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Multicenter contemporary data describing short-term outcomes after initial interventions of neonates with pulmonary atresia with intact ventricular septum (PA-IVS) are limited. This multicenter study describes characteristics and outcomes of PA-IVS neonates after their initial catheter or surgical intervention and identifies factors associated with major adverse cardiac events (MACE).Neonates with PA-IVS who underwent surgical or catheter intervention between 2009 and 2019 in 19 centers were reviewed. Risk factors for MACE, defined as cardiopulmonary resuscitation, mechanical circulatory support, stroke, or in-hospital mortality, were analyzed using multivariable logistic regression models.We reviewed 279 neonates: 79 (28%) underwent right ventricular decompression, 151 (54%) underwent systemic-to-pulmonary shunt or ductal stent placement only, 36 (13%) underwent right ventricular decompression with shunt or ductal stent placement, and 11 (4%) underwent transplantation. MACE occurred in 57 patients (20%): 26 (9%) received mechanical circulatory support, 37 (13%) received cardiopulmonary resuscitation, stroke occurred in 16 (6%), and 23 (8%) died. The presence of 2 major coronary artery stenoses (adjusted odds ratio, 4.99; 95% CI, 1.16-21.39) and lower weight at first intervention (adjusted odds ratio, 1.52; 95% CI, 1.01-2.27) were significantly associated with MACE. Coronary ischemia was the most frequent presumed mechanism of death (n = 10).In a multicenter cohort, 1 in 5 neonates with PA-IVS experienced MACE after their initial intervention. Patients with 2 major coronary artery stenoses or lower weight at the time of the initial procedure were most likely to experience MACE and warrant vigilance during preintervention planning and postintervention management.

Supplementary Methods and Legends from Increased AKT S473 phosphorylation after mTORC1 inhibition is rictor dependent and does not predict tumor cell response to PI3K/mTOR inhibition

Mammalian target of rapamycin (mTOR) regulates cellular processes important for progression of human cancer. RAD001 (everolimus), an mTORC1 (mTOR/raptor) inhibitor, has broad antitumor activity in preclinical models and cancer patients. Although most tumor lines are RAD001 sensitive, some are not. Selective mTORC1 inhibition can elicit increased AKT S473 phosphorylation, involving insulin receptor substrate 1, which is suggested to potentially attenuate effects on tumor cell proliferation and viability. Rictor may also play a role because rictor kinase complexes (including mTOR/rictor) regulate AKT S473 phosphorylation. The role of raptor and rictor in the in vitro response of human cancer cells to RAD001 was investigated. Using a large panel of cell lines representing different tumor histotypes, the basal phosphorylation of AKT S473 and some AKT substrates was found to correlate with the antiproliferative response to RAD001. In contrast, increased AKT S473 phosphorylation induced by RAD001 did not correlate. Similar increases in AKT phosphorylation occurred following raptor depletion using siRNA. Strikingly, rictor down-regulation attenuated AKT S473 phosphorylation induced by mTORC1 inhibition. Further analyses showed no relationship between modulation of AKT phosphorylation on S473 and T308 and AKT substrate phosphorylation patterns. Using a dual pan-class I phosphatidylinositol 3-kinase/mTOR catalytic inhibitor (NVP-BEZ235), currently in phase I trials, concomitant targeting of these kinases inhibited AKT S473 phosphorylation, eliciting more profound cellular responses than mTORC1 inhibition alone. However, reduced cell viability could not be predicted from biochemical or cellular responses to mTORC1 inhibitors. These data could have implications for the clinical application of phosphatidylinositol 3-kinase/mTOR inhibitors. [Mol Cancer Ther 2009;8(4):742–53]

Supplementary Figure 3 from Increased AKT S473 phosphorylation after mTORC1 inhibition is rictor dependent and does not predict tumor cell response to PI3K/mTOR inhibition

Supplementary Figure 1 from Increased AKT S473 phosphorylation after mTORC1 inhibition is rictor dependent and does not predict tumor cell response to PI3K/mTOR inhibition

