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Drug Dosage Dose form Cost* Perfluorohexyloctane ophthalmic solution (Miebo) One drop in the affected eye 4 times per day Ophthalmic solution, 3-mL bottle $850 *—Estimated retail price of 1 month of treatment. No drug-drug interactions have been identified to date.1 TOLERABILITY Perfluorohexyloctane ophthalmic solution is well tolerated, and its safety profile is consistent with long-term use up to 1 year.4 As with saline, about 1% to 3% of patients using the solution will experience blurred vision and conjunctival redness.1 Discontinuation rates were comparable with those of saline.4 EFFECTIVENESS Perfluorohexyloctane ophthalmic solution has been evaluated in two studies of more than 1,200 patients with dry eye. Participants who switched from saline to perfluorohexyloctane ophthalmic solution in the extension study had improved visual analog scale scores as early as week 4, which were sustained for the remainder of the study.4 Perfluorohexyloctane ophthalmic solution has not yet been studied in head-to-head trials with other treatments.

Premature failures in metals can arise from the local reduction of the fracture toughness when brittle phases precipitate. Precipitation can be enhanced at the grain and phase boundaries and be promoted by stress concentration causing a shift of the terminal solid solubility. This paper provides the description of a model to predict stress-induced precipitation along phase interfaces in one-phase and two-phase metals. A phase-field approach is employed to describe the microstructural evolution. The combination between the system expansion caused by phase transformation, the stress field and the energy of the phase boundary is included in the model as the driving force for precipitate growth. In this study, the stress induced by an opening interface crack is modelled through the use of linear elastic fracture mechanics and the phase boundary energy by a single parameter in the Landau potential. The results of the simulations for a hydrogenated ( α + β ) titanium alloy display the formation of a precipitate, which overall decelerates in time. Outside the phase boundary, the precipitate mainly grows by following the isostress contours. In the phase boundary, the hydride grows faster and is elongated. Between the phase boundary and its surrounding, the matrix/hydride interface is smoothened. The present approach allows capturing crack-induced precipitation at phase interfaces with numerical efficiency by solving one equation only. The present model can be applied to other multi-phase metals and precipitates through the use of their physical properties and can also contribute to the efficiency of multi-scale crack propagation schemes.

Intimal sarcomas are aggressive mesenchymal tumors arising from the tunica intima of large vessels, mainly the pulmonary artery. They are usually associated with amplification. Due to their rarity and scarce sensitivity to chemotherapy, they are characterized by late diagnosis and high mortality. Thus, there is an urgent need to unravel novel therapeutic biomarkers. This study explored the role of the immune infiltrate and molecular profile in an intimal sarcoma cohort to evaluate their amenability to immunotherapy and detect potential targets, apart from . Whole transcriptome and whole exome sequencing were performed on 5 intimal sarcoma cases (FFPE) followed by computational analyses, including immune cell profiling, differential gene expression, variant calling and copy number alteration detection. All samples presented the amplification of , confirming their diagnosis, and the co-amplification of and . Interestingly, they also showed PD-L1 expression along with a prevalence of CD4+ memory resting T-cells, M2 macrophages and different concentrations of naïve B-cells, CD8+ T-cells and monocytes. The upregulation of immunoglobulins and pathways involved in the immune response (e.g. IL6/JAK/STAT3 and TNF-α via NF-kB signaling, interferon gamma response) further suggested a potential sensitivity to immunotherapy. Our findings provided basic evidence for immunotherapy efficacy in intimal sarcomas and identified potential molecular targets. Further studies involving larger case series are required to validate these results.

Background: Novel prognostic biomarkers and therapeutic strategies are urgently required for malignant melanoma. Ecto-5-prime-nucleotidase ( NT5E ; CD73) overexpression has been reported in several human cancers. The mechanism(s) underlying deregulated expression and the clinical consequences of changes in expression are not known. Methods: We used RT–PCR, qPCR, methylation-specific PCR and pyrosequencing to analyse expression and regulation of NT5E in malignant melanoma cell lines and primary and metastatic melanomas. Results: NT5E is subject to epigenetic regulation in melanoma. NT5E mRNA is downregulated by methylation-dependent transcriptional silencing in the melanoma cell lines SKMel2, SKMel23, WM35, Mel501, Mel505 and C81–61 and expression is reactivated by azacytidine. In contrast, the CpG island is unmethylated and the gene expressed in cultured normal melanocytes. In clinical cases of melanoma, methylation in the NT5E CpG island occurs in both primary and metastatic melanomas and correlates with transcriptional downregulation of NT5E mRNA. Relapse with metastatic disease, particularly to the visceral sites and brain, is more common in primary melanomas lacking NT5E methylation. Primary melanomas with methylation in NT5E show limited metastatic potential or more commonly metastasise predominantly to nodal sites rather than viscera and brain ( P =0.01). Conclusion: Deregulation of NT5E expression in melanoma occurs via epigenetic changes in the NT5E CpG island. Confirmation of our results in larger clinical series would support the candidacy of NT5E as a clinical biomarker in melanoma, which could be applied in both primary and relapsed disease. Inhibition of NT5E may have therapeutic potential in melanoma, particularly in patients with more aggressive disease metastatic to viscera or the brain.

