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PURPOSE: Locally advanced/metastatic urothelial cancer (la/mUC) affects patients quality of life (QOL) and functioning. We describe the impact of first-line (1L) enfortumab vedotin (EV) alone or with pembrolizumab (P) on QOL/functioning/symptoms in patients with la/mUC who were cisplatin-ineligible from EV-103 Cohort K. METHODS: In this phase Ib/II trial, patients were randomly assigned 1:1 to EV + P or EV monotherapy (mono). Exploratory patient-reported outcomes (PROs) were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core Questionnaire (EORTC QLQ-C30) and Brief Pain Inventory Short Form (BPI-SF) at baseline, once per week for cycles 1-3, and then in every cycle through the end of treatment. Changes in scores from baseline to week 24, reported as least squares mean (standard error), were assessed by mixed models for repeated measures. There were no formal statistical comparisons between treatment arms. RESULTS: Of 149 patients treated, 65 (EV + P) and 63 (EV mono) comprised the PRO analysis set. For EV + P, EORTC QLQ-C30 QOL was maintained through week 24 with improvements in emotional functioning, pain, and insomnia. Clinically meaningful improvements were seen in EORTC QLQ-C30 pain after EV + P at weeks 12 (-14.41 [3.14]) and 24 (-14.99 [3.56]) and BPI-SF worst pain at week 24 (-2.07 [0.37]). For EV mono, EORTC QLQ-C30 QOL remained stable with clinically meaningful improvements in EORTC QLQ-C30 pain (-12.55 [4.27]), insomnia (-14.46 [4.69]), and constipation (-10.09 [4.35]) at week 24. There were small-to-moderate improvements in BPI-SF worst pain at week 24. CONCLUSION: EV + P in patients with la/mUC who were cisplatin-ineligible was associated with preservation or improvement of QOL/functioning/symptoms. Improvement in pain was seen in both PRO instruments and treatment arms. These data complement clinical outcomes of 1L EV + P.

WHAT IS THIS SUMMARY ABOUT?: This summary provides the results of a study of two treatments for cancer, enfortumab vedotin and pembrolizumab, that were studied together against locally advanced or metastatic urothelial cancer (la/mUC), a cancer that occurs most commonly in the bladder. WHAT WERE THE RESULTS?: In the 45 patients studied, around 16% did have serious side effects, but most side effects were manageable. Twenty-four percent of patients, however, stopped the study treatment because of their side effects. Within about 2 months of starting treatment, most patients (73%) tumors were smaller and stayed smaller, on average, for more than 2 years. WHAT DO THE RESULTS MEAN?: The combination of enfortumab vedotin plus pembrolizumab is a new treatment option for patients with locally advanced or metastatic urothelial cancer when they cannot receive the typical treatment, cisplatin. Advanced or metastatic urothelial cancer is a type of cancer where the cancer has already spread outside of the bladder or urinary tract.

BackgroundThe Critical Assessment of Genome Interpretation (CAGI) aims to advance the state-of-the-art for computational prediction of genetic variant impact, particularly where relevant to disease. The five complete editions of the CAGI community experiment comprised 50 challenges, in which participants made blind predictions of phenotypes from genetic data, and these were evaluated by independent assessors.ResultsPerformance was particularly strong for clinical pathogenic variants, including some difficult-to-diagnose cases, and extends to interpretation of cancer-related variants. Missense variant interpretation methods were able to estimate biochemical effects with increasing accuracy. Assessment of methods for regulatory variants and complex trait disease risk was less definitive and indicates performance potentially suitable for auxiliary use in the clinic.ConclusionsResults show that while current methods are imperfect, they have major utility for research and clinical applications. Emerging methods and increasingly large, robust datasets for training and assessment promise further progress ahead.