Supplementary Figure 4 from Increased AKT S473 phosphorylation after mTORC1 inhibition is rictor dependent and does not predict tumor cell response to PI3K/mTOR inhibition

Supplementary Figure 2 from Increased AKT S473 phosphorylation after mTORC1 inhibition is rictor dependent and does not predict tumor cell response to PI3K/mTOR inhibition

Supplementary Figures 1-2, Table 1 from AMP-Activated Protein Kinase Signaling Results in Cytoplasmic Sequestration of p27

Tuberin, the Tsc2 gene product, integrates the phosphatidylinositol 3-kinase/mitogen-activated protein kinase (mitogenic) and LKB1/AMP-activated protein kinase (AMPK; energy) signaling pathways, and previous independent studies have shown that loss of tuberin is associated with elevated AMPK signaling and altered p27 function. In Tsc2-null tumors and tumor-derived cells from Eker rats, we observed elevated AMPK signaling and concordant cytoplasmic mislocalization of p27. Cytoplasmic localization of p27 in Tsc2-null cells was reversible pharmacologically using inhibitors of the LKB1/AMPK pathway, and localization of p27 to the cytoplasm could be induced directly by activating AMPK physiologically (glucose deprivation) or genetically (constitutively active AMPK) in Tsc2-proficient cells. Furthermore, AMPK phosphorylated p27 in vitro on at least three sites including T170 near the nuclear localization signal, and T170 was shown to determine p27 localization in response to AMPK signaling. p27 functions in the nucleus to suppress cyclin-dependent kinase-2 (Cdk2) activity and has been reported to mediate an antiapoptotic function when localized to the cytoplasm. We found that cells with elevated AMPK signaling and cytoplasmic p27 localization exhibited elevated Cdk2 activity, which could be suppressed by inhibiting AMPK signaling. In addition, cells with elevated AMPK signaling and cytoplasmic p27 localization were resistant to apoptosis, which could be overcome by inhibition of AMPK signaling and relocalization of p27 to the nucleus. These data show that AMPK signaling determines the subcellular localization of p27, and identifies loss of integration of pathways controlling energy balance, the cell cycle, and apoptosis due to aberrant AMPK and p27 function as a feature of cells that have lost the Tsc2 tumor suppressor gene. [Cancer Res 2008;68(16):6496–506]

Contemporary multicenter data regarding midterm outcomes for neonates with pulmonary atresia with intact ventricular septum are lacking. We sought to describe outcomes in a contemporary multicenter cohort, determine factors associated with end-states, and evaluate the effect of right ventricular coronary dependency and coronary atresia on transplant-free survival. Neonates treated during 2009-2019 in 19 United States centers were reviewed. Competing risks analysis was performed to determine cumulative risk of each end-state, and multivariable regression analyses were performed to identify factors associated with each end-state and transplant-free survival. We reviewed 295 patients. Median tricuspid valve Z-score was - 3.06 (25%, 75%: - 4.00, - 1.52). Final end-state was biventricular repair for 45 patients (15.2%), one-and-a half ventricle for 16 (5.4%), Fontan for 75 (25.4%), cardiac transplantation for 29 (9.8%), and death for 54 (18.3%). Seventy-six patients (25.7%) remained in mixed circulation. Cumulative risk estimate of death was 10.9%, 16.1%, 16.9%, and 18.8% at 1, 6 months, 1 year, and 5 years, respectively. Tricuspid valve Z-score was inversely, and coronary atresia positively associated with death or transplantation [odds ratio (OR) = 0.46, (95% confidence interval (CI) = 0.29-0.75, p 0.001) and OR = 3.75 (95% CI 1.46-9.61, p = 0.011), respectively]. Right ventricular coronary dependency and left coronary atresia had a significant effect on transplant-free survival (log-rank p 0.001). In a contemporary multicenter cohort of patients with PAIVS, consisting predominantly of patients with moderate-to-severe right ventricular hypoplasia, we observed favorable survival outcomes. Right ventricular coronary dependency and left, but not right, coronary atresia significantly worsens transplant-free survival.

