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Abstract There is an urgent need to fully understand the biology of third generation EGFR‐tyrosine kinase inhibitors (EGFR‐TKIs), particularly osimertinib, and to develop mechanism‐driven strategies to manage their acquired resistance. Transient receptor potential melastatin‐2 (TRPM2) functions as an important regulator of Ca2+ influx, but its role in mediating therapeutic efficacies of EGFR‐TKIs and acquired resistance to EGFR‐TKIs has been rarely studied. This study has demonstrated a previously undiscovered role of suppression of TRPM2 and subsequent inhibition of Ca2+ influx and induction of ROS and DNA damage in mediating apoptosis induction and the therapeutic efficacy of osimertinib against EGFR mutant NSCLC. The rebound elevation represents a key mechanism accounting for the emergence of acquired resistance to osimertinib and other third generation EGFR‐TKIs. Accordingly, targeting TRPM2 is a potentially promising strategy for overcoming and preventing acquired resistance to osimertinib, warranting further study in this direction including the development of cancer therapy‐optimized TRPM2 inhibitors.

Recognition of multiple partial discharge (PD) sources in high voltage equipment has been a challenging task until now. The work reported here, aims to recognize multiple PD sources in oil-impregnated paper using Cluster Analysis (CA) and Fuzzy Logic (FL). The typical sources of PD in transformer are identified and the corresponding single source PD defect laboratory models are fabricated. From the measured PD signals, the necessary statistical parameters are extracted by applying CA for classification. A Fuzzy based algorithm has been developed to recognize single source PDs. The developed algorithm has also been applied to recognize multiple PD sources.

This study is motivated through the interesting non-Arcchimedean stability results of ρ-inequalities and ρ-equations arising from linear, second power, third power and fourth power mappings. The aim of this paper is to determine the solutions of new multiplicative inverse µ-inequalities and µ-equations arising from multiplicative inverse mapping. Further, their stabilities involved with various superior limits are proved in the context of non-Archimedean complete normed spaces.

The phase behavior of lipids extracted from Astrocaryum vulgare (AV) and Astrocaryum aculeatum (AA) pulp and kernels and their microstructural, thermal and flow properties were studied. The lipid profiles, crystal structures, microstructures, thermal stabilities and flow behaviors of these lipids provided important structure–function information that are useful to assess potential applications in the food, cosmetic and pharmaceutical industries. AV and AA fruits were sourced from the lowlands and rainforests, respectively, of Guyana. AV and AA pulp oils (AVP and AAP) were distinguished from each other in composition and unsaturation, with AVP oils being predominated by a di-unsaturated TAG (2-(palmitoyloxy)propane-1,3-diyl dioleate (POO)) and AAP oils predominated by propane-1,2,3-triyl trioleate (OOO); there were unsaturation levels of 65% and 80%, respectively. The main fatty acids in AVP oils were oleic, palmitic and stearic; for AAP, these were oleic, linoleic, palmitic and stearic. The kernel fats of AV and AA were similar in composition and had saturation levels of 80%, being mainly comprised of tri-saturated TAGs propane-1,2,3-triyl tridodecanoate (LLL) and 3-(tetradecanoyloxy)propane-1,2-diyl didodecanoate (LML). The onset of mass loss (T5%on) of AV and AA pulp oils were similar at 328 ± 6 °C, which were 31 °C ± 9 higher compared to that of the kernel fats, which demonstrated similar T5%on = 293 ± 7 °C. AA and AV pulp oils were liquid at room temperature, with melting points of −5 ± 1 °C and 3 ± 1 °C, respectively; both kernel fats were solid at room temperature, packing in β′ (90% of crystals) and β (10% of crystals) polymorphic forms and melting almost identically at 30 ± 1 °C. Pulp oils demonstrated sporadic nucleation at the onset of crystallization with slow growth into rod-shaped crystallites, leading to an approximately 50% degree of crystallization at undercooling of approximately 40K. Nucleation for kernel fats was instantaneous at undercooling of approximately 23K, demonstrating a spherulitic growth pattern incorporating crystalline lamella and a 90% degree of crystallization. Kernel fats and pulp oils demonstrated Newtonian flow behavior and similar dynamic viscosity in the melt, approximately 28.5 mPa·s at 40 °C. The lipid profiles of AVP and AAP oils were dominated by unsaturated TAGs, suggesting potential nutrition and health benefits, particularly compared to other tropical oils with higher saturation levels, such as palm oil. AAP oil in particular is as unsaturated as olive oil, contains high levels of beta carotene and provides a unique flavor profile. The AAK and AVK lipid profiles and phase transformation indicate potential for applications where a high solid fat content and medium-chain fatty acids are required. Their high lauric and myristic acid content makes them similar to industrially important tropical oils (coconut and palm kernel), suggesting their use in similar formulations. The melting point and plasticity of the kernel fats are similar to that of cocoa and shea butters, suggesting use as replacements in cosmetics, foods and confections. There is, however, the need to better understand their nutritional status and effects on health.

