Efficacy of immunotherapy in mismatch repair-deficient advanced colorectal cancer in routine clinical practice. An AGEO study

BACKGROUND

Immunotherapy demonstrated remarkable efficacy in metastatic colorectal cancers (mCRCs) with mismatch repair deficiency (MMRd)/microsatellite instability (MSI). However, data regarding efficacy and safety of immunotherapy in the routine clinical practice are scarce.

PATIENTS AND METHODS

This is a retrospective, multicenter study aiming to evaluate efficacy and safety of immunotherapy in routine clinical practice and to identify predictive markers for long-term benefit. Long-term benefit was defined as progression-free survival (PFS) exceeding 24 months. All patients who received immunotherapy for an MMRd/MSI mCRC were included. Patients who received immunotherapy in combination with another known effective therapeutic class agent (chemotherapy or tailored therapy) were excluded.

RESULTS

Overall, 284 patients across 19 tertiary cancer centers were included. After a median follow-up of 26.8 months, the median overall survival (mOS) was 65.4 months [95% confidence interval (CI) 53.8 months-not reached (NR)] and the median PFS (mPFS) was 37.9 months (95% CI 30.9 months-NR). There was no difference in terms of efficacy or toxicity between patients treated in the real-world or as part of a clinical trial. Overall, 46.6% of patients had long-term benefit. Independent markers associated with long-term benefit were Eastern Cooperative Oncology Group-performance status (ECOG-PS) 0 (P = 0.025) and absence of peritoneal metastases (P = 0.009).

CONCLUSIONS

Our study confirms the efficacy and safety of immunotherapy in patients with advanced MMRd/MSI CRC in the routine clinical practice. ECOG-PS score and absence of peritoneal metastases provide simple markers that could help identify patients who benefit the most from this treatment.

Super-resolution time-resolved imaging using computational sensor fusion

Imaging across both the full transverse spatial and temporal dimensions of a scene with high precision in all three coordinates is key to applications ranging from LIDAR to fluorescence lifetime imaging. However, compromises that sacrifice, for example, spatial resolution at the expense of temporal resolution are often required, in particular when the full 3-dimensional data cube is required in short acquisition times. We introduce a sensor fusion approach that combines data having low-spatial resolution but high temporal precision gathered with a single-photon-avalanche-diode (SPAD) array with data that has high spatial but no temporal resolution, such as that acquired with a standard CMOS camera. Our method, based on blurring the image on the SPAD array and computational sensor fusion, reconstructs time-resolved images at significantly higher spatial resolution than the SPAD input, upsampling numerical data by a factor \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$12 \times 12$$\end{document}12×12, and demonstrating up to \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$4 \times 4$$\end{document}4×4 upsampling of experimental data. We demonstrate the technique for both LIDAR applications and FLIM of fluorescent cancer cells. This technique paves the way to high spatial resolution SPAD imaging or, equivalently, FLIM imaging with conventional microscopes at frame rates accelerated by more than an order of magnitude.

Conical refraction mode of an optical resonator

The fundamental mode of a conical refraction resonator, i.e., an optical cavity where light experiences conical refraction (CR) from a biaxial crystal, is experimentally demonstrated in the plano-concave cavity configuration. We have discovered that the fundamental CR mode is characterized by the polarization and intensity structures of CR beams between the plane mirror and CR crystal, and it resembles the fundamental Gaussian mode with homogeneous polarization between the crystal and concave mirror. We theoretically explained this fundamental CR mode using the dual cone model and symmetry of the CR phenomenon and confirmed this explanation by numerical simulations.

Implementation and performance of an in-line incomplete Stokes polarimeter based on a single biaxial crystal

Due to the increasing interest of polarimetric information in numerous applications, different Stokes polarimeter designs are provided in the literature for the measure of light beam polarization. Recently, the concept of polarimeters based on the conical refraction (CR) phenomenon, occurring in biaxial crystals, was proposed. CR polarimeters are snapshot polarimeters that allow controlling the volume of data redundancy without an increase in the acquisition time. We present the implementation, calibration, and analysis of an incomplete CR-polarimeter optimized for the measure of linear polarizations. A simpler and cheaper experimental configuration is achieved, if compared with other polarimeters proposed in the literature. The suitability of the polarimeter is experimentally demonstrated and some of its benefits, such as its performance in low-intensity conditions, are discussed.

