AB1441 LEARNING NEEDS ASSESSMENT FOR PATIENTS WITH CANCER AND A PRE-EXISTING AUTOIMMUNE DISEASE WHO ARE CANDIDATES TO RECEIVE IMMUNE CHECKPOINT INHIBITORS

Background

Patients with autoimmune disorders and cancer are at risk of developing immune-related adverse events (irAEs) and increasing flares of their underlying disease with immune checkpoint inhibitors (ICI) and harms and benefits must be weighed.

Objectives

We conducted an assessment of learning needs.

Methods

We interviewed 19 patients who had received an ICI and 20 physicians who provide care for these patients. We asked what do cancer patients with pre-existing autoimmune diseases need to know in order to make an informed decision about whether to receive an ICI.

Results

Fifty-three percent of the patients were female, median age was 62.9 (±10.9). They had rheumatoid arthritis (47.4%), psoriasis (26.3%), Crohn’s disease (10.5%), ankylosing spondylitis (5.3%), systemic lupus erythematosus (5.3%), or ulcerative colitis (5.3%). Half of the patients (52.6%) had a demonstrable disease activity of the autoimmune disease at the time of making the decision on whether to start ICI. Most (84%) of the patients had melanoma, and at the time of the interview 68.4% had completed or discontinued the ICI. Physicians were melanoma oncologists (30%), thoracic-head & neck medical oncologists (25%), rheumatologists (20%), gastroenterologists (10%), and dermatologists (15%) who treat patients with irAEs. Sixty percent were female. Key points mentioned by patients and physicians included information on probability of irAEs and flares of the autoimmune condition with discussion about severity, benefits of ICI, ICI mechanism of action in the context of the autoimmune disease, and management for flare-ups. Key topics raised only by patients included possible reasons for stopping or modifying treatment (for cancer or autoimmune disease), when to contact the provider, possibility of autoimmune disease progression or organ damage, sharing information with other providers, and lifestyle changes that can be done to help.

Conclusion

Although patients and physicians listed common learning points, patients also considered specific needs to increase their self-care. The information derived from this study will be used to develop a decision support tool.

Disclosure of Interests

None declared

Broken Mirror Symmetry of Tracer's Trajectories in Turbulence

Topological properties of physical systems play a crucial role in our understanding of nature, yet their experimental determination remains elusive. We show that the mean helicity, a dynamical invariant in ideal flows, quantitatively affects trajectories of fluid elements: the linking number of Lagrangian trajectories depends on the mean helicity. Thus, a global topological invariant and a topological number of fluid trajectories become related, and we provide an empirical expression linking them. The relation shows the existence of long-term memory in the trajectories: the links can be made of the trajectory up to a given time, with particles positions in the past. This property also allows experimental measurements of mean helicity.

AB0253 A REVIEW OF SMOKING CESSATION STRATEGIES AND LUNG CANCER SCREENING PRACTICES IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Smoking rates among patients with rheumatoid arthritis (RA) exceed those reported in the general population. In addition, people with RA who smoke are more likely to develop lung cancer than smokers who do not have RA.

Objectives:

To identify smoking cessation strategies and lung cancer screening practices in patients with RA.

Methods:

We conducted a review of the literature in electronic databases (i.e., PubMed, EMBASE, Cochrane, Scopus, and Web of Science) from inception until June 2019. We included studies that reported on the results of interventions for smoking cessation or lung cancer screening in patients with RA. We excluded case reports, reviews, guidelines, protocols, or studies on tobacco use not reporting interventions. We included studies published in abstract or full-text format. We extracted study and intervention characteristics including delivery format, timing and results.

Results:

We retrieved 394 relevant citations and ultimately included 9 studies evaluating smoking cessation strategies, and one regarding lung cancer screening practices. Five studies were reported in abstract format. There were 3 studies conducted in the United Kingdom, and one each in Croatia, France, Ireland, New Zealand, Sweden, Spain and United States. Two studies were randomized control trials and the remaining were uncontrolled. Follow-up ranged between 1 month and 24 months, however, one study only reported data on the assessment immediately after the intervention. Sample sizes ranged between 20 and 185 current smokers. Smoking cessation strategies included: 1) brief advice and nicotine replacement therapy + smoking cessation counseling for 3 months; 2) information booklet on harms of smoking (i.e., impact on disease and treatment); 3) spoken information on harms of smoking (i.e., impact on disease and treatment) plus advice to quit smoking; 4) advice to quit smoking plus nicotine replacement; 5) smoking cessation support with contact every 4 weeks; 6) spoken information on harms of smoking (i.e., impact on disease and treatment) plus advice to quit smoking plus nurse telephone visit at 3rdmonth; 6) staff driven tobacco QUIT line referral process; 7) multi-modality intervention with advise to quit smoking plus guidance on safe alcohol use plus dietary advise with booklet and swimming group. The lung cancer screening study reported on a program with nurse evaluation of comorbidities and risk factors, and recommendations for lung cancer screening with a chest X-ray and smoking cessation. Most studies reported benefits when implementing a structured plan to educate, counsel, and offer pharmacological treatment to patients with RA.

Conclusion:

There was large heterogeneity among studies in patient characteristics and interventions proposed, and outcomes. Only 2 studies were randomized clinical trials. Additional controlled studies are needed to determine best practices for smoking cessation and lung cancer screening in patients with RA.

Disclosure of Interests:

None declared

A simplified and versatile calibration method for multi-camera optical systems in 3D particle imaging

This article describes a stereoscopic multi-camera calibration method that does not require any optical model. It is based on a measure of the light propagation within the measurement volume only instead of modeling its entire path up to the sensors. The calibration uses simple plane by plane transformations which allow us to directly link pixel coordinates to light rays. The appeal of the proposed method relies on the combination of its simplicity of implementation (it is particularly easy to apply in any sophisticated optical imaging setup), its versatility (it can easily handle index-of-refraction gradients, as well as complex optical arrangements), and its accuracy {we show that the proposed method gives better accuracy than commonly used techniques, based on Tsai's simple pinhole camera model [R. Tsai, J. Rob. Autom. 3, 323 (1987)], while its numerical implementation remains extremely simple}. Based on ideas that have been available in the fluid mechanics community, this method is a compact turn-key algorithm that can be implemented with open-source routines.

Equilibrium position of a rigid sphere in a turbulent jet: A problem of elastic reconfiguration

The position of floating spheres trapped within an immersed turbulent water jet is investigated. Using the self-similarity properties of the jet velocity profile, the equilibrium problem is formulated in a rescaled space where the sphere is static and deformable. This approach is found to be related to a problem of elastic reconfiguration where elasticity arises here from the geometry of the flow instead of an actual deformation of a body.

Estimating two-point statistics from derivatives of a signal containing noise: Application to auto-correlation functions of turbulent Lagrangian tracks

This article describes a method for calculating moments and correlation functions of signal derivatives, which were rid of experimental noise without the use of filtering operations. The method is based on the computation of the ensemble-average of different time (or spatial) increments of the signal. The hypotheses are that the noise is white and not correlated with the signal; however, the method is also shown to work with colored noise. The method is first developed, considering white noise, and benchmarked with synthetic trajectories containing noise with variable signal-to-noise ratios. It is then tested on experimental trajectories in the context of Lagrangian tracking of particles in turbulent flows, either containing a short-correlated noise or a colored noise.

Stochastic dynamics of particles trapped in turbulent flows

The long-time dynamics of large particles trapped in two nonhomogeneous turbulent shear flows is studied experimentally. Both flows present a common feature, a shear region that separates two colliding circulations, but with different spatial symmetries and temporal behaviors. Because large particles are less and less sensitive to flow fluctuations as their size increases, we observe the emergence of a slow dynamics corresponding to back-and-forth motions between two attractors, and a super-slow regime synchronized with flow reversals when they exist. Such dynamics is substantially reproduced by a one-dimensional stochastic model of an overdamped particle trapped in a two-well potential, forced by a colored noise. An extended model is also proposed that reproduces observed dynamics and trapping without potential barrier: the key ingredient is the ratio between the time scales of the noise correlation and the particle dynamics. A total agreement with experiments requires the introduction of spatially nonhomogeneous fluctuations and a suited confinement strength.

