Radiation recall dermatitis during treatment of endometrial cancer with pembrolizumab plus lenvatinib: A case report

Radiation Recall encompasses an array of inflammatory reactions, most commonly dermatitis, that occurs in response to a systemic medication with distribution in a previously irradiated field. While historically cytotoxic chemotherapy was a major culprit, this case report describes radiation recall dermatitis in response to pembrolizumab and lenvatinib in a 62-year old female with ongoing advanced endometrial cancer and history of breast cancer. Discontinuation of lenvatinib alone lead to complete resolution of the dermatitis, and she ultimately resumed her previous lenvatinib dose without recurrent symptoms. This case represents an important possible adverse effect of a commonly used targeted therapy, particularly in a population likely to have a history of prior radiation exposure

Climate warming alters photosynthetic responses to elevated CO2 in prairie plants

Premise: The impact of elevated CO2 concentration ([CO2]) and climate warming on plant productivity in dryland ecosystems is influenced strongly by soil moisture availability. We predicted that the influence of warming on the stimulation of photosynthesis by elevated [CO2] in prairie plants would operate primarily through direct and indirect effects on soil water. Methods: We measured light-saturated photosynthesis (Anet), stomatal conductance (gs), maximum Rubisco carboxylation rate (Vcmax), maximum electron transport capacity (Jmax) and related variables in four C3 plant species in the Prairie Heating and CO2 Enrichment (PHACE) experiment in southeastern Wyoming. Measurements were conducted over two growing seasons that differed in the amount of precipitation and soil moisture content. Results: Anet in the C3 subshrub Artemisia frigida and the C3 forb Sphaeralcea coccinea was stimulated by elevated [CO2] under ambient and warmed temperature treatments. Warming by itself reduced Anet in all species during the dry year, but stimulated photosynthesis in S. coccinea in the wet year. In contrast, Anet in the C3 grass Pascopyrum smithii was not stimulated by elevated [CO2] or warming under wet or dry conditions. Photosynthetic downregulation under elevated [CO2] in this species countered the potential stimulatory effect under improved water relations. Warming also reduced the magnitude of CO2-induced down-regulation in this grass, possibly by sustaining high levels of carbon utilization. Conclusions: Direct and indirect effects of elevated [CO2] and warming on soil water was an overriding factor influencing patterns of Anet in this semi-arid temperate grassland, emphasizing the important role of water relations in driving grassland responses to global change

Elevated carbon dioxide alters impacts of precipitation pulses on ecosystem photosynthesis and respiration in a semi-arid grassland

Predicting net C balance under future global change scenarios requires a comprehensive understanding of how ecosystem photosynthesis (gross primary production; GPP) and respiration (Re) respond to elevated atmospheric [CO2] and altered water availability. We measured net ecosystem exchange of CO2 (NEE), GPP and Re under ambient and elevated [CO2] in a northern mixed-grass prairie (Wyoming, USA) during dry intervals and in response to simulated precipitation pulse events. Elevated [CO2] resulted in higher rates of both GPP and Re across the 2006 growing season, and the balance of these two fluxes (NEE) accounted for cumulative growing season C uptake (-14.4 ± 8.3 g C m-2). Despite lower GPP and Re, experimental plots under ambient [CO2] had greater cumulative uptake (-36.2 ± 8.2 g C m-2) than plots under elevated [CO2]. Non-irrigated control plots received 50% of average precipitation during the drought of 2006, and had near-zero NEE (1.9 ± 6.4 g C m-2) for the growing season. Elevated [CO2] extended the magnitude and duration of pulse-related increases in GPP, resulting in a significant [CO2] treatment by pulse day interaction, demonstrating the potential for elevated [CO2] to increase the capacity of this ecosystem to respond to late-season precipitation. However, stimulation of Re throughout the growing season under elevated [CO2] reduced net C uptake compared to plots under ambient [CO2]. These results indicate that although elevated [CO2] stimulates gross rates of ecosystem C fluxes, it does not necessarily enhance net C uptake, and that C cycle responses in semi-arid grasslands are likely to be more sensitive to changes in precipitation than atmospheric [CO2]

Validation of prognosis-based in vitro fertilization grant selection criteria

Objective: To validate a prognosis-based scoring system for in vitro fertilization (IVF) grant allocation. Design: Retrospective cohort study. Setting: A 501(c)(3) nonprofit foundation that awards donated IVF cycles and grants to those with demonstrated financial need. In contrast to lottery-based or subjective allocation systems, applications are scored according to medical prognostic criteria in addition to personal characteristics. Patients: Grant recipients from 2015 to 2019. Interventions: None. Main outcome measures: Live birth rate (LBR) and cumulative LBR (CLBR) among grant recipients were compared with 2019 Society for Assisted Reproductive Technology (SART) national averages. Results: A total of 435 applications were reviewed, with 59 grants awarded for 51 autologous IVF cycles, 6 donor oocyte cycles, and 2 gestational carrier cycles, resulting in 39 live births after initial embryo transfer (LBR 61.9%) and 43 CLBRs (CLBR 72.9%). Among autologous cycles, the mean (±SD=3.9 years) age was 31.8 years, and LBR and CLBR were 62.8% and 68.6% vs. 28.2% and 37.1% among all autologous SART cycles, respectively. A subanalysis of grant recipients aged <35 years (n=39) revealed LBR and CLBR of 66.7% and 74.4% vs. 40.7% and 47.8% among autologous SART cycles aged <35 years, respectively. Conclusions: A scoring system incorporating medical criteria identified IVF grant applicants with a high likelihood of achieving a LB. Although most IVF grant programs select recipients through a lottery or personal characteristics, a prognosis-based scoring system should be considered to maximize LBR in a limited resource setting