Transformation of vector beams with radial and azimuthal polarizations in biaxial crystals

We present both experimentally and theoretically the transformation of radially and azimuthally polarized vector beams when they propagate through a biaxial crystal and are transformed by the conical refraction phenomenon. We show that, at the focal plane, the transverse pattern is formed by a ring-like light structure with an azimuthal node, this node being found at diametrically opposite points of the ring for radial/azimuthal polarizations. We also prove that the state of polarization of the transformed beams is conical refraction-like, i.e., that every two diametrically opposite points of the light ring are linearly orthogonally polarized.

On the dual-cone nature of the conical refraction phenomenon

In conical refraction (CR), a focused Gaussian input beam passing through a biaxial crystal and parallel to one of the optic axes is transformed into a pair of concentric bright rings split by a dark (Poggendorff) ring at the focal plane. Here, we show the generation of a CR transverse pattern that does not present the Poggendorff fine splitting at the focal plane, i.e., it forms a single light ring. This light ring is generated from a nonhomogeneously polarized input light beam obtained by using a spatially inhomogeneous polarizer that mimics the characteristic CR polarization distribution. This polarizer allows modulating the relative intensity between the two CR light cones in accordance with the recently proposed dual-cone model of the CR phenomenon. We show that the absence of interfering rings at the focal plane is caused by the selection of one of the two CR cones.

Polarization tailored novel vector beams based on conical refraction

Coherent vector beams with involved states of polarization (SOP) are widespread in the literature, having applications in laser processing, super-resolution imaging and particle trapping. We report novel vector beams obtained by transforming a Gaussian beam passing through a biaxial crystal, by means of the conical refraction phenomenon. We analyze both experimentally and theoretically the SOP of the different vector beams generated and demonstrate that the SOP of the input beam can be used to control both the shape and the SOP of the transformed beam. We also identify polarization singularities of such beams for the first time and demonstrate their control by the SOP of the input beam.

Blue-detuned optical ring trap for Bose-Einstein condensates based on conical refraction

We present a novel approach for the optical manipulation of neutral atoms in annular light structures produced by the phenomenon of conical refraction occurring in biaxial optical crystals. For a beam focused to a plane behind the crystal, the focal plane exhibits two concentric bright rings enclosing a ring of null intensity called the Poggendorff ring. We demonstrate both theoretically and experimentally that the Poggendorff dark ring of conical refraction is confined in three dimensions by regions of higher intensity. We derive the positions of the confining intensity maxima and minima and discuss the application of the Poggendorff ring for trapping ultra-cold atoms using the repulsive dipole force of blue-detuned light. We give analytical expressions for the trapping frequencies and potential depths along both the radial and the axial directions. Finally, we present realistic numerical simulations of the dynamics of a ⁸⁷Rb Bose-Einstein condensate trapped inside the Poggendorff ring which are in good agreement with corresponding experimental results.

Super-Gaussian conical refraction beam

We demonstrate the transformation of Gaussian input beams into super-Gaussian beams with a quasi flat-top transverse profile by means of the conical refraction phenomenon by adjusting the ratio between the ring radius and the waist radius of the input beam to 0.445. We discuss the beam propagation of the super-Gaussian beam and show that it has a confocal parameter three times larger than the one that would be obtained from a Gaussian beam. The experiments performed with a KGd(WO₄)₂ biaxial crystal are in good agreement with the theoretical predictions.

[What do clinicians do with the results of the systematic staging imaging at the time of the breast cancer diagnosis?]

