Prognostic utility of body composition parameters based on computed tomography analysis of advanced non-small cell lung cancer treated with immune checkpoint inhibitors

OBJECTIVE

The purpose of this study was to evaluate the prognostic impact of body composition parameters based on computed tomography (CT) in patients with non-small cell lung cancer (NSCLC) who received ICI treatment.

METHODS

This retrospective study analyzed the data from advanced NSCLC patients treated with ICI therapy between 2013 and 2019. We included patients with NSCLC who underwent baseline CT scans. The exclusion criteria included patients who received three or more lines of chemotherapy, those with insufficient clinical information, or those without treatment response evaluation.

RESULTS

A total of 136 patients were enrolled. Among the volumetric body composition parameters, patients in the highest quartiles (Q2-4) of the visceral fat index (VFI) exhibited a higher response rate to ICI therapy than those in the lowest quartile (Q1) of VFI (Q1 vs. Q2-4: 18.2% vs. 43.1%, p = 0.012). Patients with a VFI in Q2-4 had significantly prolonged progression-free survival (PFS) and overall survival (OS) (PFS, Q1 vs. Q2-4: 3.0 months vs. 6.4 months, p = 0.043; OS, Q1 vs. Q2-4: 5.6 months vs. 16.3 months, p = 0.004). Kaplan-Meier analysis based on the VFI and visceral fat Hounsfield unit (HU) revealed that patients with VFI in Q1 and HU in Q2-4 had the worst prognosis.

CONCLUSIONS

Visceral fat volume is significantly associated with treatment outcomes in ICI-treated patients with NSCLC. Moreover, fat quality may impact the treatment outcomes. This finding underscores the potential significance of both fat compartments and fat quality as prognostic indicators.

CRITICAL RELEVANCE STATEMENT

Visceral fat volume is significantly associated with treatment outcomes in ICI-treated patients with non-small cell lung cancer. Moreover, fat quality may impact the treatment outcomes. This finding underscores the potential significance of both fat compartments and fat quality as prognostic indicators.

KEY POINTS

• We found that visceral fat volume positively correlated with treatment response and survival in patients with non-small cell lung cancer receiving immune checkpoint inhibitors. • Additionally, a trend toward a negative correlation between visceral fat attenuation and survival was observed. • The findings highlight the prognostic utility of fat compartments and fat quality.

Small intestinal adenocarcinoma accompanied by lynch syndrome: A case report

RATIONALE

Lynch syndrome is caused by germline mutations of DNA mismatch repair genes. A significant risk increase for several types of cancer is one of the characteristics of lynch syndrome.

PATIENT CONCERNS

A 45-year-old female presented to the emergency department with abdominal pain that had persisted for a month.

DIAGNOSES

The abdominal and pelvic computed tomography scan showed edematous and thickening of the proximal small bowel wall, as well as dilatation of the proximal bowel and stomach.

INTERVENTIONS

Tumor resection of the small bowel was performed, and adenocarcinoma was confirmed pathologically. Microsatellite instability was also confirmed.

OUTCOMES

Postoperative imaging revealed soft tissue lesions with potential for tumor seeding. Two months after the first surgery, a secondary surgery was performed as a result of cancer recurrence. The patient received chemotherapy with capecitabine. The latest computed tomography scan, performed 19 months after the cessation of chemotherapy, did not show any recurrence.

LESSONS

In the rare incidence of small bowel cancer genetic mutation testing and detailed family history should be actively considered.

RCMVis: A Visual Analytics System for Route Choice Modeling

We present RCMVis, a visual analytics system to support interactive Route Choice Modeling analysis. It aims to model which characteristics of routes, such as distance and the number of traffic lights, affect travelers' route choice behaviors and how much they affect the choice during their trips. Through close collaboration with domain experts, we designed a visual analytics framework for Route Choice Modeling. The framework supports three interactive analysis stages: exploration, modeling, and reasoning. In the exploration stage, we help analysts interactively explore trip data from multiple origin-destination (OD) pairs and choose a subset of data they want to focus on. To this end, we provide coordinated multiple OD views with different foci that allow analysts to inspect, rank, and compare OD pairs in terms of their multidimensional attributes. In the modeling stage, we integrate a k-medoids clustering method and a path-size logit model into our system to enable analysts to model route choice behaviors from trips with support for feature selection, hyperparameter tuning, and model comparison. Finally, in the reasoning stage, we help analysts rationalize and refine the model by selectively inspecting the trips that strongly support the modeling result. For evaluation, we conducted a case study and interviews with domain experts. The domain experts discovered unexpected insights from numerous modeling results, allowing them to explore the hyperparameter space more effectively to gain better results. In addition, they gained OD- and road-level insights into which data mainly supported the modeling result, enabling further discussion of the model.

