INTRODUCTION: Trastuzumab deruxtecan (T-DXd) has revolutionised treatment for metastatic breast cancer (MBC). While effective, its high cost and toxicities, such as fatigue and nausea, pose challenges. METHOD: Medical records from the Joint Breast Cancer Registry in Singapore were used to study MBC patients treated with T-DXd (February 2021-June 2024). This study was conducted to address whether reducing dose intensity and density may have an adverse effect on treatment outcomes. RESULTS: Eighty-seven MBC patients were treated with T-DXd, with a median age of 59 years. At the time of data cutoff, 32.1% of patients were still receiving T-DXd. Over half (54%) of the patients received treatment with an initial relative dose intensity (RDI) of <;85%. Overall median real-world progression-free survival (rwPFS) was 8.1 months. rwPFS was similar between RDI groups (<85%: 8.7 months, <85%: 8.1 months, P=0.62). However, human epidermal growth receptor 2 (HER2)-positive patients showed significantly better rwPFS outcomes compared to HER2-low patients (8.8 versus 2.5 months, P<0.001). Only 16% with central nervous system (CNS) involvement had CNS progressive disease on treatment. No significant progression-free survival (PFS) differences were found between patients with or without CNS disease, regardless of RDI groups. Five patients (5.7%) developed interstitial lung disease (ILD), with 3 (3.4%) having grade 3 events. Two required high-dose steroids and none were rechallenged after ILD. There were no fatalities. CONCLUSION Our study demonstrated that reduced dose intensity and density had no significant impact on rwPFS or treatment-related toxicities. Furthermore, only 5.7% of patients developed ILD. T-Dxd provided good control of CNS disease, with 82% of patients achieving CNS disease control.
Humans ; Female ; Breast Neoplasms/mortality* ; Middle Aged ; Trastuzumab/adverse effects* ; Aged ; Adult ; Singapore/epidemiology* ; Antineoplastic Agents, Immunological/adverse effects* ; Camptothecin/adverse effects* ; Immunoconjugates/adverse effects* ; Retrospective Studies ; Progression-Free Survival ; Receptor, ErbB-2/metabolism* ; Neoplasm Metastasis ; Dose-Response Relationship, Drug ; Treatment Outcome ; Registries

To investigate the recent prevalence and molecular epidemiological characteristics of por-cine diarrhea viruses in Sichuan Province,this study used fluorescence quantitative PCR to detect porcine diarrhea samples from multiple regions in Sichuan Province from 2021 to 2023.RT-PCR was used to identify the genotypes of PEDV,PoRVA,PDCoV,and PTV,and their genetic variabil-ity,evolutionary characteristics,and recombination events were analyzed.The results showed that PEDV,PoRVA,PDCoV,and PTV were still prevalent in Sichuan region,with overall positive rates of 14.2％(40/281),13.2％(37/281),15.6％(44/281),and 12.5％(35/281),respectively.PEDV mixed infection with other pathogens was the most common.This study obtained a total of six strains of G2b PEDV,three strains of G3 PDCoV,three strains of G9P[13]PoRVA,one strain of G3P[13]PoRVA,three strains of Type 5 PTV,and one strain of Type 9 PTV.Compared to the seven vaccine strains including CV777,DR13,KPEDV-9,Chinju99,KNU-0801,AJ1102,and LW/L,the 6 PEDV strains showed multiple amino acid mutation sites in the COE region and S1D epitope region.Among them,the strains PSCLZ01 and PSCMY04 formed a separate branch in the phylogenetic tree.The three PDCoV strains have a closer genetic evolution distance to the previ-ously prevalent strains in Sichuan,but they also have 6-48 amino acid mutations compared to them.The four PoRVA strains have 104-108 amino acid variations in the VP4 gene compared to the early vaccine strain LLR,and they have 25 common amino acid variations in the VP7 gene.From the phylogenetic tree,the VP7 gene of RSCMY01/G3P[13]belongs to the same branch as the Heilongjiang strain LNCY,but its VP4 gene clusters with the Sichuan strain SCYA-C7,indica-ting that this PoRVA strain may have undergone genetic reassortment during inter-provincial transmission between different genotypes.It is worth noting that in the detected samples of PTV-5 and PTV-9,other diarrheal viruses tested negative,indicating that these two genotypes of PTV may be important pathogens causing porcine diarrhea.Additionally,the S gene of PEDV PSCLZ01 strain and PDCoV PCSCMY02 strain have undergone recombination events,and their parental strains come from different regions,both domestic and international.These findings reveal the main types of porcine diarrheal viruses,as well as their genetic diversity and variations in Sichuan Province in recent years.This study enriches the molecular epidemiological data of porcine diarrhe-al pathogens in the region and provides an important theoretical basis for the prevention,control,and purification of porcine diarrhea in the local area.

