Efficacy of GV1001 with gemcitabine/capecitabine in previously untreated patients with advanced pancreatic ductal adenocarcinoma having high serum eotaxin levels (KG4/2015): an open-label, randomised, Phase 3 trial.

BACKGROUND: The TeloVac study indicated GV1001 did not improve the survival of advanced pancreatic ductal adenocarcinoma (PDAC). However, the cytokine examinations suggested that high serum eotaxin levels may predict responses to GV1001. This Phase III trial assessed the efficacy of GV1001 with gemcitabine/capecitabine for eotaxin-high patients with untreated advanced PDAC. METHODS: Patients recruited from 16 hospitals received gemcitabine (1000 mg/m2, D 1, 8, and 15)/capecitabine (830 mg/m2 BID for 21 days) per month either with (GV1001 group) or without (control group) GV1001 (0.56 mg; D 1, 3, and 5, once on week 2-4, 6, then monthly thereafter) at random in a 1:1 ratio. The primary endpoint was overall survival (OS) and secondary end points included time to progression (TTP), objective response rate, and safety. RESULTS: Total 148 patients were randomly assigned to the GV1001 (n = 75) and control groups (n = 73). The GV1001 group showed improved median OS (11.3 vs. 7.5 months, P = 0.021) and TTP (7.3 vs. 4.5 months, P = 0.021) compared to the control group. Grade >3 adverse events were reported in 77.3% and 73.1% in the GV1001 and control groups (P = 0.562), respectively. CONCLUSIONS: GV1001 plus gemcitabine/capecitabine improved OS and TTP compared to gemcitabine/capecitabine alone in eotaxin-high patients with advanced PDAC. CLINICAL TRIAL REGISTRATION: NCT02854072.

Resonantly Enhanced Electromigration Forces for Adsorbates on Graphene.

We investigate the electromigration forces for weakly bonded adsorbates on graphene by using density-functional based calculations. We find that the nature of electromigration forces on an adsorbate critically depends on the energy level alignment between the adsorbate state and the Fermi level of the graphene. For a resonant adsorbate, whose frontier orbitals lie close to the Fermi level, the electromigration force is dominated by the electron wind force that is strongly enhanced along the electron flow direction, irrespective of the sign of the adsorbate charge. For a nonresonant adsorbate, the electromigration force is essentially the direct force that depends on the adsorbate charge. We also show that the magnitude of electromigration forces can be continuously tunable through electrostatic gating for resonant adsorbates. Our results provide new insight for understanding and controlling how nanoscale objects behave in or on host materials.

Dichotomy of Electron-Phonon Coupling in Graphene Moiré Flat Bands.

Graphene moiré superlattices are outstanding platforms to study correlated electron physics and superconductivity with exceptional tunability. However, robust superconductivity has been measured only in magic-angle twisted bilayer graphene (MA-TBG) and magic-angle twisted trilayer graphene (MA-TTG). The absence of a superconducting phase in certain moiré flat bands raises a question on the superconducting mechanism. In this work, we investigate electronic structure and electron-phonon coupling in graphene moiré superlattices based on atomistic calculations. We show that electron-phonon coupling strength λ is dramatically different among graphene moiré flat bands. The total strength λ is very large (λ>1) for MA-TBG and MA-TTG, both of which display robust superconductivity in experiments. However, λ is an order of magnitude smaller in twisted double bilayer graphene (TDBG) and twisted monolayer-bilayer graphene (TMBG) where superconductivity is reportedly rather weak or absent. We find that the Bernal-stacked layers in TDBG and TMBG induce sublattice polarization in the flat-band states, suppressing intersublattice electron-phonon matrix elements. We also obtain the nonadiabatic superconducting transition temperature T_{c} that matches well with the experimental results. Our results clearly show a correlation between strong electron-phonon coupling and experimental observations of robust superconductivity.

Role of Electric Fields on Enhanced Electron Correlation in Surface-Doped FeSe.