PURPOSE: Patients with locally advanced or metastatic urothelial cancer (la/mUC) who are ineligible for cisplatin-based therapy have limited first-line (1L) treatment options and significant need for improved therapies. Enfortumab vedotin (EV) and pembrolizumab (Pembro) individually have shown a survival benefit in urothelial cancer in second-line + la/mUC settings. Here, we present data from the pivotal trial of EV plus Pembro (EV + Pembro) in the 1L setting. PATIENTS AND METHODS: In Cohort K of the EV-103 phase Ib/II study, cisplatin-ineligible patients with previously untreated la/mUC were randomly assigned 1:1 to receive EV as monotherapy or in combination with Pembro. The primary end point was confirmed objective response rate (cORR) per blinded independent central review. Secondary end points included duration of response (DOR) and safety. There were no formal statistical comparisons between treatment arms. RESULTS: The cORR was 64.5% (95% CI, 52.7 to 75.1) and 45.2% (95% CI, 33.5 to 57.3) for patients treated with EV + Pembro (N = 76) and EV monotherapy (N = 73), respectively. The median DOR was not reached for the combination and was 13.2 months for monotherapy; 65.4% and 56.3% of patients who responded to the combination and monotherapy, respectively, maintained a response at 12 months. The most common grade 3 or higher treatment-related adverse events (TRAEs) in patients treated with the combination were maculopapular rash (17.1%), fatigue (9.2%), and neutropenia (9.2%). EV TRAEs of special interest (any grade) in the combination arm included skin reactions (67.1%) and peripheral neuropathy (60.5%). CONCLUSION: EV + Pembro showed a high cORR with durable responses as 1L treatment in cisplatin-ineligible patients with la/mUC. Patients who received EV monotherapy had a response and safety profile consistent with previous studies. Adverse events for EV + Pembro were manageable, with no new safety signals observed.

Abstract Compared with previous generations, fifth-generation communications can provide faster download and upload speeds and support a greater number of connected devices. Integrating fifth-generation signals with optical wireless communication systems provides promising ways to afford higher transmission rates and faster wireless connectivity. Here we report a fifth-generation wavelength-division-multiplexing-based bidirectional optical wireless communication system with signal remodulation employing cascaded reflective semiconductor optical amplifiers to effectively remove the downstream data for uplink transmission. It shows a fifth-generation wavelength-division-multiplexing-based bidirectional optical wireless communication system using four wavelengths for communication. The uplink performance is substantially enhanced by using two reflective semiconductor optical amplifiers to remove the downstream data. The system achieves an aggregate transmission rate of 36.4 Gbit/s for both downlink and uplink transmissions over a 100-m optical wireless link. This demonstrated fifth-generation wavelength-division-multiplexing-based bidirectional optical wireless communication system employing cascaded reflective semiconductor optical amplifiers holds great potential for enhancing fifth-generation advanced communication capabilities.

Abstract Chemotherapy and immunotherapy have shown no significant outcome for unresectable pancreatic ductal adenocarcinoma (PDAC). Multi-drug combination therapy has become a consensus in clinical trials to explore how to arouse anti-tumor immunity and meanwhile overcome the poorly tumoricidal effect and the stroma barrier that greatly hinders drug penetration. To address this challenge, a comprehensive strategy is proposed to fully utilize both the ferroptotic vulnerability of PDAC to potently irritate anti-tumor immunity and the desmoplasia-associated focal adhesion kinase (FAK) to wholly improve the immunosuppressive microenvironment via sustained release of drugs in an injectable hydrogel for increasing drug penetration in tumor location and averting systematic toxicity. The injectable hydrogel ED-M@CS/MC is hybridized with micelles loaded with erastin that exclusively induces ferroptosis and a FAK inhibitor defactinib for inhibiting stroma formation, and achieves sustained release of the drugs for up to 12 days. With only a single intratumoral injection, the combination treatment with erastin and defactinib produces further anti-tumor performance both in xenograft and KrasG12D-engineered primary PDAC mice and synergistically promotes the infiltration of CD8+ cytotoxic T cells and the reduction of type II macrophages. The findings may provide a novel promising strategy for the clinical treatment of PDAC.

