Planet formation: The case for large efforts on the computational side

Modern astronomy has finally been able to observe protoplanetary disks in reasonable resolution and detail, unveiling the processes happening during planet formation. These observed processes are understood under the framework of disk-planet interaction, a process studied analytically and modeled numerically for over 40 years. Long a theoreticians' game, the wealth of observational data has been allowing for increasingly stringent tests of the theoretical models. Modeling efforts are crucial to support the interpretation of direct imaging analyses, not just for potential detections but also to put meaningful upper limits on mass accretion rates and other physical quantities in current and future large-scale surveys. This white paper addresses the questions of what efforts on the computational side are required in the next decade to advance our theoretical understanding, explain the observational data, and guide new observations. We identified the nature of accretion, ab initio planet formation, early evolution, and circumplanetary disks as major fields of interest in computational planet formation. We recommend that modelers relax the approximations of alpha-viscosity and isothermal equations of state, on the grounds that these models use flawed assumptions, even if they give good visual qualitative agreement with observations. We similarly recommend that population synthesis move away from 1D hydrodynamics. The computational resources to reach these goals should be developed during the next decade, through improvements in algorithms and the hardware for hybrid CPU/GPU clusters. Coupled with high angular resolution and great line sensitivity in ground based interferometers, ELTs and JWST, these advances in computational efforts should allow for large strides in the field in the next decade.Comment: White paper submitted to the Astro2020 decadal surve

Patients with high-risk DLBCL benefit from dose-dense immunochemotherapy combined with early systemic CNS prophylaxis

Survival of patients with high-risk diffuse large B-cell lymphoma (DLBCL) is suboptimal, and the risk of central nervous system (CNS) progression is relatively high. We conducted a phase 2 trial in 139 patients aged 18 to 64 years who had primary DLBCL with an age-adjusted International Prognostic Index (aaIPI) score of 2 to 3 or site-specific risk factors for CNS recurrence. The goal was to assess whether a dose-dense immunochemotherapy with early systemic CNS prophylaxis improves the outcome and reduces the incidence of CNS events. Treatment consisted of 2 courses of high-dose methotrexate in combination with biweekly rituximab (R), cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP-14), followed by 4 courses of R-CHOP-14 with etoposide (R-CHOEP) and 1 course of high-dose cytarabine with R. In addition, liposomal cytarabine was administered intrathecally at courses 1, 3, and 5. Coprimary endpoints were failure-free survival and CNS progression rates. Thirty-six (26%) patients experienced treatment failure. Progression occurred in 23 (16%) patients, including three (2.2%) CNS events. At 5 years of median follow-up, failure-free survival, overall survival, and CNS progression rates were 74%, 83%, and 2.3%, respectively. Treatment reduced the risk of progression compared with our previous trial, in which systemic CNS prophylaxis was given after 6 courses of biweekly R-CHOEP (hazard ratio, 0.49; 95% CI, 0.31-0.77; P=.002) and overcame the adverse impact of an aaIPI score of 3 on survival. In addition, outcome of the patients with BCL2/MYC double-hit lymphomas was comparable to the patients without the rearrangements. The results are encouraging, with a low toxic death rate, low number of CNS events, and favorable survival rates.Peer reviewe

Planet formation: The case for large efforts on the computational side

Modern astronomy has finally been able to observe protoplanetary disks in reasonable resolution and detail, unveiling the processes happening during planet formation. These observed processes are understood under the framework of disk-planet interaction, a process studied analytically and modeled numerically for over 40 years. Long a theoreticians' game, the wealth of observational data has been allowing for increasingly stringent tests of the theoretical models. Modeling efforts are crucial to support the interpretation of direct imaging analyses, not just for potential detections but also to put meaningful upper limits on mass accretion rates and other physical quantities in current and future large-scale surveys. This white paper addresses the questions of what efforts on the computational side are required in the next decade to advance our theoretical understanding, explain the observational data, and guide new observations. We identified the nature of accretion, ab initio planet formation, early evolution, and circumplanetary disks as major fields of interest in computational planet formation. We recommend that modelers relax the approximations of alpha-viscosity and isothermal equations of state, on the grounds that these models use flawed assumptions, even if they give good visual qualitative agreement with observations. We similarly recommend that population synthesis move away from 1D hydrodynamics. The computational resources to reach these goals should be developed during the next decade, through improvements in algorithms and the hardware for hybrid CPU/GPU clusters. Coupled with high angular resolution and great line sensitivity in ground based interferometers, ELTs and JWST, these advances in computational efforts should allow for large strides in the field in the next decade