Background LCMC3 (NCT02927301), an open-label, single-arm Phase 2 study to investigate neoadjuvant (neoadj) and adj atezo (anti-PD-L1) in patients (pts) with early-stage non-small cell lung cancer (NSCLC), met its primary endpoint with a 20% major pathological response (MPR) rate after neoadj atezo. Here we report efficacy and safety from the adj phase. Methods Eligible pts aged ≥18 y had resectable stage IB-IIIA or select IIIB NSCLC and ECOG PS of 0 or 1. Pts received neoadj atezo 1200 mg IV for ≤2 cycles (Days 1 and 22) followed by surgery (Day 40±10). Pts deemed to have clinical benefit were offered the option to receive adj atezo every 3 weeks for up to 12 months. The primary endpoint was MPR rate (≤10% viable tumor cells at surgery) in pts without EGFR/ALK mutations. Exploratory endpoints included DFS and OS. Safety was assessed during the adj phase. Results Data cutoff was Oct 21, 2022. The primary efficacy population (PEP) was 137 pts without EGFR/ALK alterations who had surgery and MPR assessment. In the PEP, 53 pts (39%) received adj atezo and 84 (61%) did not. The 3-y DFS rate was 83% with adj atezo vs 64% without (HR, 0.43; 95% CI: 0.21, 0.90; P=0.025). 3-y OS and results by MPR status are provided in the table. In the adj atezo safety population (n=57), treatment-related (TR) AEs after adj atezo occurred in 55 pts (97%; Gr 3/4, 40%), including 11 TRAEs (19%; Gr 3/4, 16%) leading to discontinuation of adj atezo. No Gr 5 TRAEs were seen in the adj phase. Multivariate analysis also showed a trend toward better DFS for pts receiving adj atezo vs those with no adj atezo (HR, 0.52; 95% CI: 0.22, 1.21; P=0.126). Conclusions This exploratory analysis revealed that LCMC3 pts with resectable stage IB-IIIA or select IIIB NSCLC who received adj atezo had improved DFS and showed a trend toward improved OS vs pts who did not receive adj atezo. Furthermore, the non-MPR subgroup had the same trend toward improved DFS and OS with adj atezo vs pts who did not receive adj atezo. Adj atezo was well tolerated, with no new safety concerns. Table Adj atezoa n=53 No adj atezob n=84 Tx patterns Adj atezo + adj chemo, n (%) 17 (32) 0 Adj atezo, n (%) 36 (68) 0 Adj chemo, n (%) 0 36 (43) None, n (%) 0 48 (57) Tx cycles Adj atezo, n, median (range) 53, 16 (1-18) 0 Adj chemo, n, median (range) 16, 3 (0-4.2) 35, 3 (0-4.1) HR (95% CI) P PEP (N=137) 3-y DFS, % 83 64 0.43 (0.21, 0.90) 0.025 3-y OS, % 89 77 0.48 (0.19, 1.21) 0.118 MPR (n=29) n=22 n=7 3-y DFS, % 86 86 0.93 (0.10, 8.92) 0.948 Non-MPR (n=108) n=31 n=77 3-y DFS, % 80 62 0.48 (0.20, 1.12) 0.088 3-y OS, % 87 75 0.49 (0.17, 1.46) 0.202 Multivariable Cox regression (n=114)c MPR vs non-MPR 0.37 (0.11, 1.31) 0.125 Adj atezo vs no adj atezo 0.52 (0.22, 1.21) 0.126 Adj chemo vs no adj chemo 0.57 (0.27, 1.19) 0.133 Stage I/II vs III 0.71 (0.35, 1.43) 0.338 PD-L1 tumor proportion score ≥1% vs Citation Format: David Paul Carbone, Saiama N. Waqar, Jamie E. Chaft, Mark G. Kris, Bruce E. Johnson, Jay M. Lee, Ignacio I. Wistuba, David Kwiatkowski, Paul Bunn, Katja Schulze, Ann Johnson, Evelise Brandao, Mark Awad, Karen L. Reckamp, Anne C. Chiang, Alan Nicholas, Valerie Rusch. Efficacy and safety of adjuvant (adj) atezolizumab (atezo) from the Phase 2 LCMC3 study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr CT215.