Abstract Background Lymph node metastasis (LNM) is associated with worse prognosis in bladder urothelial carcinoma (BUC) patients. This study aimed to develop and validate machine learning (ML) models to preoperatively predict LNM in BUC patients treated with radical cystectomy (RC). Methods We retrospectively collected demographic, pathological, imaging, and laboratory information of BUC patients who underwent RC and bilateral lymphadenectomy in our institution. Patients were randomly categorized into training set and testing set. Five ML algorithms were utilized to establish prediction models. The performance of each model was assessed by the area under the receiver operating characteristic curve (AUC) and accuracy. Finally, we calculated the corresponding variable coefficients based on the optimal model to reveal the contribution of each variable to LNM. Results A total of 524 and 131 BUC patients were finally enrolled into training set and testing set, respectively. We identified that the support vector machine (SVM) model had the best prediction ability with an AUC of 0.934 (95% confidence interval [CI]: 0.903–0.964) and accuracy of 0.916 in the training set, and an AUC of 0.855 (95%CI: 0.777–0.933) and accuracy of 0.809 in the testing set. The SVM model contained 14 predictors, and positive lymph node in imaging contributed the most to the prediction of LNM in BUC patients. Conclusions We developed and validated the ML models to preoperatively predict LNM in BUC patients treated with RC, and identified that the SVM model with 14 variables had the best performance and high levels of clinical applicability.

Abstract The development of electric vehicles (EVs) exhibits rapid and remarkable progress nowadays, serving as a crucial route to accomplish the target of mitigating greenhouse gas emissions. As an integral part of the thermal management system oriented toward electric vehicles, the heat pump air conditioning system for electric vehicles is the result of a comprehensive choice that trades off the cooling and heating performance, environmental performance and economic cost. Particularly, different regions around the world suffer varying cooling and heating challenges due to the complicated climatic characteristics. Thus the most suitable refrigerant and system cycle structure may differ. This paper focuses on evaluating both the refrigerants and cycle structures to screen the most suitable choice. According to the climate conditions of different cities, the annual energy consumption, life cycle climate performance, and economic cost of the basic system (Base), two-stage compression system (TSC,IC), and vapor injection (VI) system with CO2, R134a, and R1234yf refrigerants respectively, are quantitatively analyzed and evaluated. Subsequently, through comparative analysis, a comprehensive selection map for heat pump systems in electric vehicles worldwide is developed and the most suitable heat pump air conditioning system for each cites is determined. The results can provide a selection reference and decision-making for the air conditioning system of electric vehicles from regional considerations. It was found that the CO2 HPACVI was recommended for cold regions to meet both environmental and economic requirements. In warm region, the R1234yf HPACBase system was recommended to be used. For regions transitioning from cold to warm climates, the R1234yf HPACVI system was suggested. In hot region, the R1234yf AC system was recommended.

Abstract Background The impact of anatomical factors, such as the lateral tibial slope (LTS), on outcomes following anterior cruciate ligament (ACL) reconstruction is an area of growing interest. This study was led by the observation that patients with a higher LTS may have different recovery trajectories. Hypothesis/Purpose The purpose of this study was to investigate the correlation between a higher LTS and long term subjective outcomes following single-bundle ACL reconstruction. Study Design This study was designed as a retrospective cohort study. Methods The study comprised 138 patients who underwent single-bundle ACL reconstruction. The LTS was measured on preoperative radiographs. Patient-reported outcome measures (PROMs) were collected, which included the Lysholm Knee Score, UCLA Activity Score, IKDC Score, and Tegner Activity Score, over a mean follow-up duration of 137 months. Results A significant negative correlation was found between LTS and all measured PROMs (p

To meet the expectation set by Moore’s law on transistors, the search for thickness-scalable high dielectric constant (k) gate layers has become an emergent research frontier. Previous investigations have failed to solve the “polarizability–scalability–insulation robustness” trilemma. In this work, we show that this trilemma can be solved by using a gate layer of a high k ferroelectric oxide in its superparaelectric (SPE) state. In the SPE, its polar order becomes local and is dispersed in an amorphous matrix with a crystalline size down to a few nanometers, leading to an excellent dimensional scalability and a good field-stability of the k value. As an example, a stable high k value (37±3) is shown in ultrathin SPE films of (Ba0.95,Sr0.05)(Zr0.2,Ti0.8)O3 deposited on LaNiO3-buffered Pt/Ti/SiO2/(100)Si down to a 4 nm thickness, leading to a small equivalent oxide thickness of ~0.46 nm. The aforementioned characteristic microstructure endows the SPE film a high breakdown strength (~10.5 MV·cm−1 for the 4 nm film), and hence ensures a low leakage current for the operation of the complementary metal oxide semiconductor (CMOS) gate. Lastly, a high electrical fatigue resistance is displayed by the SPE films. These results reveal a great potential of superparaelectric materials as gate dielectrics in the next-generation microelectronics.