Warming Reduces Carbon Losses from Grassland Exposed to Elevated Atmospheric Carbon Dioxide

<div><p>The flux of carbon dioxide (CO₂) between terrestrial ecosystems and the atmosphere may ameliorate or exacerbate climate change, depending on the relative responses of ecosystem photosynthesis and respiration to warming temperatures, rising atmospheric CO₂, and altered precipitation. The combined effect of these global change factors is especially uncertain because of their potential for interactions and indirectly mediated conditions such as soil moisture. Here, we present observations of CO₂ fluxes from a multi-factor experiment in semi-arid grassland that suggests a potentially strong climate – carbon cycle feedback under combined elevated [CO₂] and warming. Elevated [CO₂] alone, and in combination with warming, enhanced ecosystem respiration to a greater extent than photosynthesis, resulting in net C loss over four years. The effect of warming was to reduce respiration especially during years of below-average precipitation, by partially offsetting the effect of elevated [CO₂] on soil moisture and C cycling. Carbon losses were explained partly by stimulated decomposition of soil organic matter with elevated [CO₂]. The climate – carbon cycle feedback observed in this semiarid grassland was mediated by soil water content, which was reduced by warming and increased by elevated [CO₂]. Ecosystem models should incorporate direct and indirect effects of climate change on soil water content in order to accurately predict terrestrial feedbacks and long-term storage of C in soil.</p></div

Seasonal patterns of global change effects on C fluxes.

<p>Cumulative effects of global changes on gross ecosystem production (P_eco; g m⁻² yr⁻¹) and ecosystem respiration (R_eco; g m⁻² yr⁻¹) in 2007–2010 at the Prairie Heating and CO₂ Enrichment Experiment (PHACE) in Cheyenne, WY USA. Treatment effects are differences from ambient values for each year of the experiment with increases in fluxes expressed as “stimulation” and decreases in fluxes expressed as “suppression.” Data are expressed as cumulative across the growing season with the CO₂ effect in blue, warming effect in red, CO₂×warming interactive effect in purple, and irrigation effect in green. Daily precipitation amounts are depicted in the bottom panel. Both annual and growing season precipitation totals (in parentheses) are included for each year.</p

Growing season carbon fluxes in response to global changes.

<p>Growing season sums (April–October, 2006–2010) for <b>A)</b> gross ecosystem production (P_eco), <b>B)</b> ecosystem respiration (R_eco) and heterotrophic respiration (Rh) inset white bars, and <b>C)</b> net ecosystem production (NEP) for control and global change treatments at the Prairie Heating and CO₂ Enrichment Experiment in Cheyenne, WY USA. Negative (–) values indicate C uptake and positive (+) values indicate C efflux. Treatment codes are: ct = ambient [CO₂] and temperature, cT = ambient [CO₂] and warming, Ct = elevated [CO₂] and ambient temperature, and CT = elevated [CO₂] and warming. Statistically significant main and interactive treatment effects (within a given year) along with p-values are indicated (n = 5 for all measurements).</p

C4 grasses prosper as carbon dioxide eliminates desiccation in warmed semi-arid grassland

Global warming is predicted to induce desiccation in many world regions through increases in evaporative demand. Rising CO2 may counter that trend by improving plant water-use efficiency. However, it is not clear how important this CO2-enhanced water use efficiency might be in offsetting warming-induced desiccation because higher CO2 also leads to higher plant biomass, and therefore greater transpirational surface. Furthermore, although warming is predicted to favour warm-season, C4 grasses, rising CO2 should favour C3, or cool-season plants. Here we show in a semi-arid grassland that elevated CO2 can completely reverse the desiccating effects of moderate warming. Although enrichment of air to 600 p.p.m.v. CO2 increased soil water content (SWC), 1.5/3.0 °C day/night warming resulted in desiccation, such that combined CO2 enrichment and warming had no effect on SWC relative to control plots. As predicted, elevated CO2 favoured C3 grasses and enhanced stand productivity, whereas warming favoured C4 grasses. Combined warming and CO2 enrichment stimulated above-ground growth of C4 grasses in 2 of 3 years when soil moisture most limited plant productivity. The results indicate that in a warmer, CO 2-enriched world, both SWC and productivity in semi-arid grasslands may be higher than previously expected