-8,18, and 19, while 28.0% were positive for JUNB, 44.0% for CXCR4, and 48.0% for PD-L1. Conclusively, CXCR4, JUNB, and PD-L1 were highly expressed in CTCs from mPCa patients. The CXCR4 protein expression was associated with poorer PFS, while PD-L1 was correlated with decreased OS, providing new biomarkers with potential clinical relevance.

A Correction to this paper has been published: https://doi.org/10.1038/s41467-021-23162-4.

Breast cancer (BC) risk for BRCA1 and BRCA2 mutation carriers varies by genetic and familial factors. About 50 common variants have been shown to modify BC risk for mutation carriers. All but three, were identified in general population studies. Other mutation carrier-specific susceptibility variants may exist but studies of mutation carriers have so far been underpowered. We conduct a novel case-only genome-wide association study comparing genotype frequencies between 60,212 general population BC cases and 13,007 cases with BRCA1 or BRCA2 mutations. We identify robust novel associations for 2 variants with BC for BRCA1 and 3 for BRCA2 mutation carriers, P

BackgroundGenetic testing for breast cancer susceptibility is widely used, but for many genes, evidence of an association with breast cancer is weak, underlying risk estimates are imprecise, and reliable subtype-specific risk estimates are lacking.MethodsWe used a panel of 34 putative susceptibility genes to perform sequencing on samples from 60,466 women with breast cancer and 53,461 controls. In separate analyses for protein-truncating variants and rare missense variants in these genes, we estimated odds ratios for breast cancer overall and tumor subtypes. We evaluated missense-variant associations according to domain and classification of pathogenicity.ResultsProtein-truncating variants in 5 genes (ATM, BRCA1, BRCA2, CHEK2, and PALB2) were associated with a risk of breast cancer overall with a P value of less than 0.0001. Protein-truncating variants in 4 other genes (BARD1, RAD51C, RAD51D, and TP53) were associated with a risk of breast cancer overall with a P value of less than 0.05 and a Bayesian false-discovery probability of less than 0.05. For protein-truncating variants in 19 of the remaining 25 genes, the upper limit of the 95% confidence interval of the odds ratio for breast cancer overall was less than 2.0. For protein-truncating variants in ATM and CHEK2, odds ratios were higher for estrogen receptor (ER)-positive disease than for ER-negative disease; for protein-truncating variants in BARD1, BRCA1, BRCA2, PALB2, RAD51C, and RAD51D, odds ratios were higher for ER-negative disease than for ER-positive disease. Rare missense variants (in aggregate) in ATM, CHEK2, and TP53 were associated with a risk of breast cancer overall with a P value of less than 0.001. For BRCA1, BRCA2, and TP53, missense variants (in aggregate) that would be classified as pathogenic according to standard criteria were associated with a risk of breast cancer overall, with the risk being similar to that of protein-truncating variants.ConclusionsThe results of this study define the genes that are most clinically useful for inclusion on panels for the prediction of breast cancer risk, as well as provide estimates of the risks associated with protein-truncating variants, to guide genetic counseling. (Funded by European Union Horizon 2020 programs and others.).

Abstract Liquid biopsy (LB) provides a unique minimally invasive tool to follow-up cancer patients over time, to detect minimal residual disease (MRD), to study metastasis-biology and mechanisms of therapy-resistance. Molecular characterization of CTCs offers additionally the potential to understand resistance to therapy and implement individualized targeted treatments which can be modified during the disease evolution and follow-up period of a patient. In this study, we present a long-term follow-up of operable breast cancer patients based on a comprehensive liquid biopsy analysis. We performed a comprehensive liquid biopsy analysis in peripheral blood of 13 patients with early-stage operable breast cancer at several time points for a period of ten years, consisting of: (a) CTC enumeration using the CellSearch system, (b) phenotypic analysis of CTCs using Immunofluorescence, (c) gene expression analysis, in EpCAM(+) CTCs for CK-19, CD24,CD44, ALDH1, and TWIST1, (d) analysis of PIK3CA and ESR1 mutations in EpCAM(+) CTCs and corresponding plasma ctDNA and (e) DNA methylation of ESR1 in CTCs. 10/13 (77%) patients were found negative for LB markers in PB during the whole follow-up period, and these patients did not relapse during the follow-up. However, 3/13(18%) patients that were positive for at least one LB marker relapsed within the follow-up period. The molecular characteristics of CTCs were highly different even for the same patient at different time points, and always increased before the clinical relapse. Our results indicate that liquid biopsy can reveal the presence of MRD at least 4 years before the appearance of clinically detectable metastatic disease demonstrating that a comprehensive liquid biopsy analysis provides highly important information for the therapeutic management of breast cancer patients.

Long-term exposure to ambient ozone (O _3 ) is associated with excess respiratory mortality. Pollution emissions, demographic, and climate changes are expected to drive future ozone-related mortality. Here, we assess global mortality attributable to ozone according to an Intergovernmental Panel on Climate Change (IPCC) Shared Socioeconomic Pathway (SSP) scenario applied in Coupled Model Intercomparison Project Phase 6 (CMIP6) models, projecting a temperature increase of about 3.6 °C by the end of the century. We estimated ozone-related mortality on a global scale up to 2090 following the Global Burden of Disease (GBD) 2019 approach, using bias-corrected simulations from three CMIP6 Earth System Models (ESMs) under the SSP3-7.0 emissions scenario. Based on the three ESMs simulations, global ozone-related mortality by 2090 will amount to 2.79 M [95% CI 0.97 M–5.23 M] to 3.12 M [95% CI 1.11 M–5.75 M] per year, approximately ninefold that of the 327 K [95% CI 103 K–652 K] deaths per year in 2000. Climate change alone may lead to an increase of ozone-related mortality in 2090 between 42 K [95% CI −37 K–122 K] and 217 K [95% CI 68 K–367 K] per year. Population growth and ageing are associated with an increase in global ozone-related mortality by a factor of 5.34, while the increase by ozone trends alone ranges between factors of 1.48 and 1.7. Ambient ozone pollution under the high-emissions SSP3-7.0 scenario is projected to become a significant human health risk factor. Yet, optimizing living conditions and healthcare standards worldwide to the optimal ones today (application of minimum baseline mortality rates) will help mitigate the adverse consequences associated with population growth and ageing, and ozone increases caused by pollution emissions and climate change.