SizePairs: Achieving Stable and Balanced Temporal Treemaps using Hierarchical Size-based Pairing

We present SizePairs, a new technique to create stable and balanced treemap layouts that visualize values changing over time in hierarchical data. To achieve an overall high-quality result across all time steps in terms of stability and aspect ratio, SizePairs employs a new hierarchical size-based pairing algorithm that recursively pairs two nodes that complement their size changes over time and have similar sizes. SizePairs maximizes the visual quality and stability by optimizing the splitting orientation of each internal node and flipping leaf nodes, if necessary. We also present a comprehensive comparison of SizePairs against the state-of-the-art treemaps developed for visualizing time-dependent data. SizePairs outperforms existing techniques in both visual quality and stability, while being faster than the local moves technique.

Green and Sustainable Hot Melt Adhesive (HMA) Based on Polyhydroxyalkanoate (PHA) and Silanized Cellulose Nanofibers (SCNFs)

Polyhydroxyalkanoate (PHA), with a long chain length and high poly(4-hydroxybutyric acid) (P4HB) ratio, can be used as a base polymer for eco-friendly and biodegradable adhesives owing to its high elasticity, elongation at break, flexibility, and processability; however, its molecular structures must be adjusted for adhesive applications. In this study, surface-modified cellulose nanofibers (CNFs) were used as a hydrophobic additive for the PHA-based adhesive. For the surface modification of CNFs, double silanization using tetraethyl orthosilicate (TEOS) and methyltrimethoxysilane (MTMS) was performed, and the thermal and structural properties were evaluated. The hydrophobicity of the TEOS- and MTMS-treated CNFs (TMCNFs) was confirmed by FT-IR and water contact angle analysis, with hydrophobic CNFs well dispersed in the PHA. The PHA-CNFs composite was prepared with TMCNFs, and its morphological analysis verified the good dispersion of TMCNFs in the PHA. The tensile strength of the composite was enhanced when 10% TMCNFs were added; however, the viscosity decreased as the TMCNFs acted as a thixotropic agent. Adding TMCNFs to PHA enhanced the flowability and infiltration ability of the PHA-TMCNFs-based adhesive, and an increase in the loss tangent (Tan δ) and adjustment of viscosity without reducing the adhesive strength was also observed. These changes in properties can improve the flowability and dispersibility of the PHA-TMCNFs adhesive on a rough adhesive surface at low stress. Thus, it is expected that double-silanized CNFs effectively improve their interfacial adhesion in PHA and the adhesive properties of the PHA-CNFs composites, which can be utilized for more suitable adhesive applications.

Pioglitazone-incorporated microspheres alleviates cardiac dysfunction through macrophage polarization in a rat myocardial infarction model

 

Inflammatory processes are essential for the repair processes after myocardial infarction. Among inflammatory cells involved in this process, macrophages play a critical role through polarization in pro-inflammatory M1 or reparative M2 subtype. Pioglitazone, known as a treatment drug for diabetes mellitus, is reported to regulate macrophage polarization toward reparative M2 subtype. Poly L-lactic-co-glycolic acid (PLGA) has been widely accepted as the delivery carrier in drug delivery system (DDS).

Here, we aimed to validate the therapeutic effects and investigate the mechanisms of DDS-based treatment using pioglitazone to left ventricular remodeling after myocardial infarction.

Pioglitazone-incorporated PLGA microspheres (PGZ-MS) were prepared and the drug release profile was evaluated. The concentration of interleukin-10 secreted from murine bone marrow derived macrophages incubated with PGZ-MS was quantified in the culture supernatant. To validate the therapeutic potential of PGZ-MS in vivo, Sprague-Dawley rats were subjected to permanent left coronary artery ligation to induce myocardial infarction. Mock-MS (100 μg) or PGZ-MS (100 μg) was injected to the infarct region just after induction (n=9–11/group). Cardiac function and left ventricular size were assessed by echocardiography. At 28-day after surgery, rats were sacrificed, and excised hearts were evaluated histologically.

PGZ-MS released 1.8±0.3% of incorporated PGZ within 24 hours and 29.5±1.2% within 14 days indicating sustained release of PGZ in vitro. PGZ-MS augmented Interleukin-10 release from bone marrow derived macrophages, indicating polarization toward reparative M2 subtype. PGZ-MS significantly ameliorated cardiac function after myocardial infarction (fractional shortening: MI vs MI+Mock-MS vs MI+PGZ-MS, 24.4±1.1 vs 24.3±1.6 vs 32.2±1.4%; P=0.0035) with reverse remodeling (wall thickness: MI vs MI+Mock-MS vs MI+PGZ-MS, 0.69±0.12 vs 0.71±0.13 vs 1.06±0.09; P=0.03). Immunohistochemical analyses revealed that PGZ-MS enhanced macrophage polarization toward reparative M2 subtype (ratio of reparative M2 macrophages: 0.39±0.03 vs 0.42±0.02 vs 0.54±0.02; P=0.0004) and attenuated apoptosis of cardiomyocytes in the ischemic border zone (MI vs MI+Mock-MS vs MI+PGZ-MS, 2.6±0.2 vs 1.9±0.2 vs 1.2±0.2 cells/field; P=0.002).