Electron-doped high-T_{c} FeSe reportedly has a strong electron correlation that is enhanced with doping. It has been noticed that significant electric fields exist inevitably between FeSe and external donors along with electron transfer. However, the effects of such fields on the electron correlation are yet to be explored. Here we study potassium- (K-) dosed FeSe layers using density-functional theory combined with dynamical mean-field theory to investigate the roles of such electric fields on the strength of the electron correlation. We find, very interestingly, that the electronic potential-energy difference between the topmost Se and Fe atomic layers, generated by local electric fields of ionized K atoms, weakens the Se-mediated hopping between Fe d orbitals. Since it is the dominant hopping channel in FeSe, its reduction narrows the Fe d bands near the Fermi level, enhancing the electron correlation. This effect is orbital dependent and occurs in the topmost FeSe layer only. We also find the K dosing may increase the Se height, enhancing the electron correlation further. These results shed new light on the comprehensive study of high-T_{c} FeSe and other low-dimensional systems.

Acetic acid chromoendoscopy for determining the extent of gastric intestinal metaplasia.

BACKGROUND AND AIMS: The diagnosis of gastric intestinal metaplasia (IM) is currently performed by histologic assessment of multiple endoscopic biopsies, methylene blue chromoendoscopy, or narrow-band imaging with magnification. However, practical and readily available methods are lacking. We assessed the diagnostic accuracy and reproducibility of acetic acid chromoendoscopy (AAC) for determining the extent of gastric IM. METHODS: One hundred twenty-six participants were enrolled. The participants underwent screening EGD with 1.5% acetic acid instillation for the detection of acetowhite reaction. Subsequently, targeted biopsies were performed at the 5 standard intra-gastric locations of the updated Sydney system. The accuracy of AAC was calculated using the histology results as a reference. Two endoscopists, each of whom was blinded to the other's result, determined the presence or absence of acetowhite reaction. RESULTS: The overall diagnostic accuracy of AAC was 89.0%, and the sensitivity and specificity were 77.6% and 94.4%, respectively. The specificity for the gastric body was >94%. The proportion of extensive IM, a strong risk factor for gastric cancer, increased from 0.9% to 18.1% when AAC was used instead of conventional EGD alone (P < .001). Endoscopically determined atrophy had a negative effect on the diagnosis of AAC (odds ratio, 3.012; 95% confidence interval, 1.625-5.583). There was substantial inter- and intra-observer agreement. CONCLUSIONS: AAC is a valid and reproducible tool for determining the extent of gastric IM and may serve as a practical method of identifying populations at high risk of gastric cancer. (Clinical trial registration number: NCT01499576.).

Intranasal Introduction of Fc-Fused Interleukin-7 Provides Long-Lasting Prophylaxis against Lethal Influenza Virus Infection.

UNLABELLED: Influenza A virus (IAV) infection frequently causes hospitalization and mortality due to severe immunopathology. Annual vaccination and antiviral drugs are the current countermeasures against IAV infection, but they have a limited efficacy against new IAV variants. Here, we show that intranasal pretreatment with Fc-fused interleukin-7 (IL-7-mFc) protects mice from lethal IAV infections. The protective activity of IL-7-mFc relies on transcytosis via neonatal Fc receptor (FcRn) in the lung and lasts for several weeks. Introduction of IL-7-mFc alters pulmonary immune environments, leading to recruitment of T cells from circulation and their subsequent residency as tissue-resident memory-like T (TRM-like) cells. IL-7-mFc-primed pulmonary TRM-like cells contribute to protection upon IAV infection by dual modes. First, TRM-like cells, although not antigen specific but polyclonal, attenuate viral replication at the early phase of IAV infection. Second, TRM-like cells augment expansion of IAV-specific cytotoxic T lymphocytes (CTLs), in particular at the late phase of infection, which directly control viruses. Thus, accelerated viral clearance facilitated by pulmonary T cells, which are either antigen specific or not, alleviates immunopathology in the lung and mortality from IAV infection. Depleting a subset of pulmonary T cells indicates that both CD4 and CD8 T cells contribute to protection from IAV, although IL-7-primed CD4 T cells have a more prominent role. Collectively, we propose intranasal IL-7-mFc pretreatment as an effective means for generating protective immunity against IAV infections, which could be applied to a potential prophylaxis for influenza pandemics in the future. IMPORTANCE: The major consequence of a highly pathogenic IAV infection is severe pulmonary inflammation, which can result in organ failure and death at worst. Although vaccines for seasonal IAVs are effective, frequent variation of surface viral proteins hampers development of protective immunity. In this study, we demonstrated that intranasal IL-7-mFc pretreatment protected immunologically naive mice from lethal IAV infections. Intranasal pretreatment with IL-7-mFc induced an infiltration of T cells in the lung, which reside as effector/memory T cells with lung-retentive markers. Those IL-7-primed pulmonary T cells contributed to development of protective immunity upon IAV infection, reducing pulmonary immunopathology while increasing IAV-specific cytotoxic T lymphocytes. Since a single treatment with IL-7-mFc was effective in the protection against multiple strains of IAV for an extended period of time, our findings suggest a possibility that IL-7-mFc treatment, as a potential prophylaxis, can be developed for controlling highly pathogenic IAV infections.

