BRAF Mutations in Advanced Cancers: Clinical Characteristics and Outcomes

BACKGROUND: Oncogenic BRAF mutations have been found in diverse malignancies and activate RAF/MEK/ERK signaling, a critical pathway of tumorigenesis. We examined the clinical characteristics and outcomes of patients with mutant (mut) BRAF advanced cancer referred to phase 1 clinic. METHODS: We reviewed the records of 80 consecutive patients with mutBRAF advanced malignancies and 149 with wild-type (wt) BRAF (matched by tumor type) referred to the Clinical Center for Targeted Therapy and analyzed their outcome. RESULTS: Of 80 patients with mutBRAF advanced cancer, 56 had melanoma, 10 colorectal, 11 papillary thyroid, 2 ovarian and 1 esophageal cancer. Mutations in codon 600 were found in 77 patients (62, V600E; 13, V600K; 1, V600R; 1, unreported). Multivariate analysis showed less soft tissue (Odds ratio (OR) = 0.39, 95%CI: 0.20-0.77, P = 0.007), lung (OR = 0.38, 95%CI: 0.19-0.73, p = 0.004) and retroperitoneal metastases (OR = 0.34, 95%CI: 0.13-0.86, p = 0.024) and more brain metastases (OR = 2.05, 95%CI: 1.02-4.11, P = 0.043) in patients with mutBRAF versus wtBRAF. Comparing to the corresponding wtBRAF, mutBRAF melanoma patients had insignificant trend to longer median survival from diagnosis (131 vs. 78 months, p = 0.14), while mutBRAF colorectal cancer patients had an insignificant trend to shorter median survival from diagnosis (48 vs. 53 months, p = 0.22). In melanoma, V600K mutations in comparison to other BRAF mutations were associated with more frequent brain (75% vs. 36.3%, p = 0.02) and lung metastases (91.6% vs. 47.7%, p = 0.007), and shorter time from diagnosis to metastasis and to death (19 vs. 53 months, p = 0.046 and 78 vs. 322 months, p = 0.024 respectively). Treatment with RAF/MEK targeting agents (Hazard ratio (HR) = 0.16, 95%CI: 0.03-0.89, p = 0.037) and any decrease in tumor size after referral (HR = 0.07, 95%CI: 0.015-0.35, p = 0.001) correlated with longer survival in mutBRAF patients. CONCLUSIONS: BRAF appears to be a druggable mutation that also defines subgroups of patients with phenotypic overlap, albeit with differences that correlate with histology or site of mutation

1974

History of Golf (1) The Nine Toughest Holes in the World (2) Stockie Madness (3) Bartender, One More Round for Pythium (3) Panel: 1973 Turf Problems in Review - 1974 Possible Remedies (A1-A12) Movement of Water to a Holding Pond (A13) Maintenance of Low Budget, Short Season Golf Courses (A16) Turfgrass Fertilization (A18) Determining Turfgrass Fertilizer Needs (A25) Shortage of Plant Food and How to Adjust to Supply and Cost (A29) Panel: Tricalcium Arsenate - Use and Abuse (A33-A46) Operating and Maintaining Municipal Golf Courses (A48) Maintenance of a High Budget Golf Course (A51) Trends in Agricultural Education and Where Are the Emphases (A58) Maintenance of Municipal Parks and Recreation Areas (A60) Maintenance of Grass Tennis Courts (A63) Transition from Natural to Artificial Turf (A67) Plant materials for Outlying Areas (A71) Care of University Grounds (A76) Maintenance of Industrial Sites (A79) Turfgrass Diseases and Systemic Fungicides (A81) A Look at the Future (A 84) Watering of Golf Course Turf (A92

1973

Skunks Shoot Back by William Stewart (page 1) The Daily Plan: A Management Factor by Rob McIntyre (2) Teed Off by Samuel Pavadore (3) A Responsible Neighbor by Gerald Moscato (4) Drainage by David Clement (A-1) Fairway Renovation at Baltusrol Golf Club by Joseph R. Flaherty (A-4) Converting to Kentucky Bluegrass Fairways by Thomas Rewinski (A-10) Grooming the Golf Course by Melvin B. Lucas, Jr. (A-12) Turf Diseases of 1972, Controls and Prevention for 1973 by Stanley J. Zontek (A-13) Noncropland Weed Control by John E. Gallagher (A-16) Soil Factors Affecting Arsenic Toxicity by Robert N. Carrow (A-24) The Necessity of Cart Paths and Traffic Regulations by William G. Buchanan (A-27) Herbicides for Turfgrass Areas by John A. Jagschitz (A-29) Perspectives on Lawn Making and Keeping by Robert Schery (A-33) Stadium Turf Maintenance by George P. Toma (A-39) Highway Turfgrass by Robert W. Duell (A-44) Cemetery Maintenance by Martin Stolpe (A-50) Keeping Records by Al Barauskas (A-54) Planning Capital Expenditures by Sherwood A. Moore (A-59) British Golf Course Architecture -Historical Influences- Current Trends by F.W. Hawtree (A-64) Golf Course Architecture in North America By Geoffrey S. Cornish (A-70