In the present study, we confirmed that PGZ-MS could realize sustained release of pioglitazone which resulted in sustained effect of macrophage polarization and attenuated left ventricular remodeling accompanied with the amelioration of cardiac dysfunction and cardiomyocytes apoptosis. The strategy of DDS-based macrophage polarization might serve as a promising strategy in cardiac regenerative therapy for ischemic heart disease in the future.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Grants-in-Aid for Scientific Research from the Ministry of Education, Science, Sports and Culture of Japan

Measuring and Explaining the Inter-Cluster Reliability of Multidimensional Projections

We propose Steadiness and Cohesiveness, two novel metrics to measure the inter-cluster reliability of multidimensional projection (MDP), specifically how well the inter-cluster structures are preserved between the original high-dimensional space and the low-dimensional projection space. Measuring inter-cluster reliability is crucial as it directly affects how well inter-cluster tasks (e.g., identifying cluster relationships in the original space from a projected view) can be conducted; however, despite the importance of inter-cluster tasks, we found that previous metrics, such as Trustworthiness and Continuity, fail to measure inter-cluster reliability. Our metrics consider two aspects of the inter-cluster reliability: Steadiness measures the extent to which clusters in the projected space form clusters in the original space, and Cohesiveness measures the opposite. They extract random clusters with arbitrary shapes and positions in one space and evaluate how much the clusters are stretched or dispersed in the other space. Furthermore, our metrics can quantify pointwise distortions, allowing for the visualization of inter-cluster reliability in a projection, which we call a reliability map. Through quantitative experiments, we verify that our metrics precisely capture the distortions that harm inter-cluster reliability while previous metrics have difficulty capturing the distortions. A case study also demonstrates that our metrics and the reliability map 1) support users in selecting the proper projection techniques or hyperparameters and 2) prevent misinterpretation while performing inter-cluster tasks, thus allow an adequate identification of inter-cluster structure.

Joint t-SNE for Comparable Projections of Multiple High-Dimensional Datasets

We present Joint t-Stochastic Neighbor Embedding (Joint t-SNE), a technique to generate comparable projections of multiple high-dimensional datasets. Although t-SNE has been widely employed to visualize high-dimensional datasets from various domains, it is limited to projecting a single dataset. When a series of high-dimensional datasets, such as datasets changing over time, is projected independently using t-SNE, misaligned layouts are obtained. Even items with identical features across datasets are projected to different locations, making the technique unsuitable for comparison tasks. To tackle this problem, we introduce edge similarity, which captures the similarities between two adjacent time frames based on the Graphlet Frequency Distribution (GFD). We then integrate a novel loss term into the t-SNE loss function, which we call vector constraints, to preserve the vectors between projected points across the projections, allowing these points to serve as visual landmarks for direct comparisons between projections. Using synthetic datasets whose ground-truth structures are known, we show that Joint t-SNE outperforms existing techniques, including Dynamic t-SNE, in terms of local coherence error, Kullback-Leibler divergence, and neighborhood preservation. We also showcase a real-world use case to visualize and compare the activation of different layers of a neural network.

Diffuse alveolar hemorrhage from metastatic cardiac angiosarcoma of the lung successfully treated with paclitaxel chemotherapy: A case report and brief literature review

Diffuse alveolar hemorrhage (DAH) is a life-threatening syndrome caused by various etiologies. DAH has rarely been reported to be associated with metastatic angiosarcoma. However, due to the rarity of complications, it may not be well-recognized by most clinicians. Herein, we report the case of a 70-year-old man with newly diagnosed metastatic cardiac angiosarcoma presenting with DAH. After an immediate bronchoalveolar lavage study and bronchoscopic biopsy, the patient was successfully treated with paclitaxel chemotherapy. Although most patients with this phenomenon have an extremely grave prognosis in previous literature, our experience showed that appropriate evaluation and treatment may be beneficial.

Human zoonotic infectious disease caused by Streptococcus equi subsp. zooepidemicus

Streptococcus equi subsp. zooepidemicus (SEZ) is a highly contagious infectious organism that causes disease in horses. SEZ is seldom isolated from humans; however, zoonotic infections are occasionally reported in individuals exposed to horses and other livestock. Herein, we report three human cases of SEZ in individuals, one with direct horse contact and two among individuals who had eaten raw horse meat. The phylogenetic tree showed that the genotypes of SEZ isolates from two of the cases on Jeju Island, South Korea, were similar to those of isolates from the United Kingdom and the United States of America.