The PI3K-mTOR pathway is one of the most commonly dysregulated pathways in human tumors. Rapalogs have been used extensively in human clinical trials but exhibit modest clinical benefit for the most part, possibly due to their lack of effect on 4E-BP1, a key target downstream of mTORC1. ATP-competitive mTOR inhibitors can fully inhibit mTORC1 but are poorly tolerated possibly due to their inhibition of mTORC2. A new class of selective mTORC1 inhibitors has been developed and termed ‘bi-steric’, which comprise a rapamycin-like core moiety covalently linked to an mTOR active-site inhibitor. We report that bi-steric mTORC1-selective inhibitors (RMC-4627 and RMC-6272) have greater activity than rapalogs for tumors with mTORC1 hyperactivation. RMC-4627 and RMC-6272 showed more effective growth inhibition in multiple tumor cell lines with mTORC1 dysfunction compared to rapamycin. Both RMC-4627 and RMC-6272 at ~1 nM showed near complete inhibition of p4E-BP1T37/46, which was not seen with rapamycin treatment. Rapamycin and both bi-steric compounds markedly reduced kidney tumor burden and human bladder cancer PDX tumor size after four weeks of treatment. Tumor regrowth assessed after two-month treatment cessation was significantly reduced in the RMC-6272 group as compared to the rapamycin group. Finally, TUNEL staining showed RMC-6272 treatment led to a greater induction of apoptosis in kidney tumor cells and human bladder cancer PDX tumors relative to rapamycin after a single dose of each compound. This is the first time that clear evidence for cell death after mTORC1 inhibition has been seen. Integrative multi-omic analysis reveals differential global rewiring induced by RMC-6272 in comparison to rapamycin. Genes involved in cell cycle transition were downregulated by RMC-6272 vs. rapamycin. Proteins downregulated by RMC-6272 treatment relative to rapamycin were enriched for translation and ribosome-related proteins, consistent with effects of non-phosphorylated 4E-BP1 on synthesis of those proteins. Multiple purine metabolites were decreased to a greater extent in RMC-6272 treated cells as compared to rapamycin treatment, including deoxyadenosine, AICAR, AMP, IMP, and GMP. Notably, there was no significant change in R5P, suggesting that downregulation of the purine de novo synthesis pathway was the cause of these changes. Strong tumor cell apoptosis was induced by the suppression of de novo purine synthesis through mTORC1-PRPS1 axis. PRPS1, the rate-limit enzyme involving in purine synthesis was regulated by mTORC1 activity. In summary, RMC-4627 and RMC-6272 demonstrate improved in vitro and in vivo inhibition of mTORC1 in comparison to rapamycin, and induced more cell death in preclinical models, indicating the potential of bi-steric mTORC1-selective inhibitors as a novel therapeutic strategy to treat tumors with mTORC1 dysregulation. Citation Format: Heng Du, Yu Chi Yang, Heng-Jia Liu, Min Yuan, John Asara, Kwok-Kin Wong, Mallika Singh, David Kwiatkowski. Bi-steric mTORC1 inhibitors are superior to rapamycin and induce apoptotic cell death in tumor models with hyperactivated mTORC1. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4859.

Lymphangioleiomyomatosis (LAM) is a rare lung disease of women, causing cystic remodelling of the lung and progressive respiratory failure. The cellular composition, microenvironment and cellular interactions within the LAM lesion remain unclear. To facilitate data sharing and collaborative LAM research, we performed an integrative analysis of single-cell data compiled from lung, uterus and kidney of patients with LAM from three research centres and developed an LAM Cell Atlas (LCA) Web-Portal. The LCA offers a variety of interactive options for investigators to search, visualise and reanalyse comprehensive single-cell multiomics data sets to reveal dysregulated genetic programmes at transcriptomic, epigenomic and cell–cell connectome levels.