Mosquito-borne diseases have been spreading across Europe over the past two decades, with climate change contributing to this spread. Temperature and precipitation are key factors in a mosquito’s life cycle, and are greatly affected by climate change. Using a machine learning framework, Earth Observation data, and future climate projections of temperature and precipitation, this work studies three different cases (Veneto region in Italy, Upper Rhine Valley in Germany and Pancevo, Serbia) and focuses on (i) evaluating the impact of climate factors on mosquito abundance and (ii) long-term forecasting of mosquito abundance based on EURO-CORDEX future climate projections under different Representative Concentration Pathways (RCPs) scenarios. The study shows that increases in precipitation and temperature are directly linked to increased mosquito abundance, with temperature being the main driving factor. Additionally, as the climatic conditions become more extreme, meaning higher variance, the mosquito abundance increases. Moreover, we show that in the upcoming decades mosquito abundance is expected to increase. In the worst-case scenario (RCP8.5) Serbia will face a 10% increase, Italy around a 40% increase, and Germany will reach almost a 200% increase by 2100, relative to the decade 2010–2020. However, in terms of absolute numbers both in Italy and Germany, the expected increase is similar. An interesting finding is that either strong (RCP2.6) or moderate mitigation actions (RCP4.5) against greenhouse gas concentration lead to similar levels of future mosquito abundance, as opposed to no mitigation action at all (RCP8.5), which is projected to lead to high mosquito abundance for all cases studied.

BackgroundWe examined the associations between germline variants and breast cancer mortality using a large meta-analysis of women of European ancestry.MethodsMeta-analyses included summary estimates based on Cox models of twelve datasets using ~10.4 million variants for 96,661 women with breast cancer and 7697 events (breast cancer-specific deaths). Oestrogen receptor (ER)-specific analyses were based on 64,171 ER-positive (4116) and 16,172 ER-negative (2125) patients. We evaluated the probability of a signal to be a true positive using the Bayesian false discovery probability (BFDP).ResultsWe did not find any variant associated with breast cancer-specific mortality at P

Stratification of women according to their risk of breast cancer based on polygenic risk scores (PRSs) could improve screening and prevention strategies. Our aim was to develop PRSs, optimized for prediction of estrogen receptor (ER)-specific disease, from the largest available genome-wide association dataset and to empirically validate the PRSs in prospective studies. The development dataset comprised 94,075 case subjects and 75,017 control subjects of European ancestry from 69 studies, divided into training and validation sets. Samples were genotyped using genome-wide arrays, and single-nucleotide polymorphisms (SNPs) were selected by stepwise regression or lasso penalized regression. The best performing PRSs were validated in an independent test set comprising 11,428 case subjects and 18,323 control subjects from 10 prospective studies and 190,040 women from UK Biobank (3,215 incident breast cancers). For the best PRSs (313 SNPs), the odds ratio for overall disease per 1 standard deviation in ten prospective studies was 1.61 (95%CI: 1.57-1.65) with area under receiver-operator curve (AUC) = 0.630 (95%CI: 0.628-0.651). The lifetime risk of overall breast cancer in the top centile of the PRSs was 32.6%. Compared with women in the middle quintile, those in the highest 1% of risk had 4.37- and 2.78-fold risks, and those in the lowest 1% of risk had 0.16- and 0.27-fold risks, of developing ER-positive and ER-negative disease, respectively. Goodness-of-fit tests indicated that this PRS was well calibrated and predicts disease risk accurately in the tails of the distribution. This PRS is a powerful and reliable predictor of breast cancer risk that may improve breast cancer prevention programs.

Background: SARS–CoV–2 virus has undergone several mutations on its genome, since the onset of the pandemic. Multiple variants of concern (VOC) have emerged including Alpha, Beta, Gamma, and Delta with the more recent one being the Omicron (B.1.1.529). Specific rapid antigen tests (RADs) have been used for the detection of SARS–CoV–2. However, since the emergence of new VOCs, the performance characteristics of these RADs needs to be re–evaluated. Objectives: The main purposes of this clinical study were to determine the diagnostic sensitivity and specificity of the BOSON Rapid Antigen Test compared to the gold standard real time RT–PCR and to determine the ability of the RAD to accurately depict different VOC. Additionally, the cross reactivity to other viruses and pathogen, as well as, the possible interference of non Covid–19 hospitalized patients for various causes, were investigated. Results: A total of 623 individuals (symptomatic) were tested. The sensitivity, specificity and accuracy of the BOSON RAD was 95.27%, 100% and 98.45% (n = 448), meeting the WHO recommended standards. Additionally, the Delta (83.33%, Ct

Front-line bevacizumab (BEV) in combination with taxanes offers benefit in progression-free survival (PFS) in metastatic breast cancer (mBC). The medical records of mBC patients, treated with front-line BEV-based chemotherapy, were retrospectively reviewed in order to generate real life safety and efficacy data. Patients with human epidermal growth factor receptor 2 (HER2)-negative mBC treated with front-line BEV in combination with chemotherapy were eligible. Maintenance therapy with BEV and/or hormonal agents was at the physicians’ discretion. Among the 387 included patients, the most common adverse events were anemia (61.9%, mainly grade 1), grade 3/4 neutropenia (16.5%), grade 1/2 fatigue (22.3%), and grade 1/2 neuropathy (19.6%). Dose reductions were required in 164 cycles (7.1%) and toxicity led to treatment discontinuation in 21 patients (5.4%). The median PFS and the median overall survival (OS) were 13.3 (95% CI: 11.7–14.8) and 32.3 months (95% CI: 27.7–36.9), respectively. Maintenance therapy, with hormonal agents (ET) and/or BEV, was associated with longer OS versus no maintenance therapy (47.2 versus 23.6 months; p < 0.001) in patients with hormone receptor (HR)-positive disease and BEV maintenance offered longer OS versus no maintenance in patients with HR-negative disease (52.8 versus 23.3; p = 0.023). These real-life data show that front-line BEV-based chemotherapy in HER2-negative mBC patients is an effective treatment with an acceptable toxicity profile. The potential benefit of maintenance treatment, especially ET, is important and warrants further research.