Objective: To investigate the potential association among preoperative breast MRI features, axillary nodal burden (ANB), and disease-free survival (DFS) in patients with early-stage breast cancer. Materials and Methods: We retrospectively reviewed 297 patients with early-stage breast cancer (cT1-2N0M0) who underwent preoperative MRI between December 2016 and December 2018. Based on the number of positive axillary lymph nodes (LNs) determined by postoperative pathology, the patients were divided into high nodal burden (HNB; ≥3 positive LNs) and non-HNB (<3 positive LNs) groups. Univariable and multivariable logistic regression analyses were performed to identify independent risk factors associated with ANB. Predictive efficacy was evaluated using the receiver operating characteristic (ROC) curve and area under the curve (AUC). Univariable and multivariable Cox proportional hazards regression analyses were performed to determine preoperative features associated with DFS. Results: We included 47 and 250 patients in the HNB and non-HNB groups, respectively. Multivariable logistic regression analysis revealed that multifocality/multicentricity (adjusted odds ratio [OR] = 3.905, 95% confidence interval [CI]: 1.685– 9.051, P= 0.001) and peritumoral edema (adjusted OR = 3.734, 95% CI: 1.644–8.479, P = 0.002) were independent risk factors for HNB. Combined peritumoral edema and multifocality/multicentricity achieved an AUC of 0.760 (95% CI: 0.707– 0.807) for predicting HNB, with a sensitivity and specificity of 83.0% and 63.2%, respectively. During the median follow-up period of 45 months (range, 5–61 months), 26 cases (8.75%) of breast cancer recurrence were observed. Multivariable Cox proportional hazards regression analysis indicated that younger age (adjusted hazard ratio [HR] = 3.166, 95% CI: 1.200–8.352, P= 0.021), larger tumor size (adjusted HR = 4.370, 95% CI: 1.671–11.428, P= 0.002), and multifocality/multicentricity (adjusted HR = 5.059, 95% CI: 2.166–11.818, P< 0.001) were independently associated with DFS. Conclusion Preoperative breast MRI features may be associated with ANB and DFS in patients with early-stage breast cancer.

Objective To investigate the effects and regulating mechanisms of matrix metalloproteinase 9 (MMP-9) gene silencing on aquaporin 4(AQP4) expression in astrocytes induced by oxygen-glucose deprivation.Methods Cerebral cortical astrocytes from 2 days newborn SD rats were undergone the primary culture.The ischemic cell model was established by oxygen-glucose deprivation.This experiment were divided into control group,negative control group and MMP-9 gene silencing group.The leakage rate of lactated dehydrogenase (LDH)was detected by chromatoptometry.The MMP-9 gene silencing was carried out by Lentivirus transfection.Real-time fluorescence quantitative PCR and Western blot were used to detect the expression levels of AQP4 and MMP-9.The expressions of PKA,PKC,PKG and CaMK Ⅱ were determined by Western blot.Results Compared with control group,LDH leakage rate was significantly higher in astrocytes induced by oxygen-glucose deprivation(t=13.35,P＜0.01).The expression of MMP-9 mRNA in astrocytes in MMP-9 gene silencing group(0.412±0.297) decreased significantly compared with that in negative control group(1.118 ± 0.240) (t =-4.964,P＜ 0.05).The expression of AQP4 mRNA in astrocytes in MMP-9 gene silencing group(1.002±0.082) decreased significantly compared with that in negative control group(1.442±0.066) (t=-9.886,P＜0.01).The expression of AQP4 protein in astrocytes in MMP-9 gene silencing group(0.643±0.036)decreased significantly compared with that in negative control group(1.000± 0.069)(t=-11.073,P＜0.01).The expression of PKC protein in astrocytes in MMP-9 gene silencing group (0.198±0.110)decreased significantly compared with that in negative control group (0.980± 0.232) (t =-7.218,P＜0.01).The expressions of PKA(t=0.875),PKG(t=0.818) and CaMK Ⅱ (t=0.933) protein had no statistically significant difference between negative control group and MMP-9 gene silencing group(all P＞0.05).Conclusion The permeability of astrocytes is increased by oxygen-glucose deprivation.Gene silencing MMP-9 could induce expression of AQP4 mRNA and protein decreased,and MMP-9 may regulate AQP4 expression by regulating PKC activity.