A Low Matter Density Decaying Vacuum Cosmology from Complex Metric

A low matter density decaying vacuum cosmology is proposed on the assumption that the universe's radius is a complex quantity \hat{R} if it is regarded as having a zero energy-momentum tensor. But we find that when the radius is real, it contains matter. Using the Einstein-Hilbert action principle, the physical scale factor R(t) =|\hat{R}| is obtained as equal to (R_0^{2} + t^{2})^{1/2} with R_0 representing the finite radius of the universe at t=0. The resulting physical picture is roughly a theoretical justification of the old Ozer-Taha model. The new model is devoid of all cosmological problems. In particular, it confirms the bounds on H_p, the present value of the Hubble parameter: 0.85 < H_p t_p < 1.91 and faces no age problem. We argue that the total energy density consists of parts corresponding to relativistic/non-relativistic matter, a positive vacuum energy and a form of matter with equation of state p_K = -(1/3) rho_K (textures or generally K-matter), and the following predictions are made for the present nonrelativistic era: Omega_{M,n.rel.} \approx 2/3, Omega_{V,n.rel.} \approx 1/3, Omega_ <<1, Omega_K \approx 1, where a parameter corresponding to K-matter is taken to be unity. It is shown that the spacetime with complex metric has signature changing properties. Using quantum cosmological considerations, it is shown that the wave function is peaked about the classical contour of evolution and the minimum radius R_0 of the nonsingular model is predicted as comparable with the Planck length. PACS No(s); 98.80 Hw, 04.20, 04.60Comment: 21 pages, no figure

The Behavioral Roots of Information Systems Security:Exploring Key Factors Related to Unethical IT Use

Unethical information technology (IT) use, related to activities such as hacking, software piracy, phishing, and spoofing, has become a major security concern for individuals, organizations, and society in terms of the threat to information systems (IS) security. While there is a growing body of work on this phenomenon, we notice several gaps, limitations, and inconsistencies in the literature. In order to further understand this complex phenomenon and reconcile past findings, we conduct an exploratory study to uncover the nomological network of key constructs salient to this phenomenon, and the nature of their interrelationships. Using a scenario-based study of young adult participants, and both linear and nonlinear analyses, we uncover key nuances of this phenomenon of unethical IT use. We find that unethical IT use is a complex phenomenon, often characterized by nonlinear and idiosyncratic relationships between the constructs that capture it. Overall, ethical beliefs held by the individuals, along with economic, social, and technological considerations are found to be relevant to this phenomenon. In terms of practical implications, these results suggest that multiple interventions at various levels may be required to combat this growing threat to IS security

Therapy for metastatic melanoma: the past, present, and future

Metastatic melanoma is the most aggressive form of skin cancer with a median overall survival of less than one year. Advancements in our understanding of how melanoma evades the immune system as well as the recognition that melanoma is a molecularly heterogeneous disease have led to major improvements in the treatment of patients with metastatic melanoma. In 2011, the US Food and Drug Administration (FDA) approved two novel therapies for advanced melanoma: a BRAF inhibitor, vemurafenib, and an immune stimulatory agent, ipilimumab. The success of these agents has injected excitement and hope into patients and clinicians and, while these therapies have their limitations, they will likely provide excellent building blocks for the next generation of therapies. In this review we will discuss the advantages and limitations of the two new approved agents, current clinical trials designed to overcome these limitations, and future clinical trials that we feel hold the most promise

MRC chronic Dyspnea Scale: Relationships with cardiopulmonary exercise testing and 6-minute walk test in idiopathic pulmonary fibrosis patients: a prospective study

<p>Abstract</p> <p>Background</p> <p>Exertional dyspnea is the most prominent and disabling feature in idiopathic pulmonary fibrosis (IPF). The Medical Research Chronic (MRC) chronic dyspnea score as well as physiological measurements obtained during cardiopulmonary exercise testing (CPET) and the 6-minute walk test (6MWT) are shown to provide information on the severity and survival of disease.</p> <p>Methods</p> <p>We prospectively recruited IPF patients and examined the relationship between the MRC score and either CPET or 6MWT parameters known to reflect physiologic derangements limiting exercise capacity in IPF patients</p> <p>Results</p> <p>Twenty-five patients with IPF were included in the study. Significant correlations were found between the MRC score and the distance (r = -.781, p < 0.001), the SPO₂at the initiation and the end (r = -.542, p = 0.005 and r = -.713, p < 0.001 respectively) and the desaturation index (r = .634, p = 0.001) for the 6MWT; the MRC score and <it>V</it>O₂peak/kg (r = -.731, p < 0.001), SPO₂at peak exercise (r = -. 682, p < 0.001), VE/VCO₂slope (r = .731, p < 0.001), VE/VCO₂at AT (r = .630, p = 0.002) and the Borg scale at peak exercise (r = .50, p = 0.01) for the CPET. In multiple logistic regression analysis, the only variable independently related to the MRC is the distance walked at the 6MWT.</p> <p>Conclusion</p> <p>In this population of IPF patients a good correlation was found between the MRC chronic dyspnoea score and physiological parameters obtained during maximal and submaximal exercise testing known to reflect ventilatory impairment and exercise limitation as well as disease severity and survival. This finding is described for the first time in the literature in this group of patients as far as we know and could explain why a simple chronic dyspnea score provides reliable prognostic information on IPF.</p