Background and Objectives: Automated methods for the analysis of myocardial perfusion studies have been incorporated into clinical practice, but they are currently used as adjuncts to the visual interpretation. We aimed to investigate the role of automated measurements of summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) as long-term prognostic markers of morbidity and mortality, in comparison to the prognostic value of expert reading. Materials and Methods: The study was conducted at the Nuclear Medicine Laboratory of the University of Thessaly, in Larissa, Greece. A total of 378 consecutive patients with known or suspected coronary artery disease were enrolled in the study. All participants were referred to our laboratory for the performance of stress/rest myocardial perfusion single photon emission computed tomography. Automated measurements of SSS, SRS, and SDS were obtained by Emory Cardiac Toolbox (ECTb (Version 3.0), Emory University, Atlanta, GA, USA), Myovation (MYO, Xeleris version 3.05, GE Healthcare, Chicago, IL, USA), and Quantitative Perfusion SPECT (QPS (Version 4.0), Cedars-Sinai Medical Center, Los Angeles, CA, USA) software packages. Follow-up data were recorded after phone contacts, as well as through review of hospital records. Results: Expert scoring of SSS and SDS had significantly greater prognostic ability in comparison to all software packages (p < 0.001 for all comparisons). Similarly, ECTb-obtained SRS measurements had significantly lower prognostic ability in comparison to expert scoring (p < 0.001), while expert scoring of SRS showed significantly higher prognostic ability compared to MYO (p = 0.018) and QPS (p < 0.001). Conclusions: Despite the useful contribution of automated analyses in the interpretation of myocardial perfusion studies, expert reading should continue to have a crucial role, not only in clinical decision making, but also in the assessment of prognosis.

We investigate future changes of agro-climatic zones over Europe under two different IPCC Representative Concentration Pathways (RCP4.5 and RCP8.5) based on an ensemble of 11 bias-corrected regional climate model simulations covering the period 1981–2100. Eight distinct agro-climatic zones were identified by applying the k-means clustering method for the reference period 1981–2010 on two temperature-related parameters: the growing season length and the active temperature sum. Our results point towards a strong northward shift of the agro-climatic zones, especially under RCP8.5, towards the end of the century. A significant shift of the agro-climatic zones is also projected for RCP4.5 in the near-future and the end-of-the-century periods for large areas in Europe.

We examine the atmospheric concentrations of methane (CH4) over the Greater Thessaloniki Area using data from the periods 2003–2004 and 2018–2022. Earlier data are from SCIAMACHY on ENVISAT, while the later years are from TROPOMI on Sentinel 5P. Large increases are observed over this period, as expected from the overall global trend. The data show increased concentrations over the rice fields of Chalastra, biological waste treatment units and biogas plants, and garbage burial sites. The highest concentrations are observed during autumn, while the lower ones are observed during spring. The 2022 levels are around 1900 ppb. Annual increases in the examined period up to 16 ppbv (2019–2020) have been observed. During December 2021, very high CH4 was observed over an area when no high CH4 concentrations had been observed prior to or after this episode.

We investigate the effective radiative forcing (ERF) of anthropogenic aerosols using simulations from seven Earth System Models participating in the Coupled Model Intercomparison Project Phase 6 (CMIP6). The ERF of individual aerosol species (black carbon, organic carbon, sulphates) is quantified along with the all-aerosol ERF and decomposed into its aerosol–radiation interactions (ARI), aerosol–cloud interactions (ACI) and surface albedo (ALB) components, using the method proposed by Ghan in 2013. We find that the total anthropogenic aerosol ERF at the top of the atmosphere (TOA) is negative, mainly due to aerosol–cloud interactions. Sulphates exhibit a strongly negative ERF especially over industrialized regions of the Northern Hemisphere, such as Europe, North America, East and South Asia, while black carbon exerts a positive ERF predominantly over East and South Asia.

The 4th Summer School in Immuno-Oncology was held from July 1st–July 3rd as a web meeting. Many eminent researchers and leading oncologists from Europe and the USA working on basic, translational and clinical cancer research participated, presented, and discussed the most recent advances in cancer immunology and immunotherapy. Besides sharing the newest information in the field of cancer immunology and immunotherapy, the meeting also focused on the actual translation of new knowledge acquired in the lab to the clinical setting; particular emphasis was given to the mode of action of novel therapeutic modalities and to biomarkers helpful for treatment decision-making, as well as to means that may improve cancer immunotherapeutic protocols used for the treatment of a variety of malignancies. The main topics presented by the speakers included: (1) mechanisms of tumor immune evasion and resistance; (2) host-tumor interactions and means to regulate antitumor immunity; (3) exploitation of new biomarkers and tumor or immune signatures able to potentially guide therapeutic interventions; (4) emerging therapeutic modalities for cancer treatment and specific immunotherapeutics for thoracic, genito-urinary, gastrointestinal, skin and breast cancers; and (5) innovative treatment options and alternatives to minimize the toxic adverse events of cancer immunotherapy.

MLL3 histone methyltransferase, encoded by the KMT2C gene, is a tumor suppressor that has an essential role in cell‐type‐specific gene expression. We evaluated the prognostic significance of KMT2C promoter methylation as a circulating epigenetic biomarker in plasma cell‐free DNA (cfDNA) in non‐small cell lung cancer (NSCLC). We examined the methylation status of KMT2C promoter using a novel highly specific and sensitive real‐time methylation‐specific PCR (MSP) assay in (a) operable NSCLC: 48 fresh‐frozen NSCLC tissues, their corresponding adjacent non‐neoplastic tissues, and 48 matched plasma samples; (b) metastatic NSCLC: 91 plasma samples; and (c) 60 plasma samples from healthy donors (HD). KMT2C promoter methylation in plasma cfDNA was detected in 7/48 (14.6%) patients with operable and in 18/91 (19.8%) patients with advanced NSCLC but in none (0/60, 0%) of the plasma samples from HD. In operable NSCLC, in corresponding adjacent non‐neoplastic tissue samples, KMT2C promoter methylation was detected in 3/48 (6.3%) cases. Moreover, in operable NSCLC, KMT2C promoter methylation in plasma cfDNA was related to reduced disease‐free survival (ΗR = 0.239; P = 0.001) and worse overall survival (OS; HR = 0.342, P = 0.023). In metastatic NSCLC, KMT2C promoter methylation in plasma cfDNA was related to worse progression‐free survival (PFS; HR = 0.431; P = 0.005) and worse OS (HR = 0.306; P

Background: The coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known. Objectives: This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia. Methods: The International Atomic Energy Agency conducted a worldwide survey to assess changes in cardiovascular procedure volume and safety practices caused by COVID-19. Testing volumes were reported for March 2020 and April 2020 and were compared to those from March 2019. Data from 180 centers across 33 Asian countries were grouped into 4 subregions for comparison. Results: Procedure volumes decreased by 47% from March 2019 to March 2020, showing recovery from March 2020 to April 2020 in Eastern Asia, particularly in China. The majority of centers cancelled outpatient activities and increased time per study. Practice changes included implementing physical distancing and restricting visitors. Although COVID testing was not commonly performed, it was conducted in one-third of facilities in Eastern Asia. The most severe reductions in procedure volumes were observed in lower-income countries, where volumes decreased 81% from March 2019 to April 2020. Conclusions: The COVID-19 pandemic in Asia caused significant reductions in cardiovascular diagnostic procedures, particularly in low-income countries. Further studies on effects of COVID-19 on cardiovascular outcomes and changes in care delivery are warranted.