Abstract Glioma, with its heterogeneous microenvironments and genetic subtypes, presents substantial challenges for treatment prediction and development. We integrated 3D bioprinting and multi-algorithm machine learning as a novel approach to enhance the assessment and understanding of glioma treatment responses and microenvironment characteristics. The bioprinted patient-derived glioma tissues successfully recapitulated molecular properties and drug responses of native tumors. We then developed GlioML, a machine learning workflow incorporating nine distinct algorithms and a weighted ensemble model that generated robust gene expression-based predictors, each reflecting the diverse action mechanisms of various compounds and drugs. The ensemble model superseded the performance of all individual algorithms across diverse in vitro systems, including sphere cultures, complex 3D bioprinted multicellular models, and 3D patient-derived tissues. By integrating bioprinting, the evaluative scope of the treatment expanded to T cell-related therapy and anti-angiogenesis targeted therapy. We identified promising compounds and drugs for glioma treatment and revealed distinct immunosuppressive or angiogenic myeloid-infiltrated tumor microenvironments. These insights pave the way for enhanced therapeutic development for glioma and potentially for other cancers, highlighting the broad application potential of this integrative and translational approach.

Additive manufacturing provides a new way to develop high-performance superalloys and components. A γ′- strengthened CoNi-base superalloy suitable for additive manufacturing was developed，and a crack-free block material was prepared by optimizing the parameters of electron beam melting（EBM） technology. The experimental results show that the lowest porosity of the alloy is about 0.14% when the scanning speed is 2000 mm/s. The microstructures of the as-printed CoNi-base alloy are columnar grains growing along the direction，the average grain width is about 235 μm，and the volume fraction of γ′ phase is about 30%. After hot isostatic pressing and solution aging treatment，the porosity of the alloy is further reduced to about 0.09% with unobvious change of columnar grains. The average size of γ′ phases is about （70±18）nm with the volume fraction of about （32±3.6）%. The results of room temperature tensile tests show that the additive manufactured γʹ-strengthened CoNi-base superalloy exhibits excellent strength and ductility，showing a good potential of industrial application.

Abstract The 3D bin packing problem is a challenging combinatorial optimization problem with numerous real-world applications. In this paper, we present a novel approach for solving this problem by integrating a generative adversarial network (GAN) with a genetic algorithm (GA). Our proposed GAN-based GA utilizes the GAN to generate high-quality solutions and improve the exploration and exploitation capabilities of the GA. We evaluate the performance of the proposed algorithm on a set of benchmark instances and compare it with two existing algorithms. The simulation studies demonstrate that our proposed algorithm outperforms both existing algorithms in terms of the number of used bins while achieving comparable computation times. Our proposed algorithm also performs well in terms of solution quality and runtime on instances of different sizes and shapes. We conduct sensitivity analysis and parameter tuning simulations to determine the optimal values for the key parameters of the proposed algorithm. Our results indicate that the proposed algorithm is robust and effective in solving the 3D bin packing problem. The proposed GAN-based GA algorithm and its modifications can be applied to other optimization problems. Our research contributes to the development of efficient and effective algorithms for solving complex optimization problems, particularly in the context of logistics and manufacturing. In summary, the proposed algorithm represents a promising solution to the challenging 3D bin packing problem and has the potential to advance the state-of-the-art in combinatorial optimization.