The PI3K-mTOR pathway is one of the most commonly dysregulated pathways in human tumors. Rapalogs have been used extensively in human clinical trials but exhibit modest clinical benefit for the most part, possibly due to their lack of effect on 4E-BP1, a key target downstream of mTORC1. ATP-competitive mTOR inhibitors can fully inhibit mTORC1 but are poorly tolerated possibly due to their inhibition of mTORC2. A new class of selective mTORC1 inhibitors has been developed and termed ‘bi-steric', which comprise a rapamycin-like core moiety covalently linked to an mTOR active-site inhibitor. RMC-5552 is the first clinical candidate of this class and clinical testing is planned in 2021. RM-001 and RM-006 (also known as RMC-6272) are representative bi-steric tool compounds that exhibit potent and selective (> 10-fold) inhibition of mTORC1 over mTORC2. We report that bi-steric mTORC1-selective inhibitors have greater activity than rapalogs for tumors with mTORC1 hyperactivation secondary to TSC1/2 loss. RM-001 and RM-006 showed more effective growth inhibition in multiple TSC1 or TSC2 mutant tumor cell lines compared to rapamycin. RM-001 and RM-006 caused a more profound growth inhibition in the TSC1 or TSC2 mutant cells than the wild type cells. Two-week low dilution clonogenic assays in TSC1 or TSC2 mutant cells showed clone numbers were significantly reduced by rapamycin, RM-001, and RM-006, whereas in the wild type cells, Rapamycin and RM compounds had less reduction in clone numbers, indicating a differential sensitivity in TSC-null cells. Both RM-001 and RM-006 at ~1 nM showed near complete inhibition of p4E-BP1T37/46, which was not seen with rapamycin treatment, while inhibition of pS6S240/244 levels was similar for rapamycin and RM compounds. Further, the RM compounds had prolonged anti-proliferative activity in TSC-null cells, as shown by washout studies. Rapamycin, MLN0128 and both RM compounds markedly reduced kidney tumor burden in Tsc2+/- A/J mice after four weeks of treatment. Tumor regrowth was assessed two months after treatment cessation, tumor burden was significantly reduced in the RM-006 group as compared to the rapamycin and MLN0128 groups. Finally, TUNEL staining showed RM-006 treatment led to a greater induction of apoptosis in kidney tumor cells relative to rapamycin and MLN0128 after a single dose of each compound in Tsc2+/- A/J mice. This is the first time that clear evidence for cell death after mTORC1 inhibition has been seen in TSC rodent models. In summary, RM-001 and RM-006 demonstrate improved in vitro and in vivo inhibition of mTORC1 in comparison to rapamycin, and induced more cell death in TSC2 null tumors in vivo, indicating the potential of bi-steric mTORC1-selective inhibitors as a novel therapeutic strategy to treat tumors with mTORC1 dysregulation. Citation Format: Heng Du, Yu Chi Yang, Mallika Singh, Heng-jia Liu, David Kwiatkowski. Bi-steric mTORC1-selective inhibitors demonstrate improved potency and efficacy in tumors with mTORC1 hyperactivation [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1026.

Orogastric and nasogastric tubes are routinely inserted in anesthetized patients to both reduce the volume of stomach contents and decrease the incidence of postoperative nausea. We present a case of esophageal perforation and subsequent pneumothorax after insertion of an orogastric tube in a patient undergoing routine shoulder arthroscopy.