ProReveal: Progressive Visual Analytics With Safeguards

We present a new visual exploration concept-Progressive Visual Analytics with Safeguards-that helps people manage the uncertainty arising from progressive data exploration. Despite its potential benefits, intermediate knowledge from progressive analytics can be incorrect due to various machine and human factors, such as a sampling bias or misinterpretation of uncertainty. To alleviate this problem, we introduce PVA-Guards, safeguards people can leave on uncertain intermediate knowledge that needs to be verified, and derive seven PVA-Guards based on previous visualization task taxonomies. PVA-Guards provide a means of ensuring the correctness of the conclusion and understanding the reason when intermediate knowledge becomes invalid. We also present ProReveal, a proof-of-concept system designed and developed to integrate the seven safeguards into progressive data exploration. Finally, we report a user study with 14 participants, which shows people voluntarily employed PVA-Guards to safeguard their findings and ProReveal's PVA-Guard view provides an overview of uncertain intermediate knowledge. We believe our new concept can also offer better consistency in progressive data exploration, alleviating people's heterogeneous interpretation of uncertainty.

Changes in Mechanical Properties of Polyhydroxyalkanoate with Double Silanized Cellulose Nanocrystals Using Different Organosiloxanes

Polyhydroxyalkanoate (PHA) is a biodegradable plastic with great potential for tackling plastic waste and marine pollution issues, but its commercial applications have been limited due to its poor processability. In this study, surface-modified cellulose nanocrystals were used to improve the mechanical properties of PHA composites produced via a melt-extrusion process. Double silanization was conducted to obtain hydrophobically treated CNC-based fillers, using tetraethyl orthosilicate (TEOS) and methyltrimethoxysilane (MTMS). The morphology, particle size distributions, and surface characteristics of the silanized CNCs and their compatibility with a PHA polymer matrix differed by the organosiloxane treatment and drying method. It was confirmed that the double silanized CNCs had hydrophobic surface characteristics and narrow particle size distributions, and thereby showed excellent dispersibility in a PHA matrix. Adding hydrophobically treated CNCs to form a PHA composite, the elongation at break of the PHA composites was improved up to 301%, with little reduction of Young's modulus, compared to pure PHA. Seemingly, the double silanized CNCs added played a similar role to a nucleation agent in the PHA composite. It is expected that such high ductility can improve the mechanical properties of PHA composites, making them more suitable for commercial applications.

Nobiletin Exhibits Neuroprotective Effects against Mitochondrial Complex I Inhibition via Regulating Apoptotic Signaling

Nobiletin, a polymethoxylated flavonoid found in citrus, has been studied because of its modulatory functions in cellular signaling cascades, and effects to prevent mitochondrial calcium overload and neuronal cell death. Particularly, we previously reported that nobiletin induced changes in the mitochondrial membrane potential through K⁺ channel regulation, suggesting that nobiletin might exert neuroprotective effects via regulating mitochondrial functions associated with the electron transport chain (ETC) system. This study investigated whether nobiletin regulated mitochondrial dysfunction mediated by ETC system downregulation by inhibiting complex I (CI) and complex III (CIII) in pure mitochondria and the cortical neurons of rats. The results showed that nobiletin significantly reduced mitochondrial reactive oxygen species (ROS) production, inhibited apoptotic signaling, enhanced ATP production and then restored neuronal viability under conditions of CI inhibition, but not CIII inhibition. These effects were attributed to the downregulation of translocation of apoptosis-induced factor (AIF), and the upregulation of CI activity and the expression of antioxidant enzymes such as Nrf2 and HO-1. Together with our previous study, these results indicate that the neuroprotective effects of nobiletin under mitochondrial dysfunction may be associated with its function to activate antioxidant signaling cascades. Our findings suggest the possibility that nobiletin has therapeutic potential in treating oxidative neurological and neurodegenerative diseases mediated by mitochondrial dysfunction.