The impact of viral mutations on recognition by SARS-CoV-2 specific T cells.

We identify amino acid variants within dominant SARS-CoV-2 T cell epitopes by interrogating global sequence data. Several variants within nucleocapsid and ORF3a epitopes have arisen independently in multiple lineages and result in loss of recognition by epitope-specific T cells assessed by IFN-γ and cytotoxic killing assays. Complete loss of T cell responsiveness was seen due to Q213K in the A∗01:01-restricted CD8+ ORF3a epitope FTSDYYQLY207-215; due to P13L, P13S, and P13T in the B∗27:05-restricted CD8+ nucleocapsid epitope QRNAPRITF9-17; and due to T362I and P365S in the A∗03:01/A∗11:01-restricted CD8+ nucleocapsid epitope KTFPPTEPK361-369. CD8+ T cell lines unable to recognize variant epitopes have diverse T cell receptor repertoires. These data demonstrate the potential for T cell evasion and highlight the need for ongoing surveillance for variants capable of escaping T cell as well as humoral immunity.This work is supported by the UK Medical Research Council (MRC); Chinese Academy of Medical Sciences(CAMS) Innovation Fund for Medical Sciences (CIFMS), China; National Institute for Health Research (NIHR)Oxford Biomedical Research Centre, and UK Researchand Innovation (UKRI)/NIHR through the UK Coro-navirus Immunology Consortium (UK-CIC). Sequencing of SARS-CoV-2 samples and collation of data wasundertaken by the COG-UK CONSORTIUM. COG-UK is supported by funding from the Medical ResearchCouncil (MRC) part of UK Research & Innovation (UKRI),the National Institute of Health Research (NIHR),and Genome Research Limited, operating as the Wellcome Sanger Institute. T.I.d.S. is supported by a Well-come Trust Intermediate Clinical Fellowship (110058/Z/15/Z). L.T. is supported by the Wellcome Trust(grant number 205228/Z/16/Z) and by theUniversity of Liverpool Centre for Excellence in Infectious DiseaseResearch (CEIDR). S.D. is funded by an NIHR GlobalResearch Professorship (NIHR300791). L.T. and S.C.M.are also supported by the U.S. Food and Drug Administration Medical Countermeasures Initiative contract75F40120C00085 and the National Institute for Health Research Health Protection Research Unit (HPRU) inEmerging and Zoonotic Infections (NIHR200907) at University of Liverpool inpartnership with Public HealthEngland (PHE), in collaboration with Liverpool School of Tropical Medicine and the University of Oxford.L.T. is based at the University of Liverpool. M.D.P. is funded by the NIHR Sheffield Biomedical ResearchCentre (BRC – IS-BRC-1215-20017). ISARIC4C is supported by the MRC (grant no MC_PC_19059). J.C.K.is a Wellcome Investigator (WT204969/Z/16/Z) and supported by NIHR Oxford Biomedical Research Centreand CIFMS. The views expressed are those of the authors and not necessarily those of the NIHR or MRC

Idiopathic Interstitial Pneumonia: What Is the Effect of a Multidisciplinary Approach to Diagnosis?

Current guidelines recommend that the clinician, radiologist, and pathologist work together to establish a diagnosis of idiopathic interstitial pneumonia. Three clinicians, two radiologists, and two pathologists reviewed 58 consecutive cases of suspected idiopathic interstitial pneumonia. Each participant was provided information in a sequential manner and was asked to record their diagnostic impression and level of confidence at each step. Interobserver agreement improved from the beginning to the end of the review. After the presentation of histopathologic information, radiologists changed their diagnostic impression more often than did clinicians. In general, as more information was provided the confidence level for a given diagnosis improved, and the diagnoses rendered with a high level of confidence were more likely congruent with the final pathologic consensus diagnosis. The final consensus pathologist diagnosis was idiopathic pulmonary fibrosis in 30 cases. Clinicians identified 75% and radiologists identified 48% of these cases before presentation of the histopathologic information. Histopathologic information has the greatest impact on the final diagnosis, especially when the initial clinical/radiographic diagnosis is not idiopathic pulmonary fibrosis. We conclude that dynamic interactions between clinicians, radiologists, and pathologists improve interobserver agreement and diagnostic confidence.Supported in part by National Institutes of Health NHLBI grant P50HL46487, NIH/ NCRR 3 MO1 RR00042-33S3, NIH/NIA P60 AG08808-06, NHLBI, 1 K24 HL04212, and 1 K23 HL68713.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91971/1/2004 AJRCCM Idiopathic interstitial pneumonia - What is the effect of a multidisciplinary approach to diagnosis.pd