Crucial roles of interleukin-7 in the development of T follicular helper cells and in the induction of humoral immunity.

UNLABELLED: T follicular helper (Tfh) cells are specialized providers of cognate B cell help, which is important in promoting the induction of high-affinity antibody production in germinal centers (GCs). Interleukin-6 (IL-6) and IL-21 have been known to play important roles in Tfh cell differentiation. Here, we demonstrate that IL-7 plays a pivotal role in Tfh generation and GC formation in vivo, as treatment with anti-IL-7 neutralizing antibody markedly impaired the development of Tfh cells and IgG responses. Moreover, codelivery of mouse Fc-fused IL-7 (IL-7-mFc) with a vaccine enhanced the generation of GC B cells as well as Tfh cells but not other lineages of T helper cells, including Th1, Th2, and Th17 cells. Interestingly, a 6-fold-lower dose of an influenza virus vaccine codelivered with Fc-fused IL-7 induced higher antigen-specific and cross-reactive IgG titers than the vaccine alone in both mice and monkeys and led to markedly enhanced protection against heterologous influenza virus challenge in mice. Enhanced generation of Tfh cells by IL-7-mFc treatment was not significantly affected by the neutralization of IL-6 and IL-21, indicating an independent role of IL-7 on Tfh differentiation. Thus, IL-7 holds promise as a critical cytokine for selectively inducing Tfh cell generation and enhancing protective IgG responses. IMPORTANCE: Here, we demonstrate for the first time that codelivery of Fc-fused IL-7 significantly increased influenza virus vaccine-induced antibody responses, accompanied by robust expansion of Tfh cells and GC B cells as well as enhanced GC formation. Furthermore, IL-7-mFc induced earlier and cross-reactive IgG responses, leading to striking protection against heterologous influenza virus challenge. These results suggest that Fc-fused IL-7 could be used for inducing strong and cross-protective humoral immunity against highly mutable viruses, such as HIV and hepatitis C virus, as well as influenza viruses.

SiX2 (X = S, Se) Single Chains and (Si-Ge)X2 Quaternary Alloys.

Layered or chain materials have received significant research attention owing to their interesting physical properties, which can dramatically change when the material is thinned from bulk (three-dimensional) to thin two-dimensional sheet or one-dimensional (1D) chain form. Materials with the stoichiometry AX2 with A = Si or Ge and X = S or Se form an especially intriguing semiconducting class. For example, bulk silicon dichalcogenides (SiX2) consist of 1D chains held together by van der Waals forces. Although this structural configuration has the potential to reveal interesting physical phenomena within the 1D limit, obtaining SiX2 single chains has been challenging. We here examine experimentally and theoretically SiX2 materials in the low chain number limit. Carbon nanotubes serve as growth templates and stabilize and protect the structures, and atomic-resolution scanning transmission electron microscopy directly identifies the atomic structure. Two distinct chain structures are observed for SiX2. SixGe1-xS2(1-y)Se2y quaternary alloy chains are also synthesized and characterized, demonstrating tunable semiconducting properties at the atomic-chain level. Density functional theory calculations reveal that the band gap of these alloy chains can be widely tuned through composition engineering. This work offers the possibilities for synthesizing and controlling semiconductor compositions at the single-chain limit to tailor material properties.

Visualizing the Low-Energy Electronic Structure of Prototypical Hybrid Halide Perovskite through Clear Band Measurements.

