Changes in the topological organization of the default mode network in autism spectrum disorder.

Neuroimaging studies have demonstrated that autism spectrum disorder (ASD) is accompanied by abnormal functional and structural features in specific brain regions of the default mode network (DMN). However, little is known about the alterations of the topological organization and the functional connectivity (FC) of the DMN in ASD patients. Thirty-seven ASD patients and 38 healthy control (HC) participants underwent a resting-state functional magnetic resonance imaging scan. Twenty DMN subregions were specifically selected to construct the DMN architecture. We applied graph theory approaches to the topological configuration and compare the FC patterns of the DMN. We then examined the relationships between the neuroimaging measures of the DMN and clinical characteristics in patients with ASD. The current study revealed that both the ASD and HC participants showed a small-world regimen in the DMN; however there were no significant differences in global network measures. Compared with the HC group, the ASD group exhibited significantly decreased nodal centralities in the bilateral anterior medial prefrontal cortex and increased nodal centralities in the right lateral temporal cortex and the right retrosplenial cortex. Patients with ASD displayed significantly reduced and increased FC within the DMN. Our findings demonstrated that ASD patients showed a pattern of disrupted FC metrics and nodal network metrics in the DMN, which could be a potential biomarker for objective ASD diagnoses and for the level of autism spectrum traits. HIGHLIGHTS: We used graph theoretical approaches and functional connectivity (FC) to investigate the topological configuration and FC patterns of the DMN in ASD. The current study revealed that both ASD and HC participants exhibited small-world regimes in the DMN, however there were no significant differences in global network measures. The ASD group showed abnormal nodal centralities in the bilateral aMPFC, the right LTC and the Rsp of the DMN, and ASD was characterized by altered FC patterns, including decreased and increased FC within the DMN.

Immune-checkpoint inhibitor plus chemotherapy versus conventional chemotherapy for treatment of recurrent or metastatic head and neck squamous cell carcinoma: a systematic review and network meta-analysis.

BACKGROUND: Multiple therapies including immune-checkpoint inhibitors are emerging as effective treatment for patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSSC). However, the optimal first-line and second-line treatments remains controversial. METHODS: We systematically searched databases and conducted a systematic review of phase II/III randomized controlled trials (RCTs) that compared two or more treatments for R/M HNSSC. Progression-free survival (PFS), overall survival (OS) and adverse events (AEs) ⩾3 with hazard ratios (HRs) were extracted and synthesized based on a frequentist network meta-analysis. RESULTS: Twenty-six trials involving 8908 patients were included. Of first-line treatments, pembrolizumab plus cisplatin plus 5-fluorouracil is associated with significantly improved OS (P-score = 0.91) and TPEx ranked first for prolonging PFS (0.91). EXTREME plus docetaxel (0.18) ranked lowest for AEs ⩾3. Of second-line treatments, nivolumab was the highest-ranked treatment for prolonging OS (0.95), while buparlisib plus paclitaxel was the highest-ranked treatment for PFS (0.94). Subgroup analyses suggested that nivolumab was significantly associated with improvement of OS in patients with high PD-L1 expression (HR 0.55, 0.43-0.70), whereas its OS benefit is similar with conventional chemotherapy for those with low PD-L1 expression. Buparlisib plus paclitaxel showed the best OS benefit in subgroups of patients with HPV-negative status, and with oral cavity or larynx as primary tumor sites. CONCLUSIONS: Pembrolizumab plus cisplatin plus 5-fluorouracil is likely to be the best first-line treatment when OS is a priority. Otherwise, TPEx should be the optimal first-line option due to its superior PFS prolongation efficacy, best safety profile, and similar OS benefit with pembrolizumab plus cisplatin plus 5-fluorouracil. Nivolumab appears to be the best second-line option with best OS prolongation efficacy and outstanding safety profile in the overall population. Future RCTs with meticulous grouping of patients and detailed reporting are urgently needed for individualized treatment.

Radiomic Nomogram: Pretreatment Evaluation of Local Recurrence in Nasopharyngeal Carcinoma based on MR Imaging.

Background: To develop and validate a radiomic nomogram incorporating radiomic features with clinical variables for individual local recurrence risk assessment in nasopharyngeal carcinoma (NPC) patients before initial treatment. Methods: One hundred and forty patients were randomly divided into a training cohort (n = 80) and a validation cohort (n = 60). A total of 970 radiomic features were extracted from pretreatment magnetic resonance (MR) images of NPC patients from May 2007 to December 2013. Univariate and multivariate analyses were used for selecting radiomic features associated with local recurrence, and multivariate analyses was used for building radiomic nomogram. Results: Eight contrast-enhanced T1-weighted (CET1-w) image features and seven T2-weighted (T2-w) image features were selected to build a Cox proportional hazard model in the training cohort, respectively. The radiomic nomogram, which combined radiomic features and multiple clinical variables, had a good evaluation ability (C-index: 0.74 [95% CI: 0.58, 0.85]) in the validation cohort. The radiomic nomogram successfully categorized those patients into low- and high-risk groups with significant differences in the rate of local recurrence-free survival (P <0.05). Conclusions: This study demonstrates that MR imaging-based radiomics can be used as an aid tool for the evaluation of local recurrence, in order to develop tailored treatment targeting specific characteristics of individual patients.