Comparative Layouts Revisited: Design Space, Guidelines, and Future Directions

We present a systematic review on three comparative layouts-juxtaposition, superposition, and explicit-encoding-which are information visualization (InfoVis) layouts designed to support comparison tasks. For the last decade, these layouts have served as fundamental idioms in designing many visualization systems. However, we found that the layouts have been used with inconsistent terms and confusion, and the lessons from previous studies are fragmented. The goal of our research is to distill the results from previous studies into a consistent and reusable framework. We review 127 research papers, including 15 papers with quantitative user studies, which employed comparative layouts. We first alleviate the ambiguous boundaries in the design space of comparative layouts by suggesting lucid terminology (e.g., chart-wise and item-wise juxtaposition). We then identify the diverse aspects of comparative layouts, such as the advantages and concerns of using each layout in the real-world scenarios and researchers' approaches to overcome the concerns. Building our knowledge on top of the initial insights gained from the Gleicher et al.'s survey [19], we elaborate on relevant empirical evidence that we distilled from our survey (e.g., the actual effectiveness of the layouts in different study settings) and identify novel facets that the original work did not cover (e.g., the familiarity of the layouts to people). Finally, we show the consistent and contradictory results on the performance of comparative layouts and offer practical implications for using the layouts by suggesting trade-offs and seven actionable guidelines.

Incorporating hematopoietic stem-cell transplantation after second-line carfilzomib-lenalidomide-dexamethasone (KRd)

Background:

Traditionally believed to be an integral part of multiple myeloma (MM) treatment, the role of hematopoietic stem-cell transplantation (HSCT) is being challenged. As such, we sought to evaluate the impact of HSCT in the era of novel agents.

Methods:

A multicenter, retrospective, longitudinal cohort study was carried out between January 2016 and December 2018. A total of 55 patients who received VTD (bortezomib-thalidomide-dexamethasone) as first-line treatment and KRd (carfilzomib-lenalidomide-dexamethasone) as second-line treatment were analyzed for outcomes.

Results:

The enrolled patients were divided into Group 1, defined as those who continued KRd treatment until progression (n = 41), versus Group 2, defined as those who underwent HSCT after a certain number of cycles of KRd (n = 14). Both groups showed a generally favorable response to KRd, with overall response rate (ORR) of 87.9% and clinical benefit rate of 92.8% after a median of seven cycles in Group 1, and ORR 92.8% and clinical benefit rate 100% after median of five cycles in Group 2. However, significantly poorer progression-free survival (PFS) (p = 0.004) was observed in Group 1 (median 12 months) compared with Group 2 (median not reached). Multivariate analyses identified HSCT after KRd as potential risk factors associated with PFS. Also, in Group 1, bortezomib refractoriness was associated with significantly shorter PFS compared with those who were responsive (median 12 months versus 14 months, respectively, p = 0.039).

Conclusions:

In conclusion, even with the advent of novel agents, HSCT still remains a valuable treatment modality with additive efficacy.

L-Ascorbic Acid Inhibits Breast Cancer Growth by Inducing IRE/JNK/CHOP-Related Endoplasmic Reticulum Stress-Mediated p62/SQSTM1 Accumulation in the Nucleus

Anticancer effects of L-ascorbic acid (Vitamin C, L-AA) have been reported in various types of cancers. L-AA intake reduces breast cancer recurrence and mortality; however, the role of L-AA in the treatment of breast cancer remains poorly understood. In this study, we investigated the effect and mechanism action of L-AA on breast cancer growth. L-AA inhibited the growth of breast cancer cells by inducing apoptotic cell death at the evaluated treatment concentrations without affecting normal cells. Moreover, L-AA induces autophagosome formation via regulation of mammalian target of rapamycin (mTOR), Beclin1, and autophagy-related genes (ATGs) and increased autophagic flux. Notably, we observed that L-AA increased p62/SQSTM1 (sequestosome 1) protein levels. Accumulation of p62 protein in cancer cells in response to stress has been reported, but its role in cancer regulation remains controversial. Here, we demonstrated that L-AA-induced p62 accumulation is related to L-AA-induced breast cancer growth inhibition. Furthermore, L-AA induced endoplasmic reticulum (ER) stress via the IRE–JNK–CHOP (inositol-requiring endonuclease–c-Jun N-terminal kinase–C/EBP homologous protein) signaling pathways, which increased the nuclear levels of p62/SQSTM1. These findings provide evidence that L-AA-induced ER stress could be crucial for p62 accumulation-dependent cell death, and L-AA can be useful in breast cancer treatment.

PANENE: A Progressive Algorithm for Indexing and Querying Approximate k-Nearest Neighbors

We present PANENE, a progressive algorithm for approximate nearest neighbor indexing and querying. Although the use of k-nearest neighbor (KNN) libraries is common in many data analysis methods, most KNN algorithms can only be queried when the whole dataset has been indexed, i.e., they are not online. Even the few online implementations are not progressive in the sense that the time to index incoming data is not bounded and cannot satisfy the latency requirements of progressive systems. This long latency has significantly limited the use of many machine learning methods, such as t-SNE, in interactive visual analytics. PANENE is a novel algorithm for Progressive Approximate k-NEarest NEighbors, enabling fast KNN queries while continuously indexing new batches of data. Following the progressive computation paradigm, PANENE operations can be bounded in time, allowing analysts to access running results within an interactive latency. PANENE can also incrementally build and maintain a cache data structure, a KNN lookup table, to enable constant-time lookups for KNN queries. Finally, we present three progressive applications of PANENE, such as regression, density estimation, and responsive t-SNE, opening up new opportunities to use complex algorithms in interactive systems.