Organic-inorganic hybrid perovskites (OIHPs) are a promising class of materials that rival conventional semiconductors in various optoelectronic applications. However, unraveling the precise nature of their low-energy electronic structures continues to pose a significant challenge, primarily due to the absence of clear band measurements. Here, we investigate the low-energy electronic structure of CH3NH3PbI3 (MAPI3) using angle-resolved photoelectron spectroscopy combined with ab initio density functional theory. We successfully visualize the electronic structure of MAPI3 near the bulk valence band maximum by using a laboratory photon source (He Iα, 21.2 eV) at low temperature and explore its fundamental properties. The observed valence band exhibits a highly isotropic and parabolic band characterized by small effective masses of 0.20-0.21 me, without notable spectral signatures associated with a large polaron or the Rashba effect, subjects that are intensely debated in the literature. Concurrently, our spin-resolved measurements directly disprove the giant Rashba scenario previously suggested in a similar perovskite compound by establishing an upper limit for the Rashba parameter (αR) of 0.28 eV Å. Our results unveil the unusually complex nature of the low-energy electronic structure of OIHPs, thereby advancing our fundamental understanding of this important class of materials.

Predictors of Choledocholithiasis in Cholecystectomy Patients and Their Cutoff Values and Prediction Model in Korea in Comparison with the 2019 ASGE Guidelines.

Background/Aims: : In 2019, the American Society for Gastrointestinal Endoscopy (ASGE) established clinical predictors for choledocholithiasis. Our study was designed to evaluate these predictors within the Korean clinical context, establish cutoff values, and develop a predictive model. Methods: : This retrospective study analyzed patients who underwent laparoscopic cholecystectomy. The relationships between choledocholithiasis and predictors including age, blood tests, and imaging findings were assessed through univariate and multivariate logistic regression analyses. We established Korean cutoff values for these predictors and developed a scoring system for choledocholithiasis using a multivariate logistic regression. The performance of this scoring system was then compared with that of the 2019 ASGE guidelines through a receiver operating characteristic curve. Results: : We established Korean cutoff values for age (>70 years), alanine aminotransferase (>26.5 U/L), aspartate aminotransferase (>28.5 U/L), gamma-glutamyl transferase (GGT; >82.5 U/L), alkaline phosphatase (ALP; >77.5 U/L), and total bilirubin (>0.95 mg/dL). In the multivariate analysis, only age >70 years, GGT >77.5 U/L, ALP >77.5 U/L, and common bile duct dilatation remained significant. We then developed a new Korean risk stratification model from the multivariate analysis, with an area under the curve of 0.777 (95% confidence interval, 0.75 to 0.81). Our model was stratified into the low-risk, intermediate-risk, and high-risk groups with the scores being <1.0, 1.0-5.5, and >5.5, respectively. Conclusions: : Predictors of choledocholithiasis in cholecystectomy patients and their cutoff values in Korean should be adjusted and further studies are needed to develop appropriate guidelines.

Modulation of Phonons and Excitons Due to Moiré Potentials in Twisted Bilayer of WSe2/MoSe2.

The application of two-dimensional materials has been expanded by introducing the twisted bilayer (TBL) system. However, the landscape of the interlayer interaction in hetero-TBLs has not yet been fully understood, while that in homo-TBLs has been extensively studied, with the dependence on the twist angle between the constituent layers. Here, we present detailed analyses on the interlayer interaction that depends on the twist angle in WSe2/MoSe2 hetero-TBL via Raman and photoluminescence studies combined with first-principles calculation. We observe interlayer vibrational modes, moiré phonons, and the interlayer excitonic states that evolve with the twist angle and identify different regimes with distinct characteristics of such features. Moreover, the interlayer excitons that appear strong in the hetero-TBLs with twist angles near 0° or 60° have different energies and photoluminescence excitation spectra for the two cases, which results from different electronic structures and carrier relaxation dynamics. These results would enable a better understanding of the interlayer interaction in hetero-TBLs.

Terahertz Spectroscopy and DFT Analysis of Phonon Dynamics of the Layered Van der Waals Semiconductor Nb3 X 8 (X = Cl, I).