Chaotic mixing in effective compressible flows

We study numerically joint mixing of salt and colloids by chaotic advection and how salt inhomogeneities accelerate or delay colloid mixing by inducing a velocity drift V(dp) between colloids and fluid particles as proposed in recent experiments [J. Deseigne et al., Soft Matter 10, 4795 (2014)]. We demonstrate that because the drift velocity is no longer divergence free, small variations to the total velocity field drastically affect the evolution of colloid variance σ(2) = 〈C(2)〉-〈C〉(2). A consequence is that mixing strongly depends on the mutual coherence between colloid and salt concentration fields, the short time evolution of scalar variance being governed by a new variance production term P = -〈C(2)∇ · V(dp)〉/2 when scalar gradients are not developed yet so that dissipation is weak. Depending on initial conditions, mixing is then delayed or enhanced, and it is possible to find examples for which the two regimes (fast mixing followed by slow mixing) are observed consecutively when the variance source term reverses its sign. This is indeed the case for localized patches modeled as Gaussian concentration profiles.

Long-term memory in experiments and numerical simulations of hydrodynamic and magnetohydrodynamic turbulence

We analyze time series stemming from experiments and direct numerical simulations of hydrodynamic and magnetohydrodynamic turbulence. Simulations are done in periodic boxes, but with a volumetric forcing chosen to mimic the geometry of the flow in the experiments, the von Kármán swirling flow between two counterrotating impellers. Parameters in the simulations are chosen to (within computational limitations) allow comparisons between the experiments and the numerical results. Conducting fluids are considered in all cases. Two different configurations are considered: a case with a weak externally imposed magnetic field and a case with self-sustained magnetic fields. Evidence of long-term memory and 1/f noise is observed in experiments and simulations, in the case with weak magnetic field associated with the hydrodynamic behavior of the shear layer in the von Kármán flow, and in the dynamo case associated with slow magnetohydrodynamic behavior of the large-scale magnetic field.

Clustering of finite-size particles in turbulence

We investigate experimentally the spatial distributions of heavy and neutrally buoyant particles of finite size in a fully turbulent flow. Because their Stokes number (i.e., the ratio of the particle viscous relaxation time to a typical flow time scale) is close to unity, one may expect both classes of particles to aggregate in specific flow regions. This is not observed. Using a Voronoï analysis we show that neutrally buoyant particles sample turbulence homogeneously, whereas heavy particles do cluster. These results show that several dimensionless numbers are needed in the modeling (and understanding) of the behavior of particles entrained by turbulent motions.

Chaotic dynamos generated by a turbulent flow of liquid sodium

We report the observation of several dynamical regimes of the magnetic field generated by a turbulent flow of liquid sodium (VKS experiment). Stationary dynamos, transitions to relaxation cycles or to intermittent bursts, and random field reversals occur in a fairly small range of parameters. Large scale dynamics of the magnetic field result from the interactions of a few modes. The low dimensional nature of these dynamics is not smeared out by the very strong turbulent fluctuations of the flow.

Generation of a magnetic field by dynamo action in a turbulent flow of liquid sodium

We report the observation of dynamo action in the von Kármán sodium experiment, i.e., the generation of a magnetic field by a strongly turbulent swirling flow of liquid sodium. Both mean and fluctuating parts of the field are studied. The dynamo threshold corresponds to a magnetic Reynolds number R(m) approximately 30. A mean magnetic field of the order of 40 G is observed 30% above threshold at the flow lateral boundary. The rms fluctuations are larger than the corresponding mean value for two of the components. The scaling of the mean square magnetic field is compared to a prediction previously made for high Reynolds number flows.

Transport of magnetic field by a turbulent flow of liquid sodium

We study the effect of a turbulent flow of liquid sodium generated in the von Kármán geometry, on the localized field of a magnet placed close to the frontier of the flow. We observe that the field can be transported by the flow on distances larger than its integral length scale. In the most turbulent configurations, the mean value of the field advected at large distance vanishes. However, the rms value of the fluctuations increases linearly with the magnetic Reynolds number. The advected field is strongly intermittent.