FJ: Idiopathic interstitial pneumonia: what is the effect of a multidisciplinary approach to diagnosis? Am J Respir Crit Care Med 2004

Current guidelines recommend that the clinician, radiologist, and pathologist work together to establish a diagnosis of idiopathic interstitial pneumonia. Three clinicians, two radiologists, and two pathologists reviewed 58 consecutive cases of suspected idiopathic interstitial pneumonia. Each participant was provided information in a sequential manner and was asked to record their diagnostic impression and level of confidence at each step. Interobserver agreement improved from the beginning to the end of the review. After the presentation of histopathologic information, radiologists changed their diagnostic impression more often than did clinicians. In general, as more information was provided the confidence level for a given diagnosis improved, and the diagnoses rendered with a high level of confidence were more likely congruent with the final pathologic consensus diagnosis. The final consensus pathologist diagnosis was idiopathic pulmonary fibrosis in 30 cases. Clinicians identified 75% and radiologists identified 48% of these cases before presentation of the histopathologic information. Histopathologic information has the greatest impact on the final diagnosis, especially when the initial clinical/radiographic diagnosis is not idiopathic pulmonary fibrosis. We conclude that dynamic interactions between clinicians, radiologists, and pathologists improve interobserver agreement and diagnostic confidence. Keywords: diagnosis; nonspecific interstitial pneumonia; usual interstitial pneumonia Histopathologic subsets of idiopathic interstitial pneumonia exhibit different prognoses (1-8). Therefore, an accurate diagnosis is critical to the management of patients with idiopathic interstitial pneumonia. Clinical features, high-resolution computed tomography (HRCT) (9-12), and surgical lung biopsy (13) all play a role in establishing a diagnosis. An American Thoracic Society/ European Respiratory Society (ATS/ERS) committee emphasized the need for a dynamic diagnostic integrated process in which clinicians, radiologists, and pathologists exchange information in the determination of a diagnosis in individual patients with suspected idiopathic interstitial pneumonia (14). Using histology alone as the &quot;gold standard&quot; for diagnosis can be complicated by difficulties with interrater agreement (15) and the potential for sampling error (2). The combination of HRCT and histologic features also better predicts prognosis compared with either modality alone (16). In the current study, we hypothesized that an interactive process would improve the interobserver agreement between expert clinicians, radiologists, and pathologists in consecutive patients with suspected idiopathic interstitial pneumonia compared with each group working in diagnostic isolation. This study illustrates that a consensus diagnosis, reached after a careful exchange of clinical, radiographic, and histopathologic information, often differs from the initial diagnosis reached by the individual clinician, radiologist, or pathologist working in isolation. Some of these results have been previously reported in the form of an abstract (17, 18). . Through the course of evaluation all patients underwent a history, physical examination, complete pulmonary function testing, HRCT, and surgical lung biopsy. Patients without an HRCT scan or a surgical lung biopsy were excluded. Patients with known collagen vascular disease at the time of presentation were excluded. Patients without collagen vascular disease at initial presentation, but that developed a discrete collagen vascular disease during the course of follow-up, were included. METHODS Data Collection A standard form was used to collect clinical information including symptoms, environmental exposures, comorbid illnesses, medication use, smoking history, family history, physical examination findings, and serologic data. Pulmonary function data (spirometry, lung volumes, and diffusion capacity for carbon monoxide) and HRCT within 6 months of surgical lung biopsy were reviewed. Pathology Interpretation Two expert pulmonary pathologists (T.C. and W.T.) individually reviewed each patient&apos;s surgical lung biopsy without clinical or HRCT information. The slides from each patient&apos;s surgical lung biopsy were independently reviewed by the two pathologists before the study meeting. At the study meeting, during Steps 1-3 (see below) the pathologists were physically separated from the clinicians and radiologists and resolved individual differences in histopathologic opinion through joint review and a consensus histopathologic diagnosis was reached. Study Organizational Scheme The overall study format was designed to evaluate whether the addition of specific clinical, radiographic, and pathologic information impacted the diagnostic impression of each participant. Participants met at the University of Michigan and were given information in a stepwise fashion as outlined below and i