Arginine deprivation, either by nutritional starvation or exposure to ADI-PEG20, induces adaptive transcriptional upregulation of ASS1 and ASL in glioblastoma multiforme ex vivo cultures and cell lines. This adaptive transcriptional upregulation is blocked by neoplasia-specific CpG island methylation in either gene, causing arginine auxotrophy and cell death. In cells with methylated ASS1 or ASL CpG islands, ADI-PEG20 initially induces a protective autophagic response, but abrogation of this by chloroquine accelerates and potentiates cytotoxicity. Concomitant methylation in the CpG islands of both ASS1 and ASL , observed in a subset of cases, confers hypersensitivity to ADI-PEG20. Cancer stem cells positive for CD133 and methylation in the ASL CpG island retain sensitivity to ADI-PEG20. Our results show for the first time that epigenetic changes occur in both of the two key genes of arginine biosynthesis in human cancer and confer sensitivity to therapeutic arginine deprivation. We demonstrate that methylation status of the CpG islands, rather than expression levels per se of the genes, predicts sensitivity to arginine deprivation. Our results suggest a novel therapeutic strategy for this invariably fatal central nervous system neoplasm for which we have identified robust biomarkers and which overcomes the limitations to conventional chemotherapy imposed by the blood/brain barrier.

Background/Objectives: The genomic bases of the adipose tissue abnormalities induced by chronic positive calorie excess have been only partially elucidated. We adopted a genome-wide approach to directly test whether long-term high-fat diet (HFD) exposure affects the DNA methylation profile of the mouse adipose tissue and to identify the functional consequences of these changes. Subjects/Methods: We have used epididymal fat of mice fed either high-fat (HFD) or regular chow (STD) diet for 5 months and performed genome-wide DNA methylation analyses by methylated DNA immunoprecipitation sequencing (MeDIP-seq). Mouse Homeobox ( Hox ) Gene DNA Methylation PCR, RT-qPCR and bisulphite sequencing analyses were then performed. Results: Mice fed the HFD progressively expanded their adipose mass accompanied by a significant decrease in glucose tolerance ( P <0.001) and insulin sensitivity ( P <0.05). MeDIP-seq data analysis revealed a uniform distribution of differentially methylated regions (DMR) through the entire adipocyte genome, with a higher number of hypermethylated regions in HFD mice ( P <0.005). This different methylation profile was accompanied by increased expression of the Dnmt3a DNA methyltransferase (Dnmt; P <0.05) and the methyl-CpG-binding domain protein Mbd3 ( P <0.05) genes in HFD mice. Gene ontology analysis revealed that, in the HFD-treated mice, the Hox family of development genes was highly enriched in differentially methylated genes ( P =0.008). To validate this finding, Hoxa5 , which is implicated in fat tissue differentiation and remodeling, has been selected and analyzed by bisulphite sequencing, confirming hypermethylation in the adipose tissue from the HFD mice. Hoxa5 hypermethylation was associated with downregulation of Hoxa5 mRNA and protein expression. Feeding animals previously exposed to the HFD with a standard chow diet for two further months improved the metabolic phenotype of the animals, accompanied by return of Hoxa5 methylation and expression levels ( P <0.05) to values similar to those of the control mice maintained under standard chow. Conclusions: HFD induces adipose tissue abnormalities accompanied by epigenetic changes at the Hoxa5 adipose tissue remodeling gene.