In the present work, manganese–copper co-infused nickel oxide nanoparticles (MnCu co-doped NiO NPs) were formulated via a green process using Carica papaya extract. The MnCu co-doped NiO NPs were characterized by X-ray diffraction (XRD), UV–Vis, Fourier transform infrared, field emission scanning electron microscope, energy dispersive X-ray analysis, and photoluminescence (PL) spectrum. The XRD pattern demonstrated that synthesized MnCu co-doped NiO NPs exhibit cubic structure. On the PL spectrum, various surface defects were identified. MnCu co-doped NiO NPs exhibited ferromagnetic properties at 37°C. The antimicrobial activity of green synthesis MnCu co-doped NiO NPs against human pathogens (Escherichia coli, Streptococcus pneumoniae, Bacillus megaterium, Bacillus subtilis, Shigella dysenteriae, Pseudomonas aeruginosa) and Candida albicans as fungal strains were demonstrated. The MnCu co-doped NiO NPs treatment considerably reduced MDA-MB-231 cell viability while not disturbing HBL-100 cell viability. Different fluorescent staining analyses revealed that MnCu co-doped NiO NPs induced nuclear and mitochondrial damage to improve free radical production, altering mitochondrial membrane protein potential, which led to apoptotic cell death in MDA-MB-231 cells. The MnCu co-doped NiO NP treatment enhanced pro-apoptotic protein expression and inhibited the cell cycle at the S phase in MDA-MB-231 cells. This makes it easy, cheap, and environmentally friendly to make MnCu co-doped NiO NPs using C. papaya extract, which has excellent antimicrobial properties.

Development of effective strategies to manage the inevitable acquired resistance to osimertinib, a third-generation EGFR inhibitor for the treatment of EGFR-mutant (EGFRm) non-small cell lung cancer (NSCLC), is urgently needed. This study reports that DNA topoisomerase II (Topo II) inhibitors, doxorubicin and etoposide, synergistically decreased cell survival, with enhanced induction of DNA damage and apoptosis in osimertinib-resistant cells; suppressed the growth of osimertinib-resistant tumors; and delayed the emergence of osimertinib-acquired resistance. Mechanistically, osimertinib decreased Topo II[alpha] levels in EGFRm NSCLC cells by facilitating FBXW7-mediated proteasomal degradation, resulting in induction of DNA damage; these effects were lost in osimertinib-resistant cell lines that possess elevated levels of Topo II[alpha]. Increased Topo II[alpha] levels were also detected in the majority of tissue samples from patients with NSCLC after relapse from EGFR tyrosine kinase inhibitor treatment. Enforced expression of an ectopic TOP2A gene in sensitive EGFRm NSCLC cells conferred resistance to osimertinib, whereas knockdown of TOP2A in osimertinib-resistant cell lines restored their susceptibility to osimertinib-induced DNA damage and apoptosis. Together, these results reveal an essential role of Topo II[alpha] inhibition in mediating the therapeutic efficacy of osimertinib against EGFRm NSCLC, providing scientific rationale for targeting Topo II to manage acquired resistance to osimertinib., Introduction Lung cancer has remained the leading cause of cancer death among both men and women, and it accounts for around one-fourth of all cancer deaths worldwide despite great efforts [...]

Introduction: The JAVELIN Lung 101 phase 1b/2 trial evaluated avelumab (immune checkpoint inhibitor) combined with lorlatinib or crizotinib (tyrosine kinase inhibitors) in ALK-positive or ALK-negative advanced NSCLC, respectively. Methods: Starting doses of lorlatinib 100 mg once daily or crizotinib 250 mg twice daily were administered with avelumab 10 mg/kg every 2 weeks. Primary objectives were assessment of maximum tolerated dose (MTD) and recommended phase 2 dose in phase 1 and objective response rate in phase 2. Primary end points were dose-limiting toxicity (DLT) and confirmed objective response per Response Evaluation Criteria in Solid Tumors, version 1.1. Results: In the avelumab plus lorlatinib group (ALK-positive; n = 31; 28 in phase 1b; three in phase 2), two of 28 assessable patients (7%) had DLT, and the MTD and recommended phase 2 dose was avelumab 10 mg/kg every 2 weeks plus lorlatinib 100 mg once daily. In the avelumab plus crizotinib group (ALK-negative; n = 12; all phase 1b), five of 12 assessable patients (42%) had DLT, and the MTD was exceeded with avelumab 10 mg/kg every 2 weeks plus crizotinib 250 mg twice daily; alternative crizotinib doses were not assessed. Objective response rate was 52% (95% confidence interval, 33%–70%) with avelumab plus lorlatinib (complete response, 3%; partial response, 48%) and 25% (95% confidence interval, 6%–57%) with avelumab plus crizotinib (all partial responses). Conclusions: Avelumab plus lorlatinib treatment in ALK-positive NSCLC was feasible, but avelumab plus crizotinib treatment in ALK-negative NSCLC could not be administered at the doses tested. No evidence of increased antitumor activity was observed in either group. ClinicalTrials.gov identifier: NCT02584634

