Initial experience of TAS-102 chemotherapy in Australian patients with Chemo-refractory metastatic colorectal cancer

For patients with refractory metastatic colorectal cancer (mCRC) treatment with Trifluridine/Tipiracil, also known as TAS-102, improves overall survival. This study aims to investigate the efficacy and safety of TAS-102 in a real-world population from Victoria, Australia. A retrospective analysis of prospectively collected data from the Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) registry was undertaken. The characteristics and outcomes of patients receiving TAS-102 were assessed and compared to those enrolled in the registration study (RECOURSE). Across 13 sites, 107 patients were treated with TAS-102. The median age was 60 years (range: 31-83), compared to 63 for RECOURSE. Comparing registry TAS-102-treated and RECOURSE patients, 75% vs 100% were ECOG performance status 0-1, 74% vs 79% had initiated treatment more than 18 months from diagnosis of metastatic disease and 36% vs 49% were RAS wild-type. Median time on treatment was 10.4 weeks (range: 1.7-32). Median progression-free survival (PFS) was 3.3 months compared to 2 months in RECOURSE, while median overall survival was the same at 7.1 months. Two patients (2.3%) had febrile neutropenia and there were no treatment-related deaths, where TAS-102 dose at treatment initiation was at clinician discretion.TRACC registry patients treated with TAS-102 were younger than those from the RECOURSE trial, with similar overall survival observed. Less strict application of RECIST criteria and less frequent imaging may have contributed to an apparently longer PFS.

Alterations of a serum marker of collagen X in growing children with osteogenesis imperfecta

Abnormalities in the structure and/or processing of type I collagen cause osteogenesis imperfecta and result in bone fragility, abnormal bone growth and short stature. Type I collagen is expressed in the growth plate but the mechanisms by which abnormalities in collagen I contribute to growth plate dysfunction and growth retardation are unknown. The non-collagenous domain (NC1) of type X collagen (CXM) is released from the hypertrophic zone of active growth plates and is a marker for new endochondral bone formation. Serum CXM levels are strongly correlated with the rate of growth in healthy children. We hypothesized that CXM levels in children with OI would be abnormal when compared to normally growing children. Using participants from the Brittle Bone Disease Consortium Natural History Study we analyzed the distribution of CXM over the ages of 8 months to 40 years in 187 subjects with OI (89 type I and 98 types III/IV) as well as analyzed the relationship between growth velocity and CXM levels in a subset of 100 children <16 years old with OI (44 type I and 56 types III/IV). CXM levels in both control and OI children demonstrated a similar pattern of variation by age with higher levels in early life and puberty followed by a post-pubertal drop. However, there was greater variability within the OI cohort and the relationship with growth velocity was weaker. The ratio of CXM level to growth velocity was elevated in children with type III/IV OI compared to controls. These results suggest that the relationship between hypertrophic zone function and the end point of skeletal growth is disrupted in OI.

Interweaving Multimodal Interaction With Flexible Unit Visualizations for Data Exploration

Multimodal interfaces that combine direct manipulation and natural language have shown great promise for data visualization. Such multimodal interfaces allow people to stay in the flow of their visual exploration by leveraging the strengths of one modality to complement the weaknesses of others. In this article, we introduce an approach that interweaves multimodal interaction combining direct manipulation and natural language with flexible unit visualizations. We employ the proposed approach in a proof-of-concept system, DataBreeze. Coupling pen, touch, and speech-based multimodal interaction with flexible unit visualizations, DataBreeze allows people to create and interact with both systematically bound (e.g., scatterplots, unit column charts) and manually customized views, enabling a novel visual data exploration experience. We describe our design process along with DataBreeze's interface and interactions, delineating specific aspects of the design that empower the synergistic use of multiple modalities. We also present a preliminary user study with DataBreeze, highlighting the data exploration patterns that participants employed. Finally, reflecting on our design process and preliminary user study, we discuss future research directions.

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.

Critical view of robotic-assisted transverse abdominal release (r-TAR)

INTRODUCTION

Establishing straightforward and reproducible steps to describe the technique performed with the aid of the robotic system for complex hernia surgery is key for good outcomes. Even using the description of open surgery as a parameter for performing the robotic technique, it is important to stress the particularities of this access. To describe the steps to perform robotic-assisted TAR (r-TAR) in a standardized technique, with a critical and safe view of all the anatomical structures.

DESCRIPTION OF THE TECHNIQUE

We defined 8 landmarks for the critical view of safety in r-TAR which include: (1) patient position, trocar and docking; (2) posterior rectus sheath mobilization; (3) transversus abdominis release (TAR)-Top-down technique; (4) transversus abdominis release (TAR)-bottom-up technique and mesh insertion; (5) contralateral trocar insertion and redocking, 6) posterior sheath closure; (7) final mesh positioning; and (8) anterior defect closure and drains.

DISCUSSION

Complex hernia surgery using a robotic-assisted posterior component separation requires well-established steps so the procedure can be reproducible and achieve better results.

