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Background It remains unclear whether intensification of the chemotherapy backbone in tandem with an anti-EGFR can confer superior clinical outcomes in a cohort of RAS/BRAF wild-type colorectal cancer (CRC) patients with initially unresectable colorectal liver metastases (CRLM). To that end, we sought to comparatively evaluate the efficacy and safety of cetuximab plus FOLFOXIRI (triplet arm) versus cetuximab plus FOLFOX (doublet arm) as a conversion regimen (i.e., unresectable to resectable) in CRC patients with unresectable CRLM. Methods and findings This open-label, randomized clinical trial was conducted from April 2018 to December 2022 in 7 medical centers across China, enrolling 146 RAS/BRAF wild-type CRC patients with initially unresectable CRLM. A stratified blocked randomization method was utilized to assign patients (1:1) to either the cetuximab plus FOLFOXIRI (n = 72) or cetuximab plus FOLFOX (n = 74) treatment arms. Stratification factors were tumor location (left versus right) and resectability (technically unresectable versus [greater than or equal to]5 metastases). The primary outcome was the objective response rate (ORR). Secondary outcomes included the median depth of tumor response (DpR), early tumor shrinkage (ETS), R0 resection rate, progression-free survival (PFS), overall survival (not mature at the time of analysis), and safety profile. Radiological tumor evaluations were conducted by radiologists blinded to the group allocation. Primary efficacy analyses were conducted based on the intention-to-treat population, while safety analyses were performed on patients who received at least 1 line of chemotherapy. A total of 14 patients (9.6%) were lost to follow-up (9 in the doublet arm and 5 in the triplet arm). The ORR was comparable following adjustment for stratification factors, with 84.7% versus 79.7% in the triplet and doublet arms, respectively (odds ratio [OR] 0.70; 95% confidence intervals [CI] [0.30, 1.67], Chi-square p = 0.42). Moreover, the ETS rate showed no significant difference between the triplet and doublet arms (80.6% (58/72) versus 77.0% (57/74), OR 0.82, 95% CI [0.37, 1.83], Chi-square p = 0.63). Although median DpR was higher in the triplet therapy group (59.6%, interquartile range [IQR], [50.0, 69.7] versus 55.0%, IQR [42.8, 63.8], Mann-Whitney p = 0.039), the R0/R1 resection rate with or without radiofrequency ablation/stereotactic body radiation therapy was comparable with 54.2% (39/72) of patients in the triplet arm versus 52.7% (39/74) in the doublet arm. At a median follow-up of 26.2 months (IQR [12.8, 40.5]), the median PFS was 11.8 months in the triplet arm versus 13.4 months in the doublet arm (hazard ratio [HR] 0.74, 95% CI [0.50, 1.11], Log-rank p = 0.14). Grade [greater than or equal to] 3 events were reported in 47.2% (35/74) of patients in the doublet arm and 55.9% (38/68) of patients in the triplet arm. The triplet arm was associated with a higher incidence of grade [greater than or equal to] 3 neutropenia (44.1% versus 27.0%, p = 0.03) and diarrhea (5.9% versus 0%, p = 0.03). The primary limitations of the study encompass the inherent bias in subjective surgical decisions regarding resection feasibility, as well as the lack of a centralized assessment for ORR and resection. Conclusions The combination of cetuximab with FOLFOXIRI did not significantly improve ORR compared to cetuximab plus FOLFOX. Despite achieving an enhanced DpR, this improvement did not translate into improved R0 resection rates or PFS. Moreover, the triplet arm was associated with an increase in treatment-related toxicity. Trial Registration ClinicalTrials.gov Identifier: NCT03493048., Author(s): De-Shen Wang 1, Chao Ren 1, Shan-Shan Li 2, William Pat Fong 1, Xiao-Jun Wu 3, Jian Xiao 2,4, Bin-Kui Li 5, Yun Zheng 5, Pei-Rong Ding 3, Gong [...]

Objective To investigate the effects of sepsis and HIF-1α agonist or inhibitor on intestinal mucosal barrier(IBM) function. Methods SD rats were randomly divided into four groups with 6 in each as follows:sham operation group (sham), sepsis group treated with cecal ligation and perforation (CLP), (sepsis+HIF-1α agonist)/(sepsis+DMOG) group receiving intra-peritoneal injection of HIF-1α agonist DMOG (40 mg/kg) for 7 consecutive days before CLP, (sepsis+HIF-1α inhibitor)/(sepsis+BAY87-2243) group orally administered with HIF-1α inhibitor BAY87-2243(9 mg/kg) for 3 consecutive days before CLP. Plasma intestinal permeability markers of diamine oxidase (DAO), intestinal type fatty acid binding protein 2 (FABP2), D-lactic acid and fluorescein isothiocyanate-dextran (FD4) were detected by ELISA. Morphological changes of intestinal mucosa were detected by HE staining. HIF-1α and TJs protein expression were detected by Western blot. Results Sepsis caused pathological damage, increased permeability (P＜0.05), up-regulation of HIF-1α and down-regulation of tight junctions (TJs) expression in intestinal mucosa of rats with sepsis(P＜0.05); Addition of DMOG alleviated intestinal mucosal pathological damage and decreased intestinal mucosal per- meability (P＜0.05); While rats treated with BAY87-2243 showed the opposite result. Conclusions HIF-1α agonist can significantly reduce intestinal mucosal permeability in sepsis, and this effect is significantly counteracted by its inhibitor. It is suggested that HIF-1α upregulation may protect intestinal mucosa aganist sepsis.

In this study, we report a case of de novo minimal change disease shortly after the second dose of the Moderna COVID-19 vaccine. A previously healthy 51-year-old Asian man presented with lower-limb edema and foamy urine 3 days after receiving the second dose of the vaccine. Laboratory data revealed the following: serum creatinine, 0.65 mg/dl; serum albumin, 1.3 g/dl; urine protein-to-creatinine ratio, 15.3 g. A renal biopsy was performed, and minimal change in the disease was confirmed. The patient achieved complete remission in the tenth week after starting treatment with prednisolone (1 mg/kg/day). Ethnic differences may influence the adverse effects of drugs and vaccines. However, there is very limited data to address the influence of ethnic diversity on disease prevalence, clinical presentation, and treatment outcomes in COVID-19 vaccine-associated glomerulonephritis.

Objective To explore the protective effect of oral glycerol on sepsis induced intestinal mucosal barrier function. Methods Mice were randomly divided to four groups: sham operation (n=6); sham operation with oral glycerol (n=6); Mouse sepsis model (n=30)was established using cecal ligation and puncture (CLP), of which 24 mice were executed at 0, 6, 12 and 24 h after CLP respectively (6 mice at each time point) as a time-dependent group,and sepsis with oral glycerol group (n=6). Besides the time-dependent group, four groups of mice were executed at 24 h after modeling. Blood and intestinal mucosal tissue samples were collected. HE staining was used to detect pathological damage of intestinal mucosa. The plasma diamine oxidase (DAO) concentration and intestinal- type fatty acid-binding protein 2(FABP2) concentration were measured by ELISA to assess intestinal mucosal permeability. Immunohistochemistry, real-time fluorescence quantitative polymerase chain reaction (RT-qPCR) and Western blot were used to detect the expression of AQP3 in intestinal mucosa. Results Sepsis induced morphological damage of intestinal mucosa, and the ChiÚs score increased in a time-dependent manner (P＜0.05). The concentrations of DAO and FABP2 in plasma were significantly increased (P＜0.05), and the expression of AQP3 significantly down-regulated with the aggravation of injury (P＜0.05). The administration of oral glycerol partially improved the sepsis-induced injury of the intestinal mucosa, as shown by partial recovery of the morphological structure, with decreased ChiÚs score, decreased plasma concentrations of DAO and FABP2 (sepsis vs sepsis+glycerol, P＜0.05). Conclusions Oral treatment with glycerol may alleviate intestinal mucosal barrier damage in sepsis mice through aquaporin-3. The specific mechanism needs to be further studied.