Purpose Obesity is one of the main predisposing factors for obstructive sleep apnea (OSA) hypopnea syndrome. It has been described that body mass index (BMI) influences the accuracy of oxygen desaturation index (ODI) for the diagnosis of OSA by polysomnography (PSG). We analyzed the relationship between traditional indicators: apnea-hypopnea index (AHI) and ODI in a population at high risk for OSA, by respiratory polygraphy (RP) and PSG. Methods This is a retrospective study of 1898 patients with suspicion of OSA, from which 1053 underwent RP and 582 underwent PSG with OSA. We compared results considering gender, age, and degree of obesity. Results This study included 1333 records of patients with OSA—more than 80 % of whom were overweight or obese. We observed that AHI and ODI increased progressively with obesity grade and said increase was associated with BMI only in men. The evaluation of the agreement between AHI and ODI found a difference between normal weight and obese patients, regardless of gender. Conclusions Study findings contribute to understand the role of oximetry in the diagnosis of OSA in obese patients. Our results were observed using full PSG and a simplified home method. The correlation between these indicators could improve our clinical interpretation of OSA severity among obese patients when abbreviated tests are used.

The formation of a second phase in presence of a crack in a crystalline material is modelled and studied for different prevailing conditions in order to predict and a posteriori prevent failure, e.g. by delayed hydride cracking. To this end, the phase field formulation of Ginzburg–Landau is selected to describe the phase transformation, and simulations using the finite volume method are performed for a wide range of material properties. A sixth order Landau potential for a single structural order parameter is adopted because it allows the modeling of both first and second order transitions and its corresponding phase diagram can be outlined analytically. The elastic stress field induced by the crack is found to cause a space-dependent shift in the transition temperature, which promotes a second-phase precipitation in vicinity of the crack tip. The spatio-temporal evolution during nucleation and growth is successfully monitored for different combinations of material properties and applied loads. Results for the second-phase shape and size evolution are presented and discussed for a number of selected characteristic cases. The numerical results at steady state are compared to mean-field equilibrium solutions and a good agreement is achieved. For materials applicable to the model, the results can be used to predict the evolution of an eventual second-phase formation through a dimensionless phase transformation in the crack-tip vicinity for given conditions.

Background: Calcium is an important intracellular messenger that mediates many biological processes that are relevant to the malignant process. Calcium ion channels are key in controlling the intracellular calcium, and little is known about their role in human cancer. Methods: We used qPCR and pyrosequencing to investigate expression and epigenetic regulation of the calcium channel regulatory subunit α 2 δ -3 (CACNA2D3) in breast cancer cell lines, primary cancers and metastatic lesions. Results: Expression of CACNA2D3 mRNA is regulated in breast cancer cell lines by methylation in the CpG island located in the 5′ regulatory region of the gene. Expression is upregulated by azacytidine (AZA) in cells with CpG island methylation but unaffected in cells lacking methylation. In primary breast carcinomas, methylation is more common in cancers, which subsequently relapse with loco-regional and, particularly, visceral metastatic disease in both oestrogen receptor- α (ER)-positive and -negative cases. Furthermore, CACNA2D3 CpG island is frequently methylated in breast cancer that has metastasised to the central nervous system. Conclusion: Methylation-dependent transcriptional silencing of CACNA2D3 may contribute to the metastatic phenotype of breast cancer. Analysis of methylation in the CACNA2D3 CpG island may have potential as a biomarker for risk of development of metastatic disease.

Background: The transforming growth factor-beta (TGF- β ) pathway has been implicated in proliferation, migration and invasion of various cancers. Endoglin is a TGF- β accessory receptor that modulates signalling. We identified Endoglin as an epigenetically silenced tumour-suppressor gene in lung cancer by means of a genome-wide screening approach, then sought to characterise its effect on lung cancer progression. Methods: Methylation microarray and RNA sequencing were carried out on lung cancer cell lines. Epigenetic silencing of Endoglin was confirmed by methylation and expression analyses. An expression vector and a 20-gene expression panel were used to evaluate Endoglin function. Pyrosequencing was carried out on two independent cohorts comprising 112 and 202 NSCLC cases, respectively, and the impact of Endoglin methylation on overall survival (OS) was evaluated. Results: Methylation in the promoter region resulted in silencing of Endoglin, which could be reactivated by demethylation. Increased invasion coupled with altered EMT marker expression was observed in cell lines with an epithelial-like, but not those with a mesenchymal-like, profile when Endoglin was absent. Methylation was associated with decreased OS in stage I but not in stages II–III disease. Conclusions: We show that Endoglin is a common target of epigenetic silencing in lung cancer. We reveal a link between Endoglin silencing and EMT progression that might be associated with decreased survival in stage I disease.