We have conducted a terahertz spectroscopic study and a density functional theory analysis of the phonon dynamics of the layered van der Waals semiconductors Nb3Cl8 and Nb3I8. Several infrared-active phonon modes were observed in the terahertz region, and their frequencies were found to be in excellent agreement with our first-principles lattice dynamics calculations. For Nb3Cl8, the observed phonon spectra are consistent with a structural transition at 90 K from the high-temperature P3̅m1 phase to the low-temperature R3̅m phase. Also, our study confirmed that the structural and magnetic transitions were coupled in Nb3Cl8. For Nb3I8, which is nonmagnetic at and below room temperature, no significant temperature or magnetic field dependence was observed in the phonon spectra. Our study provides an intriguing connection between the structural properties and the paramagnetic-nonmagnetic transitions in Nb3Cl8 and Nb3I8.

Tuning the Sharing Modes and Composition in a Tetrahedral GeX2 (X = S, Se) System via One-Dimensional Confinement.

The packing and connectivity of tetrahedral units are central themes in the structural and electronic properties of a host of solids. Here, we report one-dimensional (1D) chains of GeX2 (X = S or Se) with modification of the tetrahedral connectivity at the single-chain limit. Precise tuning of the edge- and corner-sharing modes between GeX2 blocks is achieved by diameter-dependent 1D confinement inside a carbon nanotube. Atomic-resolution scanning transmission electron microscopy directly confirms the existence of two distinct types of GeX2 chains. Density functional theory calculations corroborate the diameter-dependent stability of the system and reveal an intriguing electronic structure that sensitively depends on tetrahedral connectivity and composition. GeS2(1-x)Se2x compound chains are also realized, which demonstrate the tunability of the system's semiconducting properties through composition engineering.

1D Magnetic MX3 Single-Chains (M = Cr, V and X = Cl, Br, I).

Magnetic materials in reduced dimensions are not only excellent platforms for fundamental studies of magnetism, but they play crucial roles in technological advances. The discovery of intrinsic magnetism in monolayer 2D van der Waals systems has sparked enormous interest, but the single-chain limit of 1D magnetic van der Waals materials has been largely unexplored. This paper reports on a family of 1D magnetic van der Waals materials with composition MX3 (M = Cr, V, and X = Cl, Br, I), prepared in fully-isolated fashion within the protective cores of carbon nanotubes. Atomic-resolution scanning transmission electron microscopy identifies unique structures that differ from the well-known 2D honeycomb lattice MX3 structure. Density functional theory calculations reveal charge-driven reversible magnetic phase transitions.

An effective instillation method for water-assisted colonoscopy as performed by in-training endoscopists in terms of volume and temperature.

BACKGROUND AND STUDY AIMS: There is general consensus that water instillation helps insert a colonoscope. However, the most effective method for water instillation has not yet been established, especially for endoscopists-in-training. The aim of this study was to determine volume and temperature for effective water instillation colonoscopy. PATIENTS AND METHODS: This is a prospective, randomized, controlled trial that was carried out at a single center, and a total of 207 consecutive subjects who underwent colonoscopic examination for health checkup were included in the study. Water instillation of supplied water was conducted under four different conditions: 100 and 300 ml at room temperature, 300 ml at 30 °C and no use of water instillation. The following parameters were recorded and analyzed: intubation success rate, independent predictors of successful intubation and intubation time to reach the cecum. RESULTS: The intubation success rate was not significantly different between individual groups. Independent predictors of successful intubation were younger age (P = 0.004) and later examined subjects (P = 0.016). The 300-ml warm water instillation during colonoscopy significantly reduced intubation time over the conventional method without water instillation (P = 0.034). CONCLUSIONS: Instillation of 300-ml warm (30 °C) water during colonoscopy can reduce cecal intubation time for in-training endoscopists without improving the intubation success rate.

Comparison of one-stage laparoscopic common bile duct exploration plus cholecystectomy and two-stage endoscopic sphincterotomy plus laparoscopic cholecystectomy for concomitant gallbladder and common bile duct stones in patients over 80 years old.