Skin melanoma cells are tightly interconnected with their tumor microenvironment (TME), which influences their initiation, progression, and sensitivity/resistance to therapeutic interventions. An immune-active TME favors patient response to immune checkpoint inhibition (ICI), but not all patients respond to therapy. Here, we assessed differential gene expression in primary and metastatic tumors from the TCGA-SKCM dataset, compared to normal skin samples from the GTEx project and validated key findings across 4 independent GEO datasets, as well as using immunohistochemistry in independent patient cohorts. We focused our attention on examining the expression of various immune receptors, immune-cell fractions, immune-related signatures and mutational signatures across cutaneous melanomas with diverse tumor mutation burdens (TMB). Globally, the expression of most immunoreceptors correlated with patient survival, but did not differ between TMBhigh and TMBlow tumors. Melanomas were enriched in “naive T-cell”, “effector memory T-cell”, “exhausted T-cell”, “resting Treg T-cell” and “Th1-like” signatures, irrespective of their BRAF, NF1 or RAS mutational status. Somatic mutations in IDO1 and HLA-DRA were frequent and could be involved in hindering patient response to ICI therapies. We finally analyzed transcriptome profiles of ICI-treated patients and associated their response with high levels of IFNγ, Merck18, CD274, CD8, and low levels of myeloid-derived suppressor cells (MDSCs), cancer-associated fibroblasts (CAFs) and M2 macrophages, irrespective of their TMB status. Overall, our findings highlight the importance of pre-existing T-cell immunity in ICI therapeutic outcomes in skin melanoma and suggest that TMBlow patients could also benefit from such therapies.

Metastasis, rather than the growth of the primary tumor, accounts for approximately 90% of breast cancer patient deaths. Microtentacles (McTNs) formation represents an important mechanism of metastasis. Triple-negative breast cancer (TNBC) is the most aggressive subtype with limited targeted therapies. The present study aimed to isolate viable circulating tumor cells (CTCs) and functionally analyze them in response to drug treatment. CTCs from 20 TNBC patients were isolated and maintained in culture for 5 days. Biomarker expression was identified by immunofluorescence staining and VyCap analysis. Vinorelbine-induced apoptosis was evaluated based on the detection of M30-positive cells. Our findings revealed that the CTC absolute number significantly increased using TetherChips analysis compared to the number of CTCs in patients’ cytospins (p = 0.006) providing enough tumor cells for drug evaluation. Vinorelbine treatment (1 h) on live CTCs led to a significant induction of apoptosis (p = 0.010). It also caused a significant reduction in Detyrosinated α-tubulin (GLU), programmed death ligand (PD-L1)-expressing CTCs (p < 0.001), and disruption of McTNs. In conclusion, this pilot study offers a useful protocol using TetherChip technology for functional analysis and evaluation of drug efficacy in live CTCs, providing important information for targeting metastatic dissemination at a patient-individualized level.

Breast cancer risk for BRCA1/BRCA2 mutation carriers varies depending on other genetic factors. Here, the authors perform a case-only genome-wide association study and highlight novel loci associated with breast cancer risk for BRCA1/BRCA2 mutation carriers.

Abstract Liquid biopsy is a tool to unveil resistance mechanisms in NSCLC. We studied changes in gene expression in CTC-enriched fractions of EGFR-mutant NSCLC patients under osimertinib. Peripheral blood from 30 NSCLC patients before, after 1 cycle of osimertinib and at progression of disease (PD) was analyzed by size-based CTC enrichment combined with RT-qPCR for gene expression of epithelial (CK-8, CK-18, CK-19), mesenchymal/EMT (VIM, TWIST-1, AXL), stem cell (ALDH-1) markers, PD-L1 and PIM-1. CTCs were also analyzed by triple immunofluorescence for 45 identical blood samples. Epithelial and stem cell profile (p = 0.043) and mesenchymal/EMT and stem cell profile (p = 0.014) at PD were correlated. There was a strong positive correlation of VIM expression with PIM-1 expression at baseline and increased PD-L1 expression levels at PD. AXL overexpression varied among patients and high levels of PIM-1 transcripts were detected. PD-L1 expression was significantly increased at PD compared to baseline (p = 0.016). The high prevalence of VIM positive CTCs suggest a dynamic role of EMT during osimertinib treatment, while increased expression of PD-L1 at PD suggests a theoretical background for immunotherapy in EGFR-mutant NSCLC patients that develop resistance to osimertinib. This observation merits to be further evaluated in a prospective immunotherapy trial.

In mid-October 2017 Storm Ophelia crossed over western coastal Europe, inducing the combined transport of Saharan dust and Iberian biomass burning aerosols over several European areas. In this study we assess the performance of the Copernicus Atmosphere Monitoring Service (CAMS) forecast systems during this complex aerosol transport event and the potential benefits that data assimilation and regional models could bring. To this end, CAMS global and regional forecast data are analysed and compared against observations from passive (MODIS: Moderate Resolution Imaging Spectroradiometer aboard Terra and Aqua) and active (CALIOP/CALIPSO: Cloud-Aerosol LIdar with Orthogonal Polarization aboard Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observations) satellite sensors and ground-based measurements (EMEP: European Monitoring and Evaluation Programme). The analysis of the CAMS global forecast indicates that dust and smoke aerosols, discretely located on the warm and cold fronts of Ophelia, respectively, were affecting the aerosol atmospheric composition over Europe during the passage of the Storm. The observed MODIS aerosol optical depth (AOD) values are satisfactorily reproduced by the CAMS global forecast system, with a correlation coefficient of 0.77 and a fractional gross error (FGE) of 0.4. The comparison with a CAMS global control simulation not including data assimilation indicates a significant improvement in the bias due to data assimilation implementation, as the FGE decreases by 32 %. The qualitative evaluation of the IFS (Integrated Forecast System) dominant-aerosol type and location against the CALIPSO observations overall reveals a good agreement. Regarding the footprint on air quality, both CAMS global and regional forecast systems are generally able to reproduce the observed signal of increase in surface particulate matter concentrations. The regional component performs better in terms of bias and temporal variability, with the correlation deteriorating over forecast time. Yet, both products exhibit inconsistencies on the quantitative and temporal representation of the observed surface particulate matter enhancements, stressing the need for further development of the air quality forecast systems for even more accurate and timely support of citizens and policy-makers.