The purpose of this study is to review sedated outpatient echocardiograms performed to evaluate asymptomatic murmurs in children between the ages of 1 month and 4 years and describe outcomes of tests done to determine if utility varies among age of study and referral type (primary care physician vs. pediatric cardiologist.) We aim to describe the yield in a contemporary cohort which has increased availability and quality of diagnostic aids such as fetal ultrasound, newborn pulse oximetry, and neonatal echocardiography. Retrospective cohort study. Cincinnati Children's Hospital Medical Center: Outpatient Echocardiography Laboratory. Children between 1 month and 4 years of age with asymptomatic murmurs who are referred for outpatient echocardiogram for evaluation of murmur. Primary diagnosis of echocardiography studies, classified into severity score. Results. Four hundred sixty-two sedated echocardiograms were studied. Six (1%) echocardiograms showed severe pathology, and no severe pathology was shown in the echocardiograms ordered at the age of over 6 months old. The yield of studies decreased as age increased. The incidence of abnormal pathology was higher among tests ordered by cardiologists, across all severity levels (P.0001). Among echocardiograms ordered for children over 1 year of age with an asymptomatic murmur, there was no severe and little moderate disease. Cardiac disease is significantly less likely when echocardiograms are ordered without referral to a pediatric cardiologist. The workup for asymptomatic murmurs does not require an echocardiogram, and these results may aid clinicians when deciding whether evaluation of a child should include this study.

*Simply quote LIFE when ordering to receive your discount. This book provides a comprehensive overview of the molecular basis and clinical features of the genetic disorder tuberous sclerosis. Special focus is placed on novel insights into the signal transduction pathways affected by the disease and genotype phenotype correlations. Existing and potential therapies are also discussed in depth. Edited and authored by researchers and clinicians with outstanding international reputation as well as prominent figures in the largest patient advocacy group, this text is indispensable for doctors, researchers and patients Key Features: A unique comprehensive title on the genetic disorder Tuberous Sclerosis. Gives up to date information about the molecular basis, diagnosis and therapies. Editors are leading experts in research and treatment of the disease.

To determine whether agents that target topoisomerase I and II could be administered sequentially.A Phase I study was conducted to evaluate sequential treatment with bolus IV doxorubicin followed 48 h later by topotecan given as a 30-min i.v. infusion on 3 consecutive days, with additional cycles of therapy repeated every 3 weeks. Characteristics of the 22 patients entered into the study were: 13 male and 9 female; median age, 49.5 (range 33-66) years; Eastern Cooperative Oncology Group performance status, 0-1; and normal cardiac, hematological, hepatic, and renal function. All patients had received prior therapy (medianor=2 prior regimens).The maximum tolerated dose of the combination was 25 mg/m(2) doxorubicin and 5.25 mg/m(2) topotecan (1.75 mg/m(2)/day x 3). Neutropenia was the dose-limiting toxicity. Attempts to further escalate the dose using 5 microg/kg granulocyte colony-stimulating factor proved unsuccessful because of thrombocytopenia. Among the 17 patients who were evaluable for response, 6 had a partial response, and 4 showed evidence of disease stabilization. The partial responses occurred in patients with small cell lung cancer (3 of 7), non-small cell lung cancer (1 of 6), esophageal adenocarcinoma (1 of 2), and ovarian carcinoma (1 of 1), and it lasted for 3-6 months. Administration of doxorubicin 2 days before topotecan did not alter topotecan pharmacokinetics. Changes in topoisomerase mRNA levels were observed during chemotherapy.The sequential combination of doxorubicin followed by topotecan is highly active in several chemotherapy refractory long, ovary, and esophageal cancers. Despite significant neutropenia, toxicity is manageable and well tolerated. Phase II trials to further evaluate the efficacy of this promising combination regimen against non-Hodgkin's lymphoma and lung cancer have been initiated.

Tuberous sclerosis (TSC) is a heterogeneous multisystem disorder with loci on 9q34 (TSC1) and 16p13.3 (TSC2). The TSC2 gene has recently been isolated, while the TSC1 gene has been mapped to a 5-cM region between the markers D9S149 and D9S114. In our effort to localise and clone TSC1, we have obtained three adjacent cosmid contigs that cover the core of the candidate region. The three contigs comprise approximately 600 kb and include 80 cosmids, 2 P1 clones, 1 YAC, 5 anonymous markers and 4 sequence-tagged sites. The ABO blood group locus, the Surfeit gene cluster, the dopamine beta-hydroxylase gene (DBH) and VAV2, a homologue of the vav oncogene, have all been mapped within the contigs. Exon trapping and mutation screening experiments, aimed at identifying the TSC1 gene, are currently in progress.