INTRODUCTION

Asymptomatic distant metastasis is often looked for at the time of initial diagnosis of early breast cancer. However, there is no consensus on when to perform it and on the consequences on the treatment.

PATIENTS AND METHODS

One hundred and twenty-three asymptomatic women receiving systemic neoadjuvant (32 patients) or adjuvant treatment (91 patients) for breast cancer at the Oscar-Lambret center in September 2011 were considered. The staging imaging was a PET scan for 59 patients (pts), a CT scan and a bone scan for 59 patients and both for 5 patients. The result for each procedure was considered normal, abnormal but typically benign or potentially malignant. In this case, another imaging technique was carried out to confirm the suspected diagnosis. The patient was considered metastatic if the results of two different procedures were concordant and eventually in case of response to chemotherapy.

RESULTS

Nine pts were considered metastatic (9/125=7%). They were stage 1: 1, stage 2: 4 and stage 3: 4. The staging by CT, abdomen and pelvis scan coupled with bone scintigraphy discriminated five metastatic patients with overdiagnosis of 33 benign lesions and the need of 20 additional confirmatory tests. Similarly, the PET staging, more expensive, only discriminated two metastatic patients and 15 benign lesions requiring 20 confirmatory tests.

CONCLUSION

These results support the international recommendations to make a staging from stage IIIA. The CT, abdominal and pelvic scan coupled with bone scintigraphy should be considered as a gold standard in breast cancer staging.

Generating a three-dimensional dark focus from a single conically refracted light beam

We report here the generation of a three-dimensional (3D) dark focus from a single focused monochromatic Gaussian beam that undergoes conical refraction when it propagates along one of the optic axes of a biaxial crystal. We study the resulting ring intensity pattern behind the crystal as a function of the ratio between the ring radius and the beam waist and derive the particular parameter values for which a 3D dark focus with null intensity at the ring center is formed. We have performed experiments with a KGd(WO(4))(2) biaxial crystal, reporting the generation of a bottle beam in full agreement with our theoretical investigations.

Optical vault: a reconfigurable bottle beam based on conical refraction of light

We employ conical refraction of light in a biaxial crystal to create an optical bottle for photophoretic trapping and manipulation of particles in gaseous media. We show that by only varying the polarization state of the input light beam the optical bottle can be opened and closed in order to load and unload particles in a highly controllable manner.

Wave-vector and polarization dependence of conical refraction

We experimentally address the wave-vector and polarization dependence of the internal conical refraction phenomenon by demonstrating that an input light beam of elliptical transverse profile refracts into two beams after passing along one of the optic axes of a biaxial crystal, i.e. it exhibits double refraction instead of refracting conically. Such double refraction is investigated by the independent rotation of a linear polarizer and a cylindrical lens. Expressions to describe the position and the intensity pattern of the refracted beams are presented and applied to predict the intensity pattern for an axicon beam propagating along the optic axis of a biaxial crystal.

Sexual risk behaviour among HIV-positive persons in Kumasi, Ghana

OBJECTIVES

To assess the prevalence and predictors of sexual risk behaviours among HIV-positive individuals in clinical care in Kumasi, Ghana.

DESIGN

Cross-sectional survey of 267 (43 males and 224 females) HIV-positive individuals attending Kumasi South Regional Hospital.

METHODS

An interviewer-administered questionnaire was used to asses demographic and health characteristics, HIV/AIDS knowledge, attitudes, and beliefs and sexual risk behaviours.

RESULTS

Forty-four percent of the sample reported having sex after testing positive for HIV. Of the 175 participants with regular sex partners, 24% had HIV-positive partners. Majority (67%) had HIV-negative partners (serodiscordant couples) or partners of unknown status. More than half (51%) of the study population with regular sex partners reported that they had unprotected anal or vaginal sex. Participants who scored < 50% on the HIV/AIDS knowledge scale were 90% less likely to have used condoms during their last sexual intercourse. Disclosure of HIV status was associated with protective patterns of condom use (OR=2.2; 95% CI: 1.3-12.9). Participants on ARV were 80% less likely to have used condoms during the last sexual intercourse (OR=0.2; 95% CI: 0.04-0.6).