BackgroundHepatocellular carcinoma (HCC) is the second leading cause of cancer-related deaths, reflecting the aggressiveness of this type of cancer and the absence of effective therapeutic regimens. MicroRNAs have been involved in the pathogenesis of different types of cancers, including liver cancer. Our aim was to identify microRNAs that have both functional and clinical relevance in HCC and examine their downstream signaling effectors.MethodsMicroRNA and gene expression levels were measured by quantitative real-time PCR in HCC tumors and controls. A TargetScan algorithm was used to identify miR-9 downstream direct targets.ResultsA high-throughput screen of the human microRNAome revealed 28 microRNAs as regulators of liver cancer cell invasiveness. MiR-9, miR-21 and miR-224 were the top inducers of HCC invasiveness and also their expression was increased in HCC relative to control liver tissues. Integration of the microRNA screen and expression data revealed miR-9 as the top microRNA, having both functional and clinical significance. MiR-9 levels correlated with HCC tumor stage and miR-9 overexpression induced SNU-449 and HepG2 cell growth, invasiveness and their ability to form colonies in soft agar. Bioinformatics and 3'UTR luciferase analyses identified E-cadherin (CDH1) and peroxisome proliferator-activated receptor alpha (PPARA) as direct downstream effectors of miR-9 activity. Inhibition of PPARA suppressed CDH1 mRNA levels, suggesting that miR-9 regulates CDH1 expression directly through binding in its 3'UTR and indirectly through PPARA. On the other hand, miR-9 inhibition of overexpression suppressed HCC tumorigenicity and invasiveness. PPARA and CDH1 mRNA levels were decreased in HCC relative to controls and were inversely correlated with miR-9 levels.ConclusionsTaken together, this study revealed the involvement of the miR-9/PPARA/CDH1 signaling pathway in HCC oncogenesis.

It is important to understand how future environmental policies will impact both climate change and air pollution. Although targeting near-term climate forcers (NTCFs), defined here as aerosols, tropospheric ozone, and precursor gases, should improve air quality, NTCF reductions will also impact climate. Prior assessments of the impact of NTCF mitigation on air quality and climate have been limited. This is related to the idealized nature of some prior studies, simplified treatment of aerosols and chemically reactive gases, as well as a lack of a sufficiently large number of models to quantify model diversity and robust responses. Here, we quantify the 2015–2055 climate and air quality effects of non-methane NTCFs using nine state-of-the-art chemistry–climate model simulations conducted for the Aerosol and Chemistry Model Intercomparison Project (AerChemMIP). Simulations are driven by two future scenarios featuring similar increases in greenhouse gases (GHGs) but with “weak” (SSP3-7.0) versus “strong” (SSP3-7.0-lowNTCF) levels of air quality control measures. As SSP3-7.0 lacks climate policy and has the highest levels of NTCFs, our results (e.g., surface warming) represent an upper bound. Unsurprisingly, we find significant improvements in air quality under NTCF mitigation (strong versus weak air quality controls). Surface fine particulate matter (PM2.5) and ozone (O3) decrease by -2.2±0.32 µg m−3 and -4.6±0.88 ppb, respectively (changes quoted here are for the entire 2015–2055 time period; uncertainty represents the 95 % confidence interval), over global land surfaces, with larger reductions in some regions including south and southeast Asia. Non-methane NTCF mitigation, however, leads to additional climate change due to the removal of aerosol which causes a net warming effect, including global mean surface temperature and precipitation increases of 0.25±0.12 K and 0.03±0.012 mm d−1, respectively. Similarly, increases in extreme weather indices, including the hottest and wettest days, also occur. Regionally, the largest warming and wetting occurs over Asia, including central and north Asia (0.66±0.20 K and 0.03±0.02 mm d−1), south Asia (0.47±0.16 K and 0.17±0.09 mm d−1), and east Asia (0.46±0.20 K and 0.15±0.06 mm d−1). Relatively large warming and wetting of the Arctic also occur at 0.59±0.36 K and 0.04±0.02 mm d−1, respectively. Similar surface warming occurs in model simulations with aerosol-only mitigation, implying weak cooling due to ozone reductions. Our findings suggest that future policies that aggressively target non-methane NTCF reductions will improve air quality but will lead to additional surface warming, particularly in Asia and the Arctic. Policies that address other NTCFs including methane, as well as carbon dioxide emissions, must also be adopted to meet climate mitigation goals.

Abstract The ability to distinguish and grade malignant cells during surgical procedures in a fast, non-invasive and staining-free manner is of high importance in tumor management. To this extend, Third Harmonic Generation (THG), Second Harmonic Generation (SHG) and Fourier-Transform Infrared (FTIR) spectroscopy were applied to discriminate malignant from healthy cells in human breast tissue biopsies. Indeed, integration of non-linear processes into a single, unified microscopy platform offered complementary structural information within individual cells at the submicron level. Using a single laser beam, label-free THG imaging techniques provided important morphological information as to the mean nuclear and cytoplasmic area, cell volume and tissue intensity, which upon quantification could not only distinguish cancerous from benign breast tissues but also define disease severity. Simultaneously, collagen fibers that could be detected by SHG imaging showed a well structured continuity in benign tumor tissues, which were gradually disoriented along with disease severity. Combination of THG imaging with FTIR spectroscopy could provide a clearer distinction among the different grades of breast cancer, since FTIR analysis showed increased lipid concentrations in malignant tissues. Thus, the use of non-linear optical microscopy can be considered as powerful and harmless tool for tumor cell diagnostics even during real time surgery procedures.