Design optimization of a fast-neutron detector with scintillating fibers for triton burnup experiments at fusion experimental devices

Time-resolved triton burnup studies have been carried out to estimate the behavior of alpha particles in DD fusion experimental devices. In those studies, 14 MeV neutrons emitted through DT reactions in DD plasmas should be measured selectively in the backgrounds of DD neutrons and gamma rays. For this purpose, a scintillating-fiber (Sci-Fi) based fast-neutron detector has been adapted because of its advantages such as fast response, design flexibility in detection efficiency by changing the number of Sci-Fi, and discrimination property against 2.4 MeV neutrons produced through DD reactions and gamma rays. However, its length had conventionally been set to around 10 cm without an optimization study of its design parameters to meet the requirements as 14 MeV neutron detector. In the present study, we tested three types of Sci-Fi detectors with three different lengths and compared with the simulated results of energy deposition, through which we tried to understand the phenomena in the detection process of fast neutrons. From the results, it has been shown that, due to the self-shielding of neutrons by Sci-Fi and the attenuation of scintillation photons during the transmission process to the photomultiplier tube, the optimal length of Sci-Fi is concluded to be about 6 cm.

Capecitabine Plus Oxaliplatin Combination Therapy for Basal Cell Carcinoma

No effective systemic chemotherapy is well-established in basal cell carcinoma. We report a case with three simultaneous malignancies: colon cancer, basal cell carcinoma, and smoldering multiple myeloma. The patient was treated with capecitabine and oxaliplatin after surgery for colon cancer. Surprisingly, he achieved a complete response for basal cell carcinoma. This is the first report of this chemotherapy regimen in basal cell carcinoma. This finding suggests that combination capecitabine and oxaliplatin can be a treatment option for patients unable to receive local therapy.

Determination of X-ray Elastic Constants in a Ti-14Al-21Nb Nb Alloy and a Ti-14Al-21Nb/SiC Metal Matrix Composite

Residual stress values in a material are governed by the measurements of the atomic spacings in a specific crystallographic plane and the elastic constant for that plane. It has been reported that the value of the elastic constant depends on microstructure, preferred orientation, plastic deformation and morphology [1], Thus, the theoretical calculation of the elastic constant may deviate from the intrinsic value for a real alloy.

A Declarative Rendering Model for Multiclass Density Maps

Multiclass maps are scatterplots, multidimensional projections, or thematic geographic maps where data points have a categorical attribute in addition to two quantitative attributes. This categorical attribute is often rendered using shape or color, which does not scale when overplotting occurs. When the number of data points increases, multiclass maps must resort to data aggregation to remain readable. We present multiclass density maps: multiple 2D histograms computed for each of the category values. Multiclass density maps are meant as a building block to improve the expressiveness and scalability of multiclass map visualization. In this article, we first present a short survey of aggregated multiclass maps, mainly from cartography. We then introduce a declarative model-a simple yet expressive JSON grammar associated with visual semantics-that specifies a wide design space of visualizations for multiclass density maps. Our declarative model is expressive and can be efficiently implemented in visualization front-ends such as modern web browsers. Furthermore, it can be reconfigured dynamically to support data exploration tasks without recomputing the raw data. Finally, we demonstrate how our model can be used to reproduce examples from the past and support exploring data at scale.

Tumor Markers in Patients with Chronic Renal Failure

In order to evaluate the specificity of tumor markers in chronic renal failure, we have determined serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 19.9 (CA 19.9), carbohydrate antigen 50 (CA 50), alfafetoprotein (AFP), neuron-specific enolase (NSE), prostatic acid phosphatase (PAP), prostatic specific antigen (PSA), squamous cell carcinoma antigen (SCC), carbohydrate antigen 15.3 (CA 15.3) and carbohydrate antigen 125 (CA 125) in 30 patients with cronic renal failure and in 36 hemodialyzed patients without clinical evidence of neoplasia. CEA, CA 50, NSE and SCC frequently show increased serum levels, suggesting a renal metabolism, while others remain, generally, within the normal levels.