Objective To explore the risk factors of poststroke infection after cerebral infarction. Methods We consecutively included 283 patients with acute ischemic infarcts confirmed by diffusion-weighted imaging (DWI) within 72 hours from Guangxi stroke center. Based on infection status, patients were divided into Not infection group(n=198) and infection group (n=85). The serum cortisol and plasma IL-4 were assessed using chemiluminescent system and double antibody sandwich enzyme linked immunosorbent assay at admission and seventh day later,respectively. Results Compare to no infection group, smoking, mechanical ventilation, diabetes mellitus, dysphagia, COPD,level of consciousness, cortisol and IL-4 at admission, NIHSS, middle area and large area infarction, large atherosclerosis and cardiogenic infarction, left side,both side and subtentorial infarction are more liable to infection(P<0.05);After a Single-factor and Multivariate analysis,we found that cortisol(OR 3.26)and IL-4(OR 2.83)at admission,large area infarction(OR 2.67),left side(OR 3.78)and subtentorial infarction(OR 3.12)were significant correlated with infection, suggesting that they might be the independent risk factors for infection after cerebral infarction. Conclusion Immunological factors and different regional cerebral infarction may increase susceptibility to infection after stroke.

Objective To investigate the expression of AR and its relationship with clinicopathological features in human epidermal growth factor receptor-2(Her-2) enrich breast cancer. Mehtods The expression of AR was detected by immunohistochemical staining in 102 patients with Her-2 enrich breast cancer. The relationship between AR expression and its clinicopathological characteristics was analyzed. Results The positive rate of AR expression was 75.5%. Patients in the positive group had a lower level of lymph nodes and Ki-67 value (P < 0.05). However, no significant differences of AR expression were observed in age, menopausal status, tumor size, histological grade, vessel invasion, P53 and PCNA (P > 0.05). Conclusion AR was highly expressed in Her-2 enrich breast cancer, which may be a potential target for treatment of Her-2 enrich breast cancer.

Endoplasmic Reticulum ; genetics ; metabolism ; Plasmodium berghei ; genetics ; metabolism ; Plasmodium falciparum ; genetics ; metabolism ; Protozoan Proteins ; genetics ; metabolism

Objective: To determine the therapeutic effect of regular urethral dilatation on patients with postoperative urethral stricture. Methods: A total of 142 patients underwent urethral stricture. The unimproved patients after the surgery were divided into a reoperation group and a regular urethral dilatation group. All the patients were followed up for 1-3 months, and the curative effect was compared. Results: Of the 142 patients, 42 had no improvement and 27 of them had reoperation, and symptoms in 21 were improved. Another 15 patients received regular urethral dilatation, and 5 improved. hTere was signiifcant difference between the 2 groups (P<0.01). Conclusion: Regular urethral dilatation has some effect on postoperative patients, but no obvious effect on patients with dissatisifed operation for urethral stricture or restenosis.

Diffusion tensor imaging(DTI) is an efficient and noninvasive tool to investigate the characteristics and functions of white matter fiber tracts,and it can be used to study the relationship between the structure and function in the nervous system,the plasticity and damage repair of visual development,abnormalities of the white matters that relate to the visual pathways.Recently,the quantification of white matter fiber tracts from the lateral geniculate bodies to the occipital lobe visual cortex using DTI offers morphological information for the function and structure of the white matters during visual development.Some studies attempt to compare the DTI outcomes and tractography between amblyopic children and normal children so as to better display the variations of optic radiation in children with amblyopia,and to evaluate the relationship between structure and function of the white matters.DTI becomes an important supplementary research approach in these fields.This paper reviews the application of DTI in visual development and amblyopic eyes.