In this work, we use Coupled Model Intercomparison Project Phase 6 (CMIP6) simulations from 10 Earth system models (ESMs) and general circulation models (GCMs) to study the fast climate responses on pre-industrial climate, due to present-day aerosols. All models carried out two sets of simulations: a control experiment with all forcings set to the year 1850 and a perturbation experiment with all forcings identical to the control, except for aerosols with precursor emissions set to the year 2014. In response to the pattern of all aerosols effective radiative forcing (ERF), the fast temperature responses are characterized by cooling over the continental areas, especially in the Northern Hemisphere, with the largest cooling over East Asia and India, sulfate being the dominant aerosol surface temperature driver for present-day emissions. In the Arctic there is a warming signal for winter in the ensemble mean of fast temperature responses, but the model-to-model variability is large, and it is presumably linked to aerosol-induced circulation changes. The largest fast precipitation responses are seen in the tropical belt regions, generally characterized by a reduction over continental regions and presumably a southward shift of the tropical rain belt. This is a characteristic and robust feature among most models in this study, associated with weakening of the monsoon systems around the globe (Asia, Africa and America) in response to hemispherically asymmetric cooling from a Northern Hemisphere aerosol perturbation, forcing possibly the Intertropical Convergence Zone (ITCZ) and tropical precipitation to shift away from the cooled hemisphere despite that aerosols' effects on temperature and precipitation are only partly realized in these simulations as the sea surface temperatures are kept fixed. An interesting feature in aerosol-induced circulation changes is a characteristic dipole pattern with intensification of the Icelandic Low and an anticyclonic anomaly over southeastern Europe, inducing warm air advection towards the northern polar latitudes in winter.

In this work we present downscaling experiments with the Weather Research and Forecasting model (WRF) to test the sensitivity to resolving aerosol–radiation and aerosol–cloud interactions on simulated regional climate for the EURO-CORDEX domain. The sensitivities mainly focus on the aerosol–radiation interactions (direct and semi-direct effects) with four different aerosol optical depth datasets (Tegen, MAC-v1, MACC, GOCART) being used and changes to the aerosol absorptivity (single scattering albedo) being examined. Moreover, part of the sensitivities also investigates aerosol–cloud interactions (indirect effect). Simulations have a resolution of 0.44∘ and are forced by the ERA-Interim reanalysis. A basic evaluation is performed in the context of seasonal-mean comparisons to ground-based (E-OBS) and satellite-based (CM SAF SARAH, CLARA) benchmark observational datasets. The impact of aerosols is calculated by comparing it against a simulation that has no aerosol effects. The implementation of aerosol–radiation interactions reduces the direct component of the incoming surface solar radiation by 20 %–30 % in all seasons, due to enhanced aerosol scattering and absorption. Moreover the aerosol–radiation interactions increase the diffuse component of surface solar radiation in both summer (30 %–40 %) and winter (5 %–8 %), whereas the overall downward solar radiation at the surface is attenuated by 3 %–8 %. The resulting aerosol radiative effect is negative and is comprised of the net effect from the combination of the highly negative direct aerosol effect (−17 to −5 W m−2) and the small positive changes in the cloud radiative effect (+5 W m−2), attributed to the semi-direct effect. The aerosol radiative effect is also stronger in summer (−12 W m−2) than in winter (−2 W m−2). We also show that modelling aerosol–radiation and aerosol–cloud interactions can lead to small changes in cloudiness, mainly regarding low-level clouds, and circulation anomalies in the lower and mid-troposphere, which in some cases, mainly close to the Black Sea in autumn, can be of statistical significance. Precipitation is not affected in a consistent pattern throughout the year by the aerosol implementation, and changes do not exceed ±5 % except for the case of unrealistically absorbing aerosol. Temperature, on the other hand, systematically decreases by −0.1 to −0.5 ∘C due to aerosol–radiation interactions with regional changes that can be up to −1.5 ∘C.

Minetta C Liu,1 Wolfgang Janni,2 Vassilis Georgoulias,3 Denise A Yardley,4 Nadia Harbeck,5 Xin Wei,6 Desmond McGovern,7 Robert Beck7 1Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; 2Department of Obstetrics and Gynecology, University Clinic Ulm, Ulm, Germany; 3Department of Medical Oncology, School of Medicine, University of Crete, Crete, Greece; 4Department of Medical Oncology, Breast Cancer Research Program, Sarah Cannon Research Institute, Nashville, TN, USA; 5Department of Breast Center, Oncological Therapy and Clinical Trials Unit, University of Munich (LMU), Munich, Germany; 6Department of Translational/Clinical Development, Celgene Corporation, Summit, NJ, USA; 7Department of Clinical Research, Celgene Corporation, Summit, NJ, USACorrespondence: Minetta C LiuDepartment of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USATel +1 507 293 0526Email Liu.Minetta@mayo.eduPurpose: Circulating tumor cells (CTCs) are prognostic biomarkers in metastatic breast cancer, but their role in predicting treatment outcomes in metastatic triple-negative breast cancer (mTNBC) is less clear. The tnAcity trial demonstrated a significant progression-free survival (PFS) benefit with nab-paclitaxel (nab-P)/carboplatin (C) over nab-P/gemcitabine (G) or G/C in patients with mTNBC. We assessed the correlation between CTC dynamics and clinical benefit in all patients and by treatment arm.Methods: CTC enumeration, performed using CELLSEARCH technology (Menarini Silicon Biosystems, Huntingdon Valley, PA, USA), was a prespecified exploratory endpoint in the tnAcity trial. Patients with TNBC were categorized based on pre- and post-treatment CTC levels: Group 1 (+ + +; elevated CTCs at baseline and postbaseline), Group 2 (+ ± ±; CTCs elevated at baseline and cleared postbaseline [cycle 3 and/or cycle 5]), or Group 3 (−; no CTCs detected at baseline). The baseline cutoff was ≥1 CTC/7.5 mL for the main analysis; cutoffs of ≥2 and ≥5 CTCs were used for supporting analyses.Results: The main analysis included 126 patients (Group 1, n = 24; Group 2, n = 54; and Group 3, n = 48). The median PFS was longer in Group 2 vs Group 1 (8.5 vs 4.7 months; HR, 0.30 [95% CI, 0.17–0.54]). These results were supported by the ≥2- and ≥5-CTC cutoff analyses. The median overall survival rates were 17.8, 16.0, and 9.8 months in Groups 2, 3, and 1, respectively. The overall response rates were 79.6%, 43.8%, and 29.2%, respectively. A numerically higher percentage of patients had CTC clearance during nab-P/C treatment vs nab-P/G or G/C.Conclusion: Efficacy outcomes trended positively with chemotherapy-induced elimination of CTCs, suggesting that CTC clearance may predict the chemosensitivity of mTNBC tumors.Trial registration: EudraCT Number: 2013-000113-20; ClinicalTrials.gov number: NCT01881230.Keywords: metastatic triple-negative breast cancer, circulating tumor cells, nab-paclitaxel, chemotherapy, prognosis

