MicroCT: Automated Analysis of CT Reconstructed Data of Home Made Explosive Materials Using the Matlab MicroCT Analysis GUI

This Standard Operating Procedure (SOP) provides the specific procedural steps for analyzing reconstructed CT images obtained under the IDD Standard Operating Procedures for data acquisition [1] and MicroCT image reconstruction [2], per the IDD Quality Assurance Plan for MicroCT Scanning [3]. Although intended to apