Explore the vast range of titles available.

Cabozantinib is an oral inhibitor of tyrosine kinases including MET, VEGFR, and AXL. The randomised phase 3 METEOR trial compared the efficacy and safety of cabozantinib versus the mTOR inhibitor everolimus in patients with advanced renal cell carcinoma who progressed after previous VEGFR tyrosine-kinase inhibitor treatment. Here, we report the final overall survival results from this study based on an unplanned second interim analysis. In this open-label, randomised phase 3 trial, we randomly assigned (1:1) patients aged 18 years and older with advanced or metastatic clear-cell renal cell carcinoma, measurable disease, and previous treatment with one or more VEGFR tyrosine-kinase inhibitors to receive 60 mg cabozantinib once a day or 10 mg everolimus once a day. Randomisation was done with an interactive voice and web response system. Stratification factors were Memorial Sloan Kettering Cancer Center risk group and the number of previous treatments with VEGFR tyrosine-kinase inhibitors. The primary endpoint was progression-free survival as assessed by an independent radiology review committee in the first 375 randomly assigned patients and has been previously reported. Secondary endpoints were overall survival and objective response in all randomly assigned patients assessed by intention-to-treat. Safety was assessed per protocol in all patients who received at least one dose of study drug. The study is closed for enrolment but treatment and follow-up of patients is ongoing for long-term safety evaluation. This trial is registered with ClinicalTrials.gov, number NCT01865747. Between Aug 8, 2013, and Nov 24, 2014, 658 patients were randomly assigned to receive cabozantinib (n=330) or everolimus (n=328). The median duration of follow-up for overall survival and safety was 18·7 months (IQR 16·1–21·1) in the cabozantinib group and 18·8 months (16·0–21·2) in the everolimus group. Median overall survival was 21·4 months (95% CI 18·7–not estimable) with cabozantinib and 16·5 months (14·7–18·8) with everolimus (hazard ratio [HR] 0·66 [95% CI 0·53–0·83]; p=0·00026). Cabozantinib treatment also resulted in improved progression-free survival (HR 0·51 [95% CI 0·41–0·62]; p<0·0001) and objective response (17% [13–22] with cabozantinib vs 3% [2–6] with everolimus; p<0·0001) per independent radiology review among all randomised patients. The most common grade 3 or 4 adverse events were hypertension (49 [15%] in the cabozantinib group vs 12 [4%] in the everolimus group), diarrhoea (43 [13%] vs 7 [2%]), fatigue (36 [11%] vs 24 [7%]), palmar-plantar erythrodysaesthesia syndrome (27 [8%] vs 3 [1%]), anaemia (19 [6%] vs 53 [17%]), hyperglycaemia (3 [1%] vs 16 [5%]), and hypomagnesaemia (16 [5%] vs none). Serious adverse events grade 3 or worse occurred in 130 (39%) patients in the cabozantinib group and in 129 (40%) in the everolimus group. One treatment-related death occurred in the cabozantinib group (death; not otherwise specified) and two occurred in the everolimus group (one aspergillus infection and one pneumonia aspiration). Treatment with cabozantinib increased overall survival, delayed disease progression, and improved the objective response compared with everolimus. Based on these results, cabozantinib should be considered as a new standard-of-care treatment option for previously treated patients with advanced renal cell carcinoma. Patients should be monitored for adverse events that might require dose modifications. Exelixis Inc.

Background. Three important studies have supported licensure of live, attenuated, cold-adapted influenza vaccine (CAIV-T [FluMist; MedImmune Vaccines]): (1) a pediatric efficacy trial involving children 15–71 months of age, (2) a large safety study of medically attended events occurring among children 1–17 years of age, and (3) an effectiveness trial involving healthy working adults 18–64 years of age. Methods. During the United States Food and Drug Administration (FDA) review for the approval of CAIV-T for use in healthy persons, additional subgroup analyses were conducted to evaluate the safety, efficacy, and effectiveness of the vaccine, by use of various age subsets not prespecified by the original protocols. CAIV-T is currently approved by the FDA for use in healthy persons 5–49 years of age. In this article, we present data from some of the aforementioned subanalyses. Results. The efficacy of CAIV-T in children ⩾5 years of age (age range of the children in year 1 of the study, 60–71 months; age range of the children in year 2 of the study, 60–83 months) was similar to that reported for the entire cohort in year 1 (90.6%; 95% confidence interval [CI], 70.3%–97.1%). In year 2 of the study, efficacy was 86.9% (95% CI, 70.8%–94.1%), despite the presence of antigenically drifted influenza type A/Sydney/5/97 (H3N2), which caused most illnesses that occurred in year 2. Safety outcomes for children 5–17 years of age revealed no significant difference between vaccine recipients and placebo recipients, with regard to acute respiratory events, acute gastrointestinal events, systemic bacterial infection, or rare events possibly related to influenza. Effectiveness among adults 18–49 years of age was similar to that reported for the entire cohort—for example, for occurrence of severe febrile illness, there was a 19.5% reduction (P = .02) in adults. Conclusions. The present reanalysis summarizes data on the indicated uses for CAIV-T in the indicated population aged 5–49 years.

In a phase 3 clinical trial involving previously treated patients with advanced renal-cell carcinoma, progression-free survival was significantly longer with the VEGF receptor inhibitor cabozantinib than with everolimus (7.4 months vs. 3.8 months). Renal-cell carcinoma is the most common form of kidney cancer, with more than 330,000 cases diagnosed and more than 140,000 deaths attributed to it worldwide every year. 1 Approximately one third of patients present with metastatic disease at diagnosis, 2 and in about one third of treated patients with localized disease, the disease will relapse. 3 – 5 Inactivation of the von Hippel–Lindau (VHL) tumor-suppressor protein characterizes clear-cell tumors, the predominant histologic subtype in patients with renal-cell carcinoma, and results in the up-regulation of vascular endothelial growth factor (VEGF) production. 6 , 7 Antiangiogenic drugs that target VEGF (bevacizumab) and its receptors (sunitinib, sorafenib, pazopanib, and . . .

Semiconductor nanocrystals are intriguing because of their electronic, optical, and chemical characteristics. Silicon nanocrystals (Si-NCs) of sub-5 nm dimension are of particular interest due to their intense photoluminescent response and the promise of linking silicon photonics and electronics. Other related nanomaterials of technological importance include SiC and Ge. The following contribution describes key experimental findings pertaining to synthetic methodology, investigation of nanodomain formation and growth, as determined by X-ray powder diffraction (XRD) and photoluminescence (PL) spectroscopy for a series of sol-gel derived prepolymers suitable for preparing Group 14 based nanocrystal containing composites.

Highest attack rates for influenza occur in children. Immunization of schoolchildren with inactivated influenza vaccine in Michigan and Japan was associated with decreased morbidity and mortality, respectively, in older community contacts. An open-labeled, non-randomized, community-based trial in children with the cold adapted influenza vaccine, trivalent (CAIV-T) was initiated to determine the coverage necessary to reduce spread of influenza in the community. Age-specific baseline rates of medically attended acute respiratory illness (MAARI) for Scott and White Health Plan (SWHP) members at intervention (Temple and Belton) and comparison communities (Waco, Bryan, and College Station) were obtained in 1997–1998. During three subsequent vaccination years, 4298, 5251 and 5150 children received one dose per season of CAIV-T. Vaccinees represented 20–25% of the age-eligible children. Age-specific MAARI rates were compared for SWHP members in the intervention and comparison sites during the influenza outbreaks. Baseline age-specific MAARI rates per 100 persons for the influenza season were comparable between the intervention and comparison communities. In the subsequent three influenza seasons, the age groups 35–44, 45–54, 55–65 and >64 years experienced reductions in MAARI rates in the intervention communities. In adults ≥35 years of age, significant reductions in MAARI of 0.08 (95% CI: 0.04, 0.13), 0.18 (95% CI: 0.14, 0.22) and 0.15 (95% CI: 0.12, 0.19), were observed in the influenza seasons for vaccination years 1, 2 and 3, respectively. No consistent reduction in MAARI rates was detected in the younger age groups. Vaccination of approximately 20–25% of children, 1.5–18 years of age in the intervention communities resulted in an indirect protection of 8–18% against MAARI in adults ≥35 years of age.