CONCLUSION

The high rates of sexual risk behaviour among HIV-positive individuals in this sample place others at risk of HIV infection. It also places these HIV positive individuals at risk for infection with sexually transmitted infections and super-infection with other HIV strains. These findings highlight the need to integrate HIV prevention in routine medical care in Ghana.

A two-stage neural spiking model of visual contrast detection in perimetry

Perimetry is a commonly used clinical test for visual function, limited by high variability. The sources of this variability need to be better understood. In this paper, we investigate whether noise intrinsic to neural firing could explain the variability in normal subjects. We present the most physiologically accurate model to date for stimulus detection in perimetry combining knowledge of the physiology of components of the visual system with signal detection theory, and show that it requires that detection be mediated by multiple cortical cells in order to give predictions consistent with psychometric functions measured in human observers.

Do migraineurs have difficulty judging direction of simulated heading?

Some migraineurs have increased thresholds for the detection of global dot motion. We investigated whether migraineurs show consequential abnormalities in the determination of direction of self-motion (heading) from simulated optic flow. The ability to determine heading from optic flow is likely to be necessary for optimal determination of self-motion through the environment. Twenty-five migraineurs and 25 controls participated. Global dot motion coherence thresholds were assessed, in addition to performance on two simulated heading tasks: one with a symmetrical flow field, and the second with differing velocity of optic flow on the left and right sides of the participant. While some migraineurs demonstrated abnormal global motion coherence thresholds, there was no difference in performance on the heading tasks at either simulated walking (5 km/h) or driving (50 km/h) speeds. Increased global motion coherence thresholds in migraineurs do not result in abnormal judgements of heading from 100% coherent optic flow.

Measurement error of visual field tests in glaucoma

AIM

Psychophysical strategies designed for clinical visual field testing produce rapid estimates of threshold with relatively few stimulus presentations and so represent a trade-off between test quality and efficiency. The aim of this study was to determine the measurement error of a staircase algorithm similar to full threshold with standard automated perimetry (SAP) and frequency doubling perimetry (FDP) in glaucoma patients.

METHODS

Seven patients with early open angle glaucoma (OAG) were prospectively recruited. All were experienced in laboratory based psychophysics. Three matched test locations were examined with SAP (externally driven Humphrey field analyser) and FDP (CRT) in a single arbitrarily selected eye of each subject. Each location was tested twice with a 4-2-2 dB staircase strategy, similar to full threshold, and then with the method of constant stimuli (MOCS). Accuracy (threshold estimation error) was quantified by determination of differences between "true" threshold measurements made by MOCS and single staircase threshold estimates. Precision (repeatability) was quantified by the differences between repeated staircase threshold estimates.

RESULTS

Precision was relatively high for both tests, although higher for FDP than SAP at depressed sensitivity levels. The staircase strategy significantly underestimated threshold sensitivity for both test types, with the mean difference (95% CI) between staircase and MOCS thresholds being 4.48 dB (2.35 to 7.32) and 1.35 dB (0.56 to 1.73) for SAP and FDP respectively. Agreement levels (weighted kappa) between MOCS and staircase thresholds were found to be 0.48 for SAP and 0.85 for FDP. Although this "bias" appeared constant for FDP across all sensitivity levels, this was not the case for SAP where accuracy decreased at lower sensitivity levels.

CONCLUSION

Estimations of threshold sensitivity made using staircase strategies common to clinical visual field test instrumentation are associated with varying degrees of measurement error according to visual field test type and sensitivity. In particular, SAP significantly overestimates the "true" level of sensitivity, particularly in damaged areas of the visual field, suggesting that clinical data of this type should be interpreted with caution.

Variability components of standard automated perimetry and frequency-doubling technology perimetry

PURPOSE

To evaluate and compare intra- and intertest variability components for both standard automated perimetry (SAP) and frequency-doubling technology (FDT) perimetry in a small group of normal individuals and patients with glaucoma.