Data Visceralization: Enabling Deeper Understanding of Data Using Virtual Reality

A fundamental part of data visualization is transforming data to map abstract information onto visual attributes. While this abstraction is a powerful basis for data visualization, the connection between the representation and the original underlying data (i.e., what the quantities and measurements actually correspond with in reality) can be lost. On the other hand, virtual reality (VR) is being increasingly used to represent real and abstract models as natural experiences to users. In this work, we explore the potential of using VR to help restore the basic understanding of units and measures that are often abstracted away in data visualization in an approach we call data visceralization. By building VR prototypes as design probes, we identify key themes and factors for data visceralization. We do this first through a critical reflection by the authors, then by involving external participants. We find that data visceralization is an engaging way of understanding the qualitative aspects of physical measures and their real-life form, which complements analytical and quantitative understanding commonly gained from data visualization. However, data visceralization is most effective when there is a one-to-one mapping between data and representation, with transformations such as scaling affecting this understanding. We conclude with a discussion of future directions for data visceralization.

MobileVisFixer: Tailoring Web Visualizations for Mobile Phones Leveraging an Explainable Reinforcement Learning Framework

We contribute MobileVisFixer, a new method to make visualizations more mobile-friendly. Although mobile devices have become the primary means of accessing information on the web, many existing visualizations are not optimized for small screens and can lead to a frustrating user experience. Currently, practitioners and researchers have to engage in a tedious and time-consuming process to ensure that their designs scale to screens of different sizes, and existing toolkits and libraries provide little support in diagnosing and repairing issues. To address this challenge, MobileVisFixer automates a mobile-friendly visualization re-design process with a novel reinforcement learning framework. To inform the design of MobileVisFixer, we first collected and analyzed SVG-based visualizations on the web, and identified five common mobile-friendly issues. MobileVisFixer addresses four of these issues on single-view Cartesian visualizations with linear or discrete scales by a Markov Decision Process model that is both generalizable across various visualizations and fully explainable. MobileVisFixer deconstructs charts into declarative formats, and uses a greedy heuristic based on Policy Gradient methods to find solutions to this difficult, multi-criteria optimization problem in reasonable time. In addition, MobileVisFixer can be easily extended with the incorporation of optimization algorithms for data visualizations. Quantitative evaluation on two real-world datasets demonstrates the effectiveness and generalizability of our method.

Macrophage function in the elderly and impact on injury repair and cancer

Older age is associated with deteriorating health, including escalating risk of diseases such as cancer, and a diminished ability to repair following injury. This rise in age-related diseases/co-morbidities is associated with changes to immune function, including in myeloid cells, and is related to immunosenescence. Immunosenescence reflects age-related changes associated with immune dysfunction and is accompanied by low-grade chronic inflammation or inflammageing. This is characterised by increased levels of circulating pro-inflammatory cytokines such as tumor necrosis factor (TNF), interleukin (IL)-1β and IL-6. However, in healthy ageing, there is a concomitant age-related escalation in anti-inflammatory cytokines such as transforming growth factor-β1 (TGF-β1) and IL-10, which may overcompensate to regulate the pro-inflammatory state. Key inflammatory cells, macrophages, play a role in cancer development and injury repair in young hosts, and we propose that their role in ageing in these scenarios may be more profound. Imbalanced pro- and anti-inflammatory factors during ageing may also have a significant influence on macrophage function and further impact the severity of age-related diseases in which macrophages are known to play a key role. In this brief review we summarise studies describing changes to inflammatory function of macrophages (from various tissues and across sexes) during healthy ageing. We also describe age-related diseases/co-morbidities where macrophages are known to play a key role, focussed on injury repair processes and cancer, plus comment briefly on strategies to correct for these age-related changes.

Financial toxicity in lung cancer: an assessment of magnitude, perception, and impact on quality of life

BACKGROUND

Advances in lung cancer therapy have resulted in improved clinical outcomes. Unfortunately, advances can come at a financial cost to patients and their families that poses a significant risk to overall quality of life (QoL). Financial distress has been shown to be associated with increased symptom burden and decreased treatment compliance but the magnitude of financial distress is not well characterized in lung cancer populations.

PATIENTS AND METHODS

Patients with stage II-IV newly diagnosed lung cancer and starting first-line therapy were recruited at a tertiary academic institution between July 2018 and April 2019. The comprehensive score for financial toxicity (COST) was used to assess financial toxicity and the Functional Assessment of Cancer Therapy-Lung (FACT-L) was used to assess QoL. Associations between financial toxicity and baseline variables were assessed using multivariable linear regression and correlations were assessed using the Pearson correlation.

RESULTS

In this study, 143 consecutive patients were approached and 91.6% agreed to participate (N = 131). The median age was 65 years (35-90); 52.7% were male (n = 69), and 75.6% were white (n = 99). The inability to afford basic necessities and having <1 month of savings was associated with increased financial toxicity (P < 0.001) after adjusting for other factors such as age, race, insurance, and income. There was also a trend toward increased financial toxicity among those who were employed but on sick leave (P = 0.06). Increased financial toxicity was correlated with a decrease in QoL (correlation coefficient 0.41, P < 0.001). Patients' anticipated out-of-pocket (OOP) expenses for the upcoming 6 months ranged from $0 to $50 000 (median $2150). However, there was no correlation between anticipated OOP expenses and either financial toxicity or QoL.

CONCLUSIONS

These data identify key factors for identifying at-risk patients and builds a framework for exploring the benefit of financial counseling interventions, which may improve QoL and oncologic outcomes.