Immune cell constitution in the tumor microenvironment predicts the outcome in diffuse large B-cell lymphoma

The tumor microenvironment (TME) and limited immune surveillance play important roles in lymphoma pathogenesis. Here we aimed to characterize immunological profiles of diffuse large B-cell lymphoma (DLBCL) and predict the outcome in response to immunochemotherapy. We profiled the expression of 730 immune-related genes in tumor tissues of 81 patients with DLBCL utilizing the Nanostring platform, and used multiplex immunohistochemistry to characterize T-cell phenotypes, including cytotoxic T cells (CD8, Granzyme B, OX40, Ki67), T-cell immune checkpoint (CD3, CD4, CD8, PD1, TIM3, LAG3), as well as regulatory T-cells and T(h)1 effector cells (CD3, CD4, FOXP3, TBET) in 188 patients. We observed a high degree of heterogeneity at the transcriptome level. Correlation matrix analysis identified gene expression signatures with highly correlating genes, the main cluster containing genes for cytolytic factors, immune checkpoint molecules, T cells and macrophages, together named a TME immune cell signature. Immunophenotyping of the distinct cell subsets revealed that a high proportion of immune checkpoint positive T cells translated to unfavorable survival. Together, our results demonstrate that the immunological profile of DLBCL TME is heterogeneous and clinically meaningful. This highlights the potential impact of T-cell immune checkpoint in regulating survival and resistance to immunochemotherapy.Peer reviewe

Patients in complete remission after R-CHOP(-like) therapy for diffuse large B-cell lymphoma have limited excess use of health care services in Denmark

For most patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL), R-CHOP immunochemotherapy leads to complete remission and 60-70% of patients remain progression-free after 5 years. Given a median age of 65, it is relevant to disentangle how DLBCL and DLBCL therapy influence health care use among the survivors. In this nationwide study, the health care use among Danish DLBCL patients diagnosed in 2007-2015, who achieved complete remission after R-CHOP(-like) therapy, was explored and compared to matched comparators from the Danish general population. The post-remission 5-year risk of hospitalization was significantly higher among DLBCL survivors (55%) compared to matched comparators (49%, P < 0.001). DLBCL survivors had on average 10.3 (9.3-11.3) inpatient bed days within 5 years of response evaluation, whereas matched comparators had 8.4 (7.9-8.8). The rate of outpatient visits was also significantly higher(excluding routine follow-up visits, incidence rate ratio, 1.3, P < 0.001), but translated into only a very small absolute difference of <1 outpatient visits within 5 years between DLBCL survivors (4.2 visits, 95% CI, 4.0-4.4) and matched comparators (3.8 visits, 95% CI, 3.7-3.9). In conclusion, DLBCL survivors have an increased incidence of hospital visits due to a wide range of conditions, but in absolute terms the excess use of health care services in DLBCL survivors was small

Estimation of Admission D-dimer Cut-off Value to Predict Venous Thrombotic Events in Hospitalized COVID-19 Patients: Analysis of the SEMI-COVID-19 Registry.

Venous thrombotic events (VTE) are frequent in COVID-19, and elevated plasma D-dimer (pDd) and dyspnea are common in both entities. To determine the admission pDd cut-off value associated with in-hospital VTE in patients with COVID-19. Multicenter, retrospective study analyzing the at-admission pDd cut-off value to predict VTE and anticoagulation intensity along hospitalization due to COVID-19. Among 9386 patients, 2.2% had VTE: 1.6% pulmonary embolism (PE), 0.4% deep vein thrombosis (DVT), and 0.2% both. Those with VTE had a higher prevalence of tachypnea (42.9% vs. 31.1%; p = 0.0005), basal O2 saturation 1.0 μg/ml treated with prophylactic dose (p 2.0 μg/ml treated with intermediate dose (p = 0.0001), and 31.3% for those with pDd >3.0 μg/ml and full anticoagulation (p = 0.0183). In hospitalized patients with COVID-19, a pDd value greater than 3.0 μg/ml can be considered to screen VTE and to consider full-dose anticoagulation