Induction, helicity, and alpha effect in a toroidal screw flow of liquid gallium

We investigate experimentally induction mechanisms in a screw flow of gallium in a toroidal channel. The flow is nonstationary and operated in a spin-down regime: the channel (and fluid) are initially set into solid body rotation; as the channel is stopped the fluid is set into strong helical motion by diverters located inside the channel. In this study, we put a particular emphasis on the induction generated by these helical motions, which are expected to develop over the entire range of turbulent scales. We apply an external magnetic field either perpendicular to the channel axis parallel to it. At large scales the nonlinear induction mechanisms are associated with the Parker stretch and twist effect and with the expulsion due to overall rotation. Induction mechanisms can also originate in the small scale helicity as in the alpha induction effect of mean-field magnetohydrodynamics. Our measurements yield an upper bound for the alpha coefficient, significantly lower than estimates based on dimensional analysis. We discuss the consequences of our observations for the engineering of homogeneous dynamos in the laboratory.

Backward supercontinuum emission from a filament generated by ultrashort laser pulses in air

Backward emission of the supercontinuum from a light filament induced by high-intensity femtosecond laser pulses propagating in air has been observed to be enhanced compared with linear Rayleigh-Mie scattering. This enhancement is interpreted as a nonlinear scattering process onto longitudinal refractive-index changes induced by the laser pulse itself. The spectral dependence of the supercontinuum angular distribution is also investigated.

Inhibition of ubiquitin-proteasome pathway-mediated I kappa B alpha degradation by a naturally occurring antibacterial peptide

Induction of NF-kappaB-dependent gene expression plays an important role in a number of biological processes including inflammation and ischemia-reperfusion injury. However, few attempts aimed at selective regulation of this transcription factor have been successful. We report here that a naturally occurring antibacterial peptide PR39 reversibly binds to the alpha 7 subunit of the 26S proteasome and blocks degradation of NF-kappa B inhibitor I kappa B alpha by the ubiquitin-proteasome pathway without affecting overall proteasome activity. I kappa B alpha phosphorylation and ubiquitination occur normally after PR39 treatment, and binding of valosin-containing proteins is not impaired. The inhibition of I kappa B alpha degradation abolishes induction of NF-kappa B-dependent gene expression in cell culture and in mouse models of acute pancreatitis and myocardial infarction, including upregulation of endothelial adhesion proteins VCAM-1 and ICAM-1. In the latter model, sustained infusion of PR39 peptide resulted in significant reduction of myocardial infarct size. PR39 and related peptides may provide novel means to regulate cellular function and to control of NF-kappa B-dependent gene expression for therapeutic purposes.

Anti-angiogenic cues from vascular basement membrane collagen

Vascular basement membrane is an important structural component of blood vessels and has been shown to interact with and modulate vascular endothelial behavior during angiogenesis. During the inductive phase of tumor angiogenesis, this membrane undergoes many degradative and structural changes and reorganizes to a native state around newly formed capillaries in the resolution phase. Such matrix changes are potentially associated with molecular modifications that include expression of matrix gene products coupled with conformational changes, which expose cryptic protein modules for interaction with the vascular endothelium. We speculate that these interactions provide important endogenous angiogenic and anti-angiogenic cues. In this report, we identify an important antiangiogenic vascular basement membrane-associated protein, the 26-kDa NC1 domain of the alpha1 chain of type IV collagen, termed arresten. Arresten was isolated from human placenta and produced as a recombinant molecule in Escherichia coli and 293 embryonic kidney cells. We demonstrate that arresten functions as an anti-angiogenic molecule by inhibiting endothelial cell proliferation, migration, tube formation, and Matrigel neovascularization. Arresten inhibits the growth of two human xenograft tumors in nude mice and the development of tumor metastases. Additionally, we show that the anti-angiogenic activity of arresten is potentially mediated via mechanisms involving cell surface proteoglycans and the alpha1beta1 integrin on endothelial cells. Collectively, our results suggest that arresten is a potent inhibitor of angiogenesis with a potential for therapeutic use.

PR39, a peptide regulator of angiogenesis

Although tissue injury and inflammation are considered essential for the induction of angiogenesis, the molecular controls of this cascade are mostly unknown. Here we show that a macrophage-derived peptide, PR39, inhibited the ubiquitin-proteasome-dependent degradation of hypoxia-inducible factor-1alpha protein, resulting in accelerated formation of vascular structures in vitro and increased myocardial vasculature in mice. For the latter, coronary flow studies demonstrated that PR39-induced angiogenesis resulted in the production of functional blood vessels. These findings show that PR39 and related compounds can be used as potent inductors of angiogenesis, and that selective inhibition of hypoxia-inducible factor-1alpha degradation may underlie the mechanism of inflammation-induced angiogenesis.