Liquid biopsy analysis, mainly based on circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA), provides an extremely powerful tool for the molecular profiling of cancer patients in real time. In this study, we directly compared PIK3CA hotspot mutations (E545K, H1047R) in EpCAM‐positive CTCs and paired plasma‐ctDNA in breast cancer (BrCa). PIK3CA hotspot mutations in CTCs and ctDNA were analyzed using our previously developed highly sensitive (0.05%), specific, and validated assay in plasma‐ctDNA from 77 early and 73 metastatic BrCa patients and 40 healthy donors. We further analyzed and directly compared PIK3CA hotspot mutations in DNAs isolated from CellSearch® cartridges (CTCs) and paired plasma‐ctDNA, in 56 cases of early and 27 cases of metastatic breast cancer, and 16 corresponding primary tumors. In plasma‐ctDNA, PIK3CA hotspot mutations were identified in 30/77(39.0%) early and 35/73(47.9%) metastatic BrCa cases; none (0/40, 0%) of the healthy donors’ plasma‐ctDNA samples were positive. Our direct comparison study in DNAs isolated from CellSearch® cartridges (CTCs) and paired plasma‐ctDNA from the same blood draws has shown a lack of concordance in early BrCa (27/56, 48.2%), while the concordance in the metastatic setting was higher (18/27, 66.6%). Our results were validated by ddPCR methodology, and the concordance between our assay and ddPCR for PIK3CA E545K hotspot mutation was 30/37 (81.1%). In many cases, PIK3CA hotspot mutations were detected in samples found to be negative for CTCs in CellSearch®. Our data demonstrated for the first time that (a) PIK3CA hotspot mutations are present at high frequencies in CTCs isolated from CellSearch® cartridges and paired plasma‐ctDNA both in early and metastatic BrCa, (b) the detection and concordance of PIK3CA hotspot mutations between plasma‐ctDNA and CTCs are higher in the metastatic setting, (c) PIK3CA mutational status significantly changes after therapeutic intervention, and (d) PIK3CA mutation detection in CTCs and plasma‐ctDNA provides complementary information.

Background and Objectives: Myocardial perfusion imaging (MPI) has an important role in the non-invasive investigation of coronary artery disease. The interpretation of MPI studies is mainly based on the visual evaluation of the reconstructed images, while automated quantitation methods may add useful data for each patient. However, little evidence is currently available regarding the actual incremental clinical diagnostic performance of automated MPI analysis. In the present study, we aimed to assess the correlation between automated measurements of Summed Stress Score (SSS), Summed Rest Score (SRS) and Summed Difference Score (SDS), with the corresponding expert reading values, using coronary angiography as the gold standard. Materials and Methods: The study was conducted at the Nuclear Medicine Laboratory of the University Hospital of Larissa, Larissa, Greece, οver an one-year period (January 2019–January 2020). 306 patients, with known or suspected coronary artery disease, were enrolled in the study. Each participant underwent a coronary angiography, prior to or after the scintigraphic study (within a three-month period). Either symptom-limited treadmill test, or pharmacologic testing using adenosine or regadenoson, was performed in all participants, and the scintigraphic studies were carried out using technetium 99m (99mTc) tetrofosmin (one-day stress/rest protocol). Coronary angiographies were scored according to a 4-point scoring system (angiographic score; O: normal study, 1: one-vessel disease, 2: two-vessel disease, 3: three-vessel disease). Moreover, automated measurements of SSS, SRS and SDS were derived by three widely available software packages (Emory Cardiac Toolbox, Myovation, Quantitative Perfusion SPECT). Results: Interclass Correlation Coefficients of SSS, SRS and SDS between expert reading and software packages were moderate to excellent. Visually defined SSS, SRS and SDS were significantly correlated with the corresponding results of all software packages. However, visually defined SSS, SRS and SDS were more strongly correlated with the angiographic score, indicating a better performance of expert reading when compared to automated analysis. Conclusions: Based on our results, visual evaluation continues to have a crucial role for the interpretation of MPI images. Software packages can provide automated measurements of several parameters, particularly contributing to the investigation of cases with ambiguous scintigraphic findings.

The PD-1/PD-L1 axis provides CTCs an escape route from the immune system. Phosphorylation of the ribosomal protein S6 is implicated in the same pathway, following mTOR activation. The aim of the study was to investigate the expression of PD-L1 and pS6 in CTCs from NSCLC patients under Osimertinib treatment at a single cell level. CTCs were isolated using ISET from NSCLC patients’ blood [37 at baseline, 25 after the 1st cycle, and 23 at the end of treatment (EOT)]. Staining was performed using immunofluorescence. Cytokeratin-positive (CK+) CTCs were detected in 62% of patients. CK+PD-L1+CD45− and CK+pS6+ phenotypes were detected in 38% and 41% of the patients at baseline, in 28% and 32% after 1st cycle, and in 30% and 35% at EOT, respectively. Spearman’s analysis revealed statistically significant correlations between PD-L1 and pS6 phenotypes at all time points. Survival analysis revealed that CK+pS6+ (p = 0.003) and CKlowpS6+ (p = 0.021) phenotypes after 1st cycle were related to significantly decreased one-year progression-free survival (PFS12m) and PFS, respectively. CK+PD-L1+CD45−phenotype at baseline and after 1st cycle showed a trend for decreased PFS12m. Increased expression of PD-L1/pS6 in CTCs of Osimertinib-treated NSCLC patients implies the activation of the corresponding pathway, which is potentially associated with poor clinical outcomes.