Cyfra 21–1 in Lung Cancer: Comparison with Cea, Ca 125, Scc and Nse Serum Levels

CYFRA 21–1, CEA, CA 125, SCC and NSE serum levels were determined in 50 healthy subjects and in 189 patients with primary lung cancer (101 with locoregional disease, 68 with recurrence and 20 patients with no evidence of residual disease (NED). Abnormal CYFRA 21–1 serum levels were found in 53.6% (90/168) of the patients with active cancer. Neither healthy subjects nor NED patients had abnormal serum levels. CYFRa 21–1 serum concentrations were significantly higher in patients with active cancer than in healthy subjects or in NED patients (p < 0.0001). CYFRA 21–1 sensitivity was related to tumor histology with abnormal levels in 64.7% of patients with NSCLC and in 30% of patients with SCLC (P <0.0001). In NSCLC, serum CYFRA 21–1 concentrations were also related to histological type, the highest values being found in squamous cell carcinomas and LCLC and the lowest in adenocarcinomas (p < 0.04). There was also a clear relationship between CYFRA 21–1 and tumor extension, with significantly higher values in patients with metastases than in those without metastases (p < 0.0001). Abnormal CEA values were found in 49.1%, CA 125 in 39%, SCC in 27.8% and NSE in 21.3% of the patients with active cancer. With respect to histological type, CYFRA was elevated in 68.3% of squamous cell carcinomas (CEA: 46.7%, SCC: 50%, CA 125:31.7%, NSE: 11.7%), in 54.8% of adenocarcinomas (CEA: 62%, SCC: 26.2%, CA 125: 59.5%, NSE: 9.5%), in 78.6% of LCLC (CEA: 64.3%, SCC: 28.6%, CA 125: 78.6%, NSE: 7.1%) and in 30% of SCLC (CEA: 37.7%, SCC: 3.8%, CA 125:20.8%, NSE: 45.3%). In summary, CYFRA 21–1 is the most sensitive tumor marker in patients with lung cancer, especially in NSCLC patients.

Mucin-Like Carcinoma-Associated Antigen (MCA) in Tissue and Serum of Patients with Breast Cancer: Clinical Applications in Prognosis and Disease Monitoring

Mucin-like Carcinoma-associated Antigen (MCA) has been associated with many breast cancers. The aim of this study was to evaluate MCA in tumor tissue and serum as a potential tumor marker for prognosis and disease monitoring. MCA levels were determined in the tissue of 196 patients with primary breast cancer, 25 with metastatic disease and 25 patients with benign diseases, in pellet and/or cytosol. MCA levels were also determined in the serum of 50 patients with benign diseases, 148 with primary breast cancer (Mo), 150 with metastatic breast cancer (MT), and 200 with no clinical evidence of disease (NED). MCA tissue concentrations in pellet and cytosol were similar: 66.7 + 251 U/mg and 41.1 + 53 U/mg, respectively. No relationship between MCA levels and tumor size or nodal involvement was found. Higher MCA levels were observed in patients with ER + or PgR + tumors than in those with ER- or PgR- tumors (p < 0.01). Patients with MCA pellet concentrations lower than 10 U/mg of protein had shorter disease - free intervals (DFI) than those with higher values (p < 0.05).

Abnormally high serum levels of MCA were found in 8% of patients with benign diseases, 4% of NED patients, 22% of Mo patients, and in 76% of MT cases. In primary breast cancer MCA values were related to tumor size and nodal involvement. A trend toward a lower DFI in patients with elevated presurgical MCA levels was observed but was of no statistical significance. These differences became statistically significant when patients were subdivided according to nodal status, with shorter DFI in those without nodal invasion (p < 0.05). In metastatic patients, changes in serum MCA were related to the tumor's response to treatment in 82% of cases. The highest MCA values were found in patients with liver or bone metastasis and the lowest values were found in those with locoregional recurrence. In conclusion, although MCA is not a specific tumor marker, it can be useful as a prognostic factor (tissue and serum) and in monitoring metastatic patients.

CA 125 in Biological Fluids

CA 125 is not a specific tumor marker, and is synthesized by normal and malignant cells of different origin (mainly in tissues derived from the müllerian epithelia) in a similar proportion. Abnormal CA 125 levels may be found in fluids of different origin (ascites, pleura, pericardium, amniotic fluid, cyst fluid, bronchoalveolar fluid, etc.) and in serum from patients with these fluids. Differences in serum CA 125 found in malignant or benign diseases may be related to the number of cells that synthesize the marker, and are highly dependent on the access to serum, where the marker is normally determined. Moreover, CA 125 is a very good tumor marker in ovarian and lung cancer. The sensitivity of CA 125 in ovarian cancer is related to stage (40–95%), histological type (lower levels in mucinous adenocarcinoma), and the marker is useful in the early detection of recurrence (sensitivity 80%) and in therapy monitoring. It's sensitivity in lung cancer is lower than in ovarian cancer, 39% in locoregional malignancies and 69% in metastastatic disease, but clearly related to stage and histology (mainly in adenocarcinomas and large cell lung cancer) and it is useful in prognosis and disease monitoring.