Objective Immune checkpoint inhibitors (ICI) that block the programmed cell death 1 (PD-1) pathway have shown promise with limited benefit. We and others have shown in small patient cohorts that an early proliferative CD8 T-cell response in the blood may be predictive of clinical response. However, these studies lack detailed analyses and comparisons between monotherapy and combination therapies.Methods and analysis We analysed longitudinal blood samples from 103 patients with cancer who received αPD-1 monotherapy or combined with anti-cytotoxic T lymphocyte-associated protein 4 (αCTLA-4) or chemotherapy. Transcriptional analysis of CD8 T cells after the first treatment cycle with effector cells generated following yellow fever virus (YFV-17D) vaccine-induced infection was also compared.Results An early proliferative (Ki-67+) CD8 T-cell response was observed after cycle 1 in 60 patients (58.3%). Patients with early-and-sustained proliferative responses (cycle 1 and beyond) had better clinical responses and survival than patients with an early-but-limited response (p=0.02). The proliferating cells had an effector-like phenotype. The transcriptional profiles of the effector-like CD8 T cells were similar irrespective of treatment type or clinical response but distinct from that of YFV-specific effector CD8 T cells.Conclusions Our data suggest that early proliferative CD8 T-cell response in the blood is predictive, and that an early-and-sustained proliferative response may further identify patients with prolonged survival. The ICI-induced effector-like CD8 T cells are transcriptionally distinct from highly functional YFV-specific cells, suggesting opportunities for improved T-cell effector function with combination therapies for better clinical outcome.

From the past decades, rodent models have played role in evaluating the use of several drugs for the treatment of brain diseases. Generally, these tests are performed by recoding a video and examine to carry out various annotation about the behavior and activities of the rodents. However, the video must be executed continuously to ensure proper annotation that causes time complexity and increases the human observation error. Conventional techniques for rodent behavioral analysis process are not affordable for the research purpose due to increase cost and poor interpretability. To tackle this issue, a new and effective deep learning (DL) technique is introduced to analyze the multiclass behaviors in rodents under real-time scenario. At first, the video captured from camera is preprocessed by performing frame conversion and noise removal process. For removing the noise, the Butterworth-amended unsharp mask filtering (B_UMF) technique is emphasized thereby improving the image quality. Finally, the Evolutionary Gravity Neocognitron Neural Network (EGravity-NCNN) model is proposed to classify multiple rodent behaviours using adaptive feature learning. The simulation process for the developed method is carried out via the Python platform and various performance like accuracy, precision and recall are scrutinized and compared with conventional schemes. The developed method achieved the overall accuracy of 97.33 %, precision of 96.29 %, and recall of 97.02 % for the classification of rodent behaviours accurately.

Introduction: EGFR exon 20 insertion (ex20ins) mutations account for approximately 10% of EGFR mutations in lung adenocarcinoma. Patients with ex20ins mutation do not respond to standard EGFR tyrosine kinase inhibitor therapy. In this work, we analyzed the characteristics, treatment patterns, and outcomes in this subgroup of patients with NSCLC. Methods: The American Society of Clinical Oncology CancerLinQ Discovery data set was queried to identify patients with initial diagnosis of NSCLC between the years 1995 and 2018 and with EGFR ex20ins mutations. Data were extracted on patient demographics, tumor characteristics, treatments, and outcomes, and compared using chi-square and analysis of variance. Kaplan-Meier curves were generated to compare overall survival with log-rank tests. All analyses were performed using Python 3.6 (Python Software Foundation). Results: A total of 357 patients were eligible. Patient characteristics include a median age of 68 years comprising female sex of 54%, White race of 63%, and Black race of 9%. Approximately 62% of total patients had stage 4 disease, and 30% of all patients had brain metastasis. There were 54% of patients who were treated with chemotherapy and 15% with immune checkpoint inhibitors (ICIs). In patients with brain metastasis, 16% were treated with ICI, 18% with targeted therapy, and 59% with chemotherapy. The median survival of the entire group was 23.8 months. Among patients with stage 4 disease (n = 222): 51% were women, 64% were white, 37% had brain metastasis, 18% were treated with ICI, 14% had targeted therapy, and 60% were treated with chemotherapy. Stage 4 patients treated with targeted therapy had better survival compared with those who did not receive targeted therapy (20.6 versus 16.1 mo, p = 0.02). Univariate and multivariate analyses suggested favorable outcomes for patients treated with immunotherapy. Conclusions: EGFR ex20ins mutation represents a unique subset of NSCLC; it is associated with a higher propensity for brain metastases and a relatively modest overall survival. Novel treatment approaches are urgently needed to improve patient outcomes.