An induced-transmission filter (ITF) uses an ultrathin layer of metal positioned at an electric-field node within a dielectric thin-film bandpass filter to select one transmission band while suppressing other transmission bands that would have been present without the metal layer. Here, we introduce a switchable mid-infrared ITF where the metal film can be \"switched on and off\", enabling the modulation of the filter response from single-band to multiband. The switching is enabled by a deeply subwavelength film of vanadium dioxide (VO2), which undergoes a reversible insulator-to-metal phase transition. We designed and experimentally demonstrated an ITF that can switch between two states: one broad passband across the long-wave infrared (LWIR, 8 - 12 um) and one narrow passband at ~8.8 um. Our work generalizes the ITF -- previously a niche type of bandpass filter -- into a new class of tunable devices. Furthermore, our unique fabrication process -- which begins with thin-film VO2 on a suspended membrane -- enables the integration of VO2 into any thin-film assembly that is compatible with physical vapor deposition (PVD) processes, and is thus a new platform for realizing tunable thin-film filters.

The insulator-to-metal transition (IMT) in vanadium dioxide (VO2) can enable a variety of optics applications, including switching and modulation, optical limiting, and tuning of optical resonators. Despite the widespread interest in optics, the optical properties of VO2 across its IMT are scattered throughout the literature, and are not available in some wavelength regions. We characterized the complex refractive index of VO2 thin films across the IMT for free-space wavelengths from 300 nm to 30 {\\mu}m, using broadband spectroscopic ellipsometry, reflection spectroscopy, and the application of effective-medium theory. We studied VO2 thin films of different thickness, on two different substrates (silicon and sapphire), and grown using different synthesis methods (sputtering and sol gel). While there are differences in the optical properties of VO2 synthesized under different conditions, they are relatively minor compared to the change resulting from the IMT, most notably in the ~2 - 11 {\\mu}m range where the insulating phase of VO2 has relatively low optical loss. We found that the macroscopic optical properties of VO2 are much more robust to sample-to-sample variation compared to the electrical properties, making the refractive-index datasets from this article broadly useful for modeling and design of VO2-based optical and optoelectronic components.

A randomized field experiment, the Well Elderly Study was undertaken to evaluate the effectiveness of preventive occupational therapy in independent elderly adults. Drawn from two government subsidized apartment complexes, 361 culturally diverse volunteers over age 60 were randomized into one of three treatment arms: occupational therapy, generalized social activity and no-treatment control. Self-administered questionnaires designed to measure physical and social function, self-rated health, life satisfaction and depressive symptoms were used to assess outcome. Mandarin Chinese was the primary language for 31% of the subjects; translated instruments and Mandarin study staff were used for these subjects. Analysis of covariance revealed that occupational therapy provided significant benefit when compared to the pooled control groups for Quality of Interaction (p = 0.03), Life Satisfaction Z (p = 0.03) and MOS Health Perception (p = 0.05). These preliminary results indicate that occupational therapy may provide significant benefits to this population.

Pyrrolizidine alkaloids (PAs) are widely occurring phytotoxins which can induce severe liver damage in humans and other mammalian species by mechanisms that are not fully understood. Therefore, we investigated the development of PA hepatotoxicity in vivo, using an acutely toxic dose of the PA senecionine in mice, in combination with intravital two-photon microscopy, histology, clinical chemistry, and in vitro experiments with primary mouse hepatocytes and liver sinusoidal endothelial cells (LSECs). We observed pericentral LSEC necrosis together with elevated sinusoidal marker proteins in the serum of senecionine-treated mice and increased sinusoidal platelet aggregation in the damaged tissue regions. In vitro experiments showed no cytotoxicity to freshly isolated LSECs up to 500 µM senecionine. However, metabolic activation of senecionine by preincubation with primary mouse hepatocytes increased the cytotoxicity to cultivated LSECs with an EC50 of approximately 22 µM. The cytochrome P450 (CYP)-dependency of senecionine bioactivation was confirmed in CYP reductase-deficient mice where no PA-induced hepatotoxicity was observed. Therefore, toxic metabolites of senecionine are generated by hepatic CYPs, and may be partially released from hepatocytes leading to destruction of LSECs in the pericentral region of the liver lobules. Analysis of hepatic bile salt transport by intravital two-photon imaging revealed a delayed uptake of a fluorescent bile salt analogue from the hepatic sinusoids into hepatocytes and delayed elimination. This was accompanied by transcriptional deregulation of hepatic bile salt transporters like Abcb11 or Abcc1. In conclusion, senecionine destroys LSECs although the toxic metabolite is formed in a CYP-dependent manner in the adjacent pericentral hepatocytes.