Efficacy of Pemetrexed-based Chemotherapy in Comparison to Non-Pemetrexed-based Chemotherapy in Advanced, ALK+ Non-Small Cell Lung Cancer

PURPOSE

Previous retrospective studies suggest that anaplastic lymphoma kinase (ALK) mutation-positive (ALK+) non-small cell lung cancer (NSCLC) patients are sensitive to pemetrexed. To determine its efficacy, we retrospectively evaluated clinical outcomes of pemetrexed-based chemotherapy in patients with ALK+ NSCLC.

MATERIALS AND METHODS

We identified 126 patients with advanced, ALK+ NSCLC who received first-line cytotoxic chemotherapy. We compared response, progression-free survival (PFS), and overall survival (OS) rates according to chemotherapy regimens. Furthermore, we evaluated intracranial time to tumor progression (TTP) and proportion of ALK+ cells as prognostic factors.

RESULTS

Forty-eight patients received pemetrexed-based chemotherapy, while 78 received other regimens as first-line treatment. The pemetrexed-based chemotherapy group showed superior overall response (44.7% vs. 14.3%, p<0.001) and disease control (85.1% vs. 62.3%, p=0.008) rates. The pemetrexed-based chemotherapy group also exhibited longer PFS (6.6 months vs. 3.8 months, p<0.001); OS rates were not significantly different. The lack of exposure to second-generation ALK inhibitors and intracranial metastasis on initial diagnosis were independent negative prognostic factors of OS. Intracranial TTP was similar between the treatment groups (32.7 months vs. 35.7 months, p=0.733). Patients who harbored a greater number of ALK+ tumor cells (≥70%) showed prolonged OS on univariate analysis (not reached vs. 44.8 months, p=0.041), but not on multivariate analysis (hazard ratio: 0.19, 95% confidence interval: 0.03-1.42; p=0.106).

CONCLUSION

Pemetrexed-based regimens may prolong PFS in patients with ALK+ NSCLC as a first-line treatment, but are not associated with prolonged OS. Exposure to second-generation ALK inhibitors may improve OS rates in patients with ALK+ NSCLC.

A pilot study of planar coil based magnetic stimulation using acute hippocampal slice in mice

Micromagnetic stimulation using small-sized implantable coils has recently been studied. The main advantage of this method is that it can provide sustainable stimulation performance even if a fibrotic encapsulation layer is formed around the implanted coil by inflammation response, because indirectly induced currents are used to induce neural responses. In previous research, we optimized the geometrical and control parameters used in implantable magnetic stimulation. Based on those results, we fabricated the planar coil and studied the LTP effect in the hippocampal slice by two different magnetic stimulation protocols using the quadripulse stimulation (QPS) pattern. We found that direct magnetic stimulation (DMS) induced insignificant LTP effect and priming magnetic stimulation (PMS) occluded LTP effect after tetanic stimulation, when QPS patterned magnetic stimulation with 1 A current pulse was applied to the planar coil.

Prospective evaluation of the clinical implications of the tumor metabolism and chemotherapy-related changes in advanced biliary tract cancer

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Background: Tumor metabolism measured by [18F] fluorodeoxy-D-glucose (18F-FDG) positron emission tomography (PET) has a diagnostic and prognostic role in several cancers. The clinical implication of tumor metabolism in biliary tract cancer (BTC) has not been studied well. Therefore, we prospectively evaluated the prognostic value of tumor metabolism and chemotherapy-related changes in advanced BTC patients. Methods: We prospectively enrolled advanced BTC patients before the initiation of palliative chemotherapy. Using 18F-FDG PET, we assessed the baseline maximum standardized uptake value (SUVmax) and monitored the changes of SUVmax during chemotherapy. We analyzed the associations between SUVmax, and clinicopathologic factors and clinical outcomes. Results: A total of 75 patients were enrolled. All patients received gemcitabine/cisplatin as first-line chemotherapy. Primary tumor site, histologic differentiation, molecular characteristics, laboratory findings, and disease extent were associated with the metabolic characteristics. The high metabolism group showed worse survival outcome [Hazard ratio (HR)=4.09, p=0.001 for progression-free survival (PFS); HR=2.61, p=0.019 for overall survival (OS)] than the low metabolism group. The lesser reduction of SUVmax during chemotherapy was also associated with worse outcome (HR=3.35, p=0.002 for PFS; HR=1.96, p=0.082 for OS). Considering both baseline tumor metabolic activity and chemotherapy-related changes in the tumor metabolism, patients with a low metabolism and a more reduction in metabolism obtained the best OS (20.7 months, p=0.013). Conclusions: Tumor metabolic activity and the chemotherapy-related changes in the metabolism were associated with prognosis in advanced BTC patients.