The World Health Organization (WHO) recommends the requirement of human resource for health (HRH) stands at 44.5 skilled health workers per 10,000 population. WHO recognizes India as one of the countries which has HRH crisis. Karnataka, a southern state in India, has the highest number of medical colleges yet faces the shortage of specialists in the public hospitals. We conducted desk review to understand the HRH crisis, particularly the medical specialists in India. Simultaneously, we conducted secondary research to explore the initiatives taken by the Government of Karnataka (GoK) to mitigate the shortage of medical specialists in the rural areas. GoK scaled up the National Board of Examination in Medical Sciences (NBEMS) postgraduate and super-speciality courses such as Diplomate of National Board (DNB), Diploma, and Doctorate of National Board (DrNB) in district hospitals (minimum 250–500 bedded) and taluk hospitals (minimum 100 bedded) by utilizing the existing resources. Karnataka is the first state in India to expand the NBEMS (DNB and Diploma) courses in taluk hospitals and to begin DrNB courses in district hospitals. The paper documents the process of implementation of the NBEMS courses at district and taluk hospitals of Karnataka, which has supported in strengthening these hospitals in the state.

Rayan Dakroub,1,2 Solène Huard,1 Yara Hajj-Younes,1 Samyuktha Suresh,1 Bassam Badran,2 Hussein Fayyad-Kazan,2 Thierry Dubois1 1Breast Cancer Biology Group, Translational Research Department, Institut Curie-PSL Research University, Paris, 75005, France; 2Laboratory of Cancer Biology and Molecular Immunology, Faculty of Sciences-I, Lebanese University, Hadath, 1003, LebanonCorrespondence: Thierry Dubois, Breast Cancer Biology Group, Translational Research Department, Institut Curie-PSL Research University, Paris, 75005, France, Tel +33 156246250, Email thierry.dubois@curie.frPurpose: Triple-negative breast cancer (TNBC) is the most aggressive breast cancer subgroup characterized by a high risk of resistance to chemotherapies and high relapse potential. TNBC shows inter-and intra-tumoral heterogeneity; more than half expresses high EGFR levels and about 30% are classified as HER2-low breast cancers. High PRMT5 mRNA levels are associated with poor prognosis in TNBC and inhibiting PRMT5 impairs the viability of subsets of TNBC cell lines and delays tumor growth in TNBC mice models. TNBC patients may therefore benefit from a treatment targeting PRMT5. The aim of this study was to assess the therapeutic benefit of combining a PRMT5 inhibitor with different chemotherapies used in the clinics to treat TNBC patients, or with FDA-approved inhibitors targeting the HER family members.Methods: The drug combinations were performed using proliferation and colony formation assays on TNBC cell lines that were sensitive or resistant to EPZ015938, a PRMT5 inhibitor that has been evaluated in clinical trials. The chemotherapies analyzed were cisplatin, doxorubicin, camptothecin, and paclitaxel. The targeted therapies tested were erlotinib (EGFR inhibitor), neratinib (EGFR/HER2/HER4 inhibitor) and tucatinib (HER2 inhibitor).Results: We found that PRMT5 inhibition synergized mostly with cisplatin, and to a lesser extent with doxorubicin or camptothecin, but not with paclitaxel, to impair TNBC cell proliferation. PRMT5 inhibition also synergized with erlotinib and neratinib in TNBC cell lines, especially in those overexpressing EGFR. Additionally, a synergistic interaction was observed with neratinib and tucatinib in a HER2-low TNBC cell line as well as in a HER2-positive breast cancer cell line. We noticed that synergy can be obtained in TNBC cell lines that were resistant to PRMT5 inhibition alone.Conclusion: Altogether, our data highlight the therapeutic potential of targeting PRMT5 using combinatorial strategies for the treatment of subsets of TNBC patients.Keywords: TNBC, erlotinib, neratinib, cisplatin, drug combination