The microstructure and morphology of the alloy were characterized by metallographic microscope and thermasimulation test and other equipment， and the thermal deformation parameters were set at different strain temperatures of 850-1150 ℃ and strain rates of 0. 1-10 s-1. It was analyzed by combining the stress-strain curve of thermal simulation compression test and the microstructure morphology， the thermal deformation behavior and microsturcture morphology evolution process of 4J32 super invar alloy （Fe-32Ni-4Co） at high temperature 850-1 150 ℃ were systematically studied. It is found that no dynamic recrystallization occurs during hot deformation of 4J32 super invar alloy below 900 ℃， and there are a lot of deformed grain structures in the alloy. When the thermal deformation temperature is greater than 1 050 ℃， the dynamic recrystallization of the alloy begins， and the faster the strain rate， the higher the dynamic recrystallization degree.The results show that the optimum thermal deformation temperature of super invar alloy is greater than 1100 ℃ and the strain rate is 10 s-1.

Abstract The implementation of sodium metal batteries (SMBs) is known for their low cost and high energy density. However, a major concern in SMBs is the formation of dendrites on the Na metal anode, which can potentially cause short circuits and compromise safety. Herein, to address this issue, we propose a novel approach to create a protective layer by decorating Na surface with NaI particles. This protective layer exhibits a high Young’s modulus and excellent sodium ion transference ability. As a result, the lifespan of the Na/NaI||Na/NaI cell is significantly extended to 850 h at 0.5 mA cm−2/1 mAh cm−2. Furthermore, when the Na/NaI anode is combined with a Na3V2(PO4)3 (NVP) cathode, the full cell retains 83 mAh g−1 (approximately 94% of its initial capacity) even after 1500 cycles at 5 C. Overall, this work presents a simple and effective method for establishing a protective layer on the Na surface, thereby enabling the realization of long lifespan and stable SMBs.

Objective: The objective of this study was to explore the safety, efficacy, economy, and other aspects of frequently-used antitumor Chinese patent medicine injections through a comprehensive evaluation of evidence-based medical research to provide scientific information and decision-making basis for drug selection, rational drug use, public awareness of safe drug use, and medical insurance. Materials and Methods: The names of five frequently used antitumor Chinese patent medicine injections were used as search terms, including the compound Sophora flavescens injection, Kangai injection, Aidi injection, Kanglaite injection, and Brucea javanica oil emulsion injection. Relevant evidence-based medical research was extracted from the databases. A descriptive evaluation was conducted, and the Markov model was used for the cost-benefit analysis. Finally, the above injections are ranked by comprehensive scores using the multi-criteria decision analysis and Delphi method. Results: The five injections had their own advantages in enhancing the effectiveness of anti-tumor treatments, improving the quality of life for cancer patients, and reducing the incidence of adverse reactions. From the perspective of economy and other attributes, compound S. flavescens was superior to B. javanica oil, Aidi, Kangai, and Kanglaite. After a comprehensive evaluation of the above five injections, the compound S. flavescens injection received the highest score. Conclusions: Compound S. flavescens, Kangai, Aidi, B. javanica oil, and Kanglaite have their own advantages in effectiveness and no significant difference in safety. Compound S. flavescens injection has the highest comprehensive score. Clinical attention should be paid to monitoring the initial stage of medication and special groups.

Abstract Background Myasthenia gravis (MG) and the experimental autoimmune MG (EAMG) animal model are characterized by T-cell-induced and B-cell-dominated autoimmune diseases that affect the neuromuscular junction. Several subtypes of CD4+ T cells, including T helper (Th) 17 cells, follicular Th cells, and regulatory T cells (Tregs), contribute to the pathogenesis of MG. However, increasing evidence suggests that CD8+ T cells also play a critical role in the pathogenesis and treatment of MG. Main body Herein, we review the literature on CD8+ T cells in MG, focusing on their potential effector and regulatory roles, as well as on relevant evidence (peripheral, in situ, cerebrospinal fluid, and under different treatments), T-cell receptor usage, cytokine and chemokine expression, cell marker expression, and Treg, Tc17, CD3+CD8+CD20+ T, and CXCR5+ CD8+ T cells. Conclusions Further studies on CD8+ T cells in MG are necessary to determine, among others, the real pattern of the Vβ gene usage of autoantigen-specific CD8+ cells in patients with MG, real images of the physiology and function of autoantigen-specific CD8+ cells from MG/EAMG, and the subset of autoantigen-specific CD8+ cells (Tc1, Tc17, and IL-17+IFN-γ+CD8+ T cells). There are many reports of CD20-expressing T (or CD20 + T) and CXCR5+ CD8 T cells on autoimmune diseases, especially on multiple sclerosis and rheumatoid arthritis. Unfortunately, up to now, there has been no report on these T cells on MG, which might be a good direction for future studies.