Purpose: This study was performed to compare the safety and efficacy of one-stage laparoscopic common bile duct exploration (LCBDE) plus laparoscopic cholecystectomy (LC) with those of endoscopic sphincterotomy (EST) plus LC for concomitant gallbladder (GB) and common bile duct (CBD) stones in elderly patients. Methods: This single-center retrospective study reviewed the medical records of patients aged >80 years who were diagnosed with concomitant GB and CBD stones between January 2010 and December 2020. Results: Of the 137 patients included in this study, 46 underwent one-stage LCBDE + LC and 91 underwent two-stage EST + LC. The frequency of previous gastrectomy (23.9% vs. 5.5%, p = 0.002) and multiple stones (76.1% vs. 49.5%, p = 0.003) was higher in the LCBDE + LC group than in the EST + LC group. Further, patients in LCBDE + LC group had larger CBD stones (11.9 mm vs. 6.0 mm, p < 0.001). There were no significant differences in the clearance (91.3% vs. 95.6%, p = 0.311) and recurrence (4.3% vs. 8.8%, p = 0.345) rates between the groups. The incidence of posttreatment overall complications (17.4% vs. 22.0%, p = 0.530) and total hospital stay (12.7 days vs. 11.7 days, p = 0.339) were similar in the two groups. Conclusion: One-stage LCBDE + LC is a safe and effective treatment for concomitant GB and CBD stones, even in elderly patients, and may be considered as the first treatment option in elderly patients with previous gastrectomy, multiple large (≥ 15 mm) CBD stones, or inability to cooperate with endoscopic procedures.

Fuel cell performance improvement via the steric effect of a hydrocarbon-based binder for cathode in proton exchange membrane fuel cells.

In this study, a sulfonated poly(ether sulfone) having cardo-type fluorenyl groups (FL-SPES) was investigated as a cathodic binder to improve fuel cell performance via increased the oxygen diffusion in the cathode. The maximum power density achieved by using the membrane electrode assembly (MEA) prepared with FL-SPES with a low ion exchange capacity (IEC) of 1.31 meq g-1 was 520 mW cm-2, which is more than twice as high as that of BP-SPES (210 mW cm-2) having typical biphenyl groups with a similar IEC. At high IEC of 1.55 meq g-1, the power density obtained by using BP-SPES was improved to 454 mW cm-2 but remained lower than that of FL-SPES. In addition, although the IEC, swelling degree, and specific resistance were similar to each other, the gas permeability of FL-SPES was improved by approximately three times compared to that of BP-SPES. The steric structure of cardo-type FL-SPES increased the free volume between the polymer backbones, leading to an increase in gas transfer. Consequently, oxygen diffusion was promoted at the cathode, resulting in improved fuel cell performance.

Experimental and Computational Approaches to Sulfonated Poly(arylene ether sulfone) Synthesis Using Different Halogen Atoms at the Reactive Site.

Engineering thermoplastics, such as poly(arylene ether sulfone), are more often synthesized using F-containing monomers rather than Cl-containing monomers because the F atom is considered more electronegative than Cl, leading to a better condensation polymerization reaction. In this study, the reaction's spontaneity improved when Cl atoms were used compared to the case using F atoms. Specifically, sulfonated poly(arylene ether sulfone) was synthesized by reacting 4,4'-dihydroxybiphenyl with two types of biphenyl sulfone monomers containing Cl and F atoms. No significant difference was observed in the structural, elemental, and chemical properties of the two copolymers based on nuclear magnetic resonance spectroscopy, Fourier transform infrared spectroscopy, thermogravimetric analysis, X-ray diffraction, transmission electron microscopy, and electrochemical impedance spectroscopy. However, the solution viscosity and mechanical strength of the copolymer synthesized with the Cl-terminal monomers were slightly higher than those of the copolymer synthesized with the F-terminal monomers due to higher reaction spontaneity. The first-principle study was employed to elucidate the underlying mechanisms of these reactions.

The dependence of enhanced lysosomal activity on the cellular aging of bovine aortic endothelial cells.

Lysosomes are a cell organelle type processing antimicrobial activity. Here, we investigate the lysosomal activity in a primary cell line, bovine aortic endothelial cells (BAECs), during cellular aging, based on the antimicrobial activity of lysosomes isolated from BAECs at cell passages 4, 6, 8, and 10. Cytochemical analysis of lysosomes with LysoTracker reagent revealed the number of lysosome-like organelles surrounding the nucleus initially increased drastically in the BAECs and continued increasing gradually until passage 10. The lysosomes isolated from each successive passage of BAECs exhibited increased antimicrobial activity against Escherichia coli, and, in addition, an age-dependent increase in lysosome intensity coincided with increased lysosomal antimicrobial activity.