Background: LUX-Lung 8 was a randomised, controlled, phase 3 study comparing afatinib and erlotinib as second-line treatment of patients with advanced squamous cell carcinoma (SCC) of the lung. We report the final overall survival (OS) and safety analyses of LUX-Lung 8 and investigate the characteristics of patients who achieved long-term benefit (≥12 months’ treatment). Methods: LUX-Lung 8 (NCT01523587) enroled patients between March 2012 and January 2014 and this final analysis had a data cut-off of March 2018. Eligible patients had stage IIIB or IV lung SCC and had progressed after at least four cycles of platinum-based chemotherapy. Patients were randomly assigned (1:1) to receive afatinib (40 mg per day) or erlotinib (150 mg per day) until disease progression. Endpoints included OS and safety; a post-hoc analysis of patients with long-term benefit (≥12 months on treatment) was also conducted. Findings: 795 eligible patients were randomly assigned (398 to afatinib, 397 to erlotinib). OS was significantly prolonged with afatinib compared with erlotinib (median 7·8 months vs 6·8 months; hazard ratio 0·84; 95% CI 0·73–0·97; p = 0·0193). These findings were consistent with those of the primary analysis and were consistent across subgroups. Adverse events (AEs) were manageable with dose interruption and reduction, with similar AEs being experienced between both groups. Twenty-one (5·3%) patients receiving afatinib and 13 (3·3%) patients receiving erlotinib achieved long-term benefit; median OS was 34·6 months and 20·1 months, respectively. Amongst 132 afatinib-treated patients who underwent tumour genetic analysis, ERBB family mutations were more common in patients with long-term benefit than in the overall population (50% vs 21%). Interpretation: Afatinib is a treatment option for patients with SCC of the lung progressing on chemotherapy who are ineligible for immunotherapy, particularly those with ERBB family genetic aberrations. Afatinib has a predictable and manageable tolerability profile, and long-term treatment may be well tolerated. Funding: Boehringer Ingelheim.

Abstract Background Circulating tumor cells (CTCs) are important for metastatic dissemination of cancer. They can provide useful information, regarding biological features and tumor heterogeneity; however, their detection and characterization are difficult due to their limited number in the bloodstream and their mesenchymal characteristics. Therefore, new biomarkers are needed to address these questions. Methods Bioinformatics functional enrichment analysis revealed a subgroup of 24 genes, potentially overexpressed in CTCs. Among these genes, the chemokine receptor CXCR4 plays a central role. After prioritization according to the CXCR4 corresponding pathways, five molecules (JUNB, YWHAB, TYROBP, NFYA, and PRDX1) were selected for further analysis in biological samples. The SKBR3, MDA-MB231, and MCF7 cell lines, as well as PBMCs from normal (n = 10) blood donors, were used as controls to define the expression pattern of all the examined molecules. Consequently, 100 previously untreated metastatic breast cancer (mBC) patients (n = 100) were analyzed using the following combinations of antibodies: CK (cytokeratin)/CXCR4/JUNB, CK/NFYA/ΥWHΑΒ (14-3-3), and CK/TYROBP/PRDX1. A threshold value for every molecule was considered the mean expression in normal PBMCs. Results Quantification of CXCR4 revealed overexpression of the receptor in SKBR3 and in CTCs, following the subsequent scale (SKBR3>CTCs>Hela>MCF7>MDA-MB231). JUNB was also overexpressed in CTCs (SKBR3>CTCs>MCF7>MDA-MB231>Hela). According to the defined threshold for each molecule, CXCR4-positive CTCs were identified in 90% of the patients with detectable tumor cells in their blood. In addition, 65%, 75%, 14.3%, and 12.5% of the patients harbored JUNB-, TYROBP-, NFYA-, and PRDX-positive CTCs, respectively. Conversely, none of the patients revealed YWHAB-positive CTCs. Interestingly, JUNB expression in CTCs was phenotypically and statistically enhanced compared to patients’ blood cells (p = 0.002) providing a possible new biomarker for CTCs. Furthermore, the detection of JUNB-positive CTCs in patients was associated with poorer PFS (p = 0.015) and OS (p = 0.002). Moreover, JUNB staining of 11 primary and 4 metastatic tumors from the same cohort of patients revealed a dramatic increase of JUNB expression in metastasis. Conclusions CXCR4, JUNB, and TYROBP were overexpressed in CTCs, but only the expression of JUNB was associated with poor prognosis, providing a new biomarker and a potential therapeutic target for the elimination of CTCs.

Abstract An increasing number of Nuclear Medicine sites in Europe are using cardiac-centered gamma cameras for myocardial perfusion scintigraphy (MPS). Three cardiac-centered gamma cameras are currently the most frequently used in Europe: the D-SPECT (Spectrum Dynamics), the Alcyone (Discovery NM 530c and Discovery NM/CT 570c; General Electric Medical Systems), and the IQ-SPECT (Siemens Healthcare). The increased myocardial count sensitivity of these three cardiac-centered systems has allowed for a decrease in the activities of radiopharmaceuticals injected to patients for myocardial perfusion imaging and, consequently, radiation exposure of patients. When setting up protocols for MPS, the overall objective should be to maintain high diagnostic accuracy of MPS, while injecting the lowest activities reasonably achievable to reduce the level of radiation exposure of patient and staff. These guidelines aim at providing recommendations for acquisition protocols and image interpretation using cardiac-centered cameras. As each imaging system has specific design and features for image acquisition and analysis, these guidelines have been separated into three sections for each gamma camera system. These recommendations have been written by the members of the Cardiovascular Committee of EANM and were based on their own experience with each of these systems and on the existing literature.

In this work, a ∼21-year global dataset from four different satellite sensors with a mid-morning overpass (GOME/ERS-2, SCIAMACHY/ENVISAT, GOME-2/Metop-A, and GOME-2/Metop-B) is compiled to study the long-term tropospheric NO2 patterns and trends. The Global Ozone Monitoring Experiment (GOME) and GOME-2 data are “corrected” relative to the SCanning Imaging Absorption spectroMeter for Atmospheric CHartographY (SCIAMACHY) data to produce a self-consistent dataset that covers the period April 1996–September 2017. The highest tropospheric NO2 concentrations are seen over urban, industrialized, and highly populated areas and over ship tracks in the oceans. Tropospheric NO2 has generally decreased during the last 2 decades over the industrialized and highly populated regions of the western world (a total decrease of the order of ∼49 % over the US, the Netherlands, and the UK; ∼36 % over Italy and Japan; and ∼32 % over Germany and France) and increased over developing regions (a total increase of ∼160 % over China and ∼33 % over India). It is suggested here that linear trends cannot be used efficiently worldwide for such long periods. Tropospheric NO2 is very sensitive to socioeconomic changes (e.g., environmental protection policies, economic recession, warfare, etc.) which may cause either short-term changes or even a reversal of the trends. The application of a method capable of detecting the year when a reversal of trends happened shows that tropospheric NO2 concentrations switched from positive to negative trends and vice versa over several regions around the globe. A country-level analysis revealed clusters of countries that exhibit similar positive-to-negative or negative-to-positive trend reversals, while 29 out of a total of 64 examined megacities and large urban agglomerations experienced a trend reversal at some point within the last 2 decades.