Background: Proper identification of the polymicrobial microorganisms in patients with limb-threatening diabetic foot ulcers (LTDFUs) using conventional culture is insufficient. This prospective study evaluates the potential value of adjuvant molecular testing assisting in identify fastidious micro-organisms in LTDFUs compared to standard treatment alone. Methods: Ninety patients with LTDFUs received interdisciplinary and standard antibiotic treatment in a referral diabetic foot center. A simultaneous 16S amplicon sequencing (16S AS) specimen along with conventional culture collected at admission was used to retrospectively evaluate the microbiological findings and its association with amputation outcomes. Results: The microorganism count revealed by 16S AS overwhelmed that of conventional culturing (17 vs. 3 bacteria/ulcer respectively). The Stenotrophomonas spp. revealed in 29 patients were highly correlated with major (above ankle) amputation (OR: 4.76, 95% CI 1.01–22.56), while only one had been concomitantly identified by conventional culturing. Thus, there were 27 cases without proper antibiotics coverage during treatment. Conclusions: Adjuvant molecular testing assisted identification of fastidious pathogens such as Stenotrophomonas infection and might be associated with major amputation in patients with LTDFUs.

Background: Whether early HIV diagnosis is beneficial for HIV patients themselves remains uncertain, given the stigma and social discrimination associated with an HIV diagnosis. This study aimed to measure the impact of early HIV diagnosis on quality-adjusted life expectancy (QALE) in comparison with late HIV diagnosis, from real-world data in Taiwan under universal access to antiretroviral therapy (ART). Methods: This population-based cohort study included 14,570 men who have sex with men (MSM) in the national HIV registry and a quasi-random sample (n = 127) of MSM patients to measure quality of life using the EQ-5D health utility instrument. We integrated quality of life data into the extrapolated cohort survival curve to estimate the QALE in patients with early versus late HIV diagnosis (≤30 days before AIDS diagnosis). Loss-of-QALE were estimated by comparing the cohort with age-, sex-, and calendar-year-matched referents simulated from vital statistics. Difference-in-differences was estimated to quantify the effect of early HIV diagnosis. Results: Early HIV diagnosis is associated with a loss-of-life expectancy of 3.11 years, with an average health utility of 0.95, in contrast to those diagnosed late (loss-of-life expectancy 8.47 years, with an average health utility of 0.86). After integration of survival and life quality, early HIV diagnosis results in a reduction of loss-of-QALE by 8.28 quality-adjusted life years among MSM living with HIV. Conclusions: Under universal access to ART, early HIV diagnosis is highly beneficial for people living with HIV themselves, with a net gain of 8.28 healthy life years compared with those diagnosed late.

BackgroundThe health literacy of ethnic groups in remote areas of China is far from satisfactory. However, the health literacy of ethnic groups in China remains unclear. This study aimed to explore the health literacy of the “advancing directly” ethnic group and its influencing factors.MethodsA cross-sectional study was conducted using a staged sampling method among the Wa ethnic group, who have rapidly transitioned directly from the traditional lifestyle of slash-and-burn cultivation to modern societies. We used the Health Literacy Questionnaire (HLQ) to assess health literacy. We defined low health literacy as less than 60% of the total score and adequate health literacy as more than 80% of the total score.ResultsA total of 668 individuals met the inclusion criteria and the mean age was 42.19 (SD 10.56) years. The mean HLQ total score was 29.9 (SD 10.56). The prevalence of adequate health literacy was 0.89%. There were significant differences between the low and the non-low health literacy groups in terms of gender, age, education, marital status, occupation, residing place, current smoking status, and waist circumference (all p