Hypoxic transcriptomes predict survival and tumor-infiltrating immune cell composition in cutaneous melanoma

Hypoxia has established associations with aggressive tumor phenotypes in many cancers. However, it is not currently understood whether tumor hypoxia levels map to distinct immune infiltrates in cutaneous melanoma, potentially unveiling novel therapeutic targets. To this end, we leveraged a previously identified seven-gene hypoxia signature to grade hypoxia levels of 460 cutaneous melanomas obtained from the Broad Institute GDAC Firehose portal. CIBERSORTx ( https://cibersortx.stanford.edu/ ) was employed to calculate the relative abundance of 22 mature human hematopoietic populations. Clinical outcomes and immune cell associations were assessed by computational means. Results indicated that patients with high-hypoxia tumors reported significantly worse overall survival and correlated with greater Breslow depth, validating the in-silico methodology. High-hypoxia tumors demonstrated increased infiltration of activated and resting dendritic cells, resting mast cells, neutrophils, and resting NK cells, but lower infiltration of gamma-delta T cells. These data suggest that high tumor hypoxia correlates with lower survival probability and distinct population differences of several tumor-infiltrating leukocytes in cutaneous melanomas.

Achievement of Target Gain Larger than Unity in an Inertial Fusion Experiment

On December 5, 2022, an indirect drive fusion implosion on the National Ignition Facility (NIF) achieved a target gain G_{target} of 1.5. This is the first laboratory demonstration of exceeding "scientific breakeven" (or G_{target}>1) where 2.05 MJ of 351 nm laser light produced 3.1 MJ of total fusion yield, a result which significantly exceeds the Lawson criterion for fusion ignition as reported in a previous NIF implosion [H. Abu-Shawareb et al. (Indirect Drive ICF Collaboration), Phys. Rev. Lett. 129, 075001 (2022)PRLTAO0031-900710.1103/PhysRevLett.129.075001]. This achievement is the culmination of more than five decades of research and gives proof that laboratory fusion, based on fundamental physics principles, is possible. This Letter reports on the target, laser, design, and experimental advancements that led to this result.

A Unique Case of Metastatic Cutaneous Squamous Cell Carcinoma Presenting Like Carcinoma en Cuirasse on the Face

Carcinoma en cuirasse (CeC) is a rare case of cutaneous metastases most commonly seen in the breast or visceral organs. The term carcinoma en cuirasse is largely used to describe the coalescing and fibrotic textural changes in the skin that can be seen in these metastatic lesions, which often manifest in a large plaque-like distribution. While most cases of CeC are found on the trunk, CeC has been reported in other body locations. However, to our knowledge, it has not yet been described on the face. In this report, we discuss a rare case of metastatic cutaneous squamous cell carcinoma (cSCC) that presented on the head and neck of a 67-year-old female, for which we have coined the term "carcinoma en bascinet." This novel term stems from the fibrotic changes associated with significant metastatic carcinomas of the head and neck, which bear a resemblance to a bascinet, which is a medieval-style helmet worn by European soldiers during the 14th and 15th centuries. We present this case of carcinoma en bascinet secondary to metastatic cSCC to demonstrate how metastatic cSCC can present in a facial distribution, causing significant morbidity and, as in this case, mortality. We hope that this case will increase the awareness of the highly variable presentation of metastatic cSCC, specifically as an extensive papulonodular and fibrotic plaque, allowing patients to receive early initiation of systemic therapy for symptom management and hence maximizing their quality of life.

Lawson Criterion for Ignition Exceeded in an Inertial Fusion Experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin "burn propagation" into surrounding cold fuel, enabling the possibility of high energy gain. While "scientific breakeven" (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion.

Particle damage sources for fused silica optics and their mitigation on high energy laser systems

High energy laser systems are ultimately limited by laser-induced damage to their critical components. This is especially true of damage to critical fused silica optics, which grows rapidly upon exposure to additional laser pulses. Much progress has been made in eliminating damage precursors in as-processed fused silica optics (the advanced mitigation process, AMP3), and very high damage resistance has been demonstrated in laboratory studies. However, the full potential of these improvements has not yet been realized in actual laser systems. In this work, we explore the importance of additional damage sources-in particular, particle contamination-for fused silica optics fielded in a high-performance laser environment, the National Ignition Facility (NIF) laser system. We demonstrate that the most dangerous sources of particle contamination in a system-level environment are laser-driven particle sources. In the specific case of the NIF laser, we have identified the two important particle sources which account for nearly all the damage observed on AMP3 optics during full laser operation and present mitigations for these particle sources. Finally, with the elimination of these laser-driven particle sources, we demonstrate essentially damage free operation of AMP3 fused silica for ten large optics (a total of 12,000 cm² of beam area) for shots from 8.6 J/cm² to 9.5 J/cm² of 351 nm light (3 ns Gaussian pulse shapes). Potentially many other pulsed high energy laser systems have similar particle sources, and given the insight provided by this study, their identification and elimination should be possible. The mitigations demonstrated here are currently being employed for all large UV silica optics on the National Ignition Facility.