METHODS

The method of constant stimuli (MOCS) was used to examine matched test locations with both SAP and FDT perimetry stimuli in a group of eight normal individuals and seven patients with glaucoma. Subjects were tested weekly at three predetermined visual field loci for 5 consecutive weeks. Frequency-of-seeing (FOS) curves were generated and used to quantify threshold sensitivity (50% seen on FOS, in decibels), intratest variability (FOS interquartile range, in decibels), and intertest variability (interquartile range of weekly repeated threshold determinations, in decibels).

RESULTS

In patients with glaucoma, SAP intra- and intertest variabilities were found to increase with sensitivity reductions, as previously reported. FDT perimetry revealed that both intra- and intertest variability components did not appreciably change with reductions in sensitivity. With the measurement scales used in this investigation, both intra- and intertest variability components were significantly greater for SAP than for FDT perimetry (P < 0.001 and P = 0.003, respectively). Intratest variability exceeded intertest variability for both SAP (P = 0.001) and FDT perimetry (P < 0.001).

CONCLUSIONS

For both SAP and FDT perimetry, variability occurring within a single test session contributed more to total variability than between-session variability. When the measurement scales available on commercial instrumentation were used, FDT perimetry exhibited significantly less variability than SAP, especially within regions of visual field sensitivity loss. FDT perimetry therefore shows promise as an effective test for detecting progressive glaucomatous visual field loss, although prospective longitudinal validation is still required to determine sensitivity to change.

[Investigation of the immunity status towards tetanus of a population of mechanics at the car-factory "Renault" (author's transl)]

Tetanus immunity has been studied in a population of mechanics working at the car-factory "Renault". For the study, 283 individuals were divided into 3 groups. The first group consisted of non-vaccined individuals, the second of vaccinated individuals and the third of individuals who had been boostered. The influence of different parameters on tetanus immunity status was considered, i. e. the age of the subjects, the time at which boostering was given, the serotherapy (when it was administered) and the contact with machine lubricating and cooling fluids. Clostridium tetani bacilli and spores were frequently found in aqueous machine fluids. Their presence is a potential hazard for non-vaccinated mechanics coming to contact with the fluids. Tetanus antibody levels in the sera of the tested population were determined in vivo by the toxin neutralization test. The influence on tetanus immunity of the different parameters considered in this paper was subjected to statistical analysis. From the whole population, 27% of the individuals were found to have no protection against tetanus. When age was taken into account, 53% of the individuals over 45 years old and 10% of those under 45 years old were shown to be devoid of tetanus immunity. It could be shown that younger individuals were better protected than older ones, because the formers had been immunized with adsorbed tetanus toxoid and most of the latters with fluid toxoid. Of the individuals in the third group who had received a booster injection within 15 years after primo-vaccination, 98% showed protective tetanus antibody levels in their sera in contrast to 25% when boostering had occurred more than 15 years after primo-vaccination. Contact with machine fluids was found to influence the degree of immunity of only those individuals whose boostering dated back to more than 25 years. Unexpectedly, 3 mechanics seemed to develop immunity after coming into contact with machine fluids. From the results reported here, it is concluded that tetanus immunity in vaccinated individuals should be renewed by a compulsory booster injection given every 5, 10 or, at the minimum, 15 years. Moreover, high-risk populations such as that represented by the mechanics should be immunized or boostered on commencing employment.

Titration of antibodies to tetanus toxoid by agglutination of purified tetanus toxoid sensitized latex particles

The method of sensitized latex particle agglutination which we have devised allows the selection of samples of plasma for the preparation of immunoglobulins. The population of thus selected samples is the same as is selected by the in vivo test, having a titer greater than or equeal to 6 IU/ml. The test gives a clear-cut difference between the positive and negative results and does not give any prozone phenomenon. It can be used extensively, as the batches of sensitized latex particles may be stored for quite a long time.