Achieving empowerment through information

Despite the problems we encountered, which are not uncommon with the development and implementation of any data system, we are confident that our success in achieving our goals is due to the following: establishing a reliable information database connecting several related departments; interfacing with registration and billing systems to avoid duplication of data and chance for error; appointing a qualified Systems Manager devoted to the project; developing superusers to include intensive training in the operating system (UNIX), parameters of the information system, and the report writer. We achieved what we set out to accomplish: the development of a reliable database and reports on which to base a variety of hospital decisions; improved hospital utilization; reliable clinical data for reimbursement, quality management, and credentialing; enhanced communication and collaboration among departments; and an increased profile of the departments and staff. Data quality specialists, Utilization Management and Quality Management coordinators, and the Medical Staff Credentialing Supervisor and their managers are relied upon by physicians and administrators to provide timely information. The staff are recognized for their knowledge and expertise in their department-specific information. The most significant reward is the potential for innovation. Users are no longer restricted to narrow information corridors. UNIX programming encourages creativity without demanding a degree in computer science. The capability to reach and use diverse hospital database information is no longer a dream.

Financial and operational impact of a transfer center

A tertiary care hospital established a transfer center to manage the large number of transfer requests from other hospitals in its catchment region. Motivating factors included occurrence of economic transfers, medically inappropriate transfers, poor interfacility communication, and a bed shortage. An interdisciplinary task force was convened to design and implement the transfer center, requiring two months from conception to implementation. Non-recurring direct costs were $3000. At the time of implementation, written transfer agreements were promoted and signed with many transferring hospitals. A retrospective audit covering 28 weeks of operation indicates that 1141 inpatient days were avoided for an average of 21.5 days per back-transferred patient. (Back-transfer refers to the return of a patient to the original hospital.) An additional 140 admissions were possible as a result of these avoided days. Approximately $550,000 in variable costs were saved on an annualized basis. Moreover, substantial improvements in communications and interfacility cooperation were realized. No cases of inappropriate denials or delays in transfer were identified. We conclude that a transfer center can be a highly cost-effective mechanism to manage the large number of patients transferred to a tertiary care center.

Urodynamic studies in female patients with multiple sclerosis

Patients with multiple sclerosis may have two fundamental, related problems in the lower urinary tract, i.e., urinary retention and/or urinary incontinence. Forty-six patients were assessed by urodynamic testing. Evidence of detrusor overactivity was seen in 40 patients (86.9%), elevated resting urethral pressures in 39 patients (84.8%), a positive bethanechol chloride (Urecholine) stress test in 24 patients (63.2%), and a significant residual urine in 26 patients (56.5%). Data were analyzed in an attempt to explain retention and incontinence in these patients.

Transport of organic anions through the erythrocyte membrane as K+-valinomycin complexes

K+, Rb+, or Cs+ complexes of valinomycin form ion pair complexes with picric acid and trinitrobenzenesulfonate (TNBS). The formation of a picrate-K+-valinomycin complex is supported by spectral evidence. These complexes have zero net charge and readily permeate the intact erythrocyte membrane. The K+-valinomycin complex has been used to convert the nonpenetrating TNBS into a penetrating covalent probe, making it as useful vectorial probe to measure accessible amino groups of proteins and phospholipids on both sites of the erythrocyte membrane. The enhanced transport of TNBS into the cell by valinomycin is dependent on external K+ in the medium. The entry of TNBS into the cell is manifested by an increased labeling of hemoglobin and membrane phosphatidylethanolamine (PE). Stilbeneisothiocyanatedisulfonate (SITS) and anilinonaphthalenesulfonate (ANS) inhibit both the basal and K+-valinomycin stimulated labeling of PE and hemoglobin by TNBS. The data suggest two independent effects of ANS and SITS, one mediated by an inhibition of the anion transport protein and another by the incorporation of these hydrobic anions into the cell membrane with an increase in negative charge on the membrane which leads to an inhibition of TNBS permeation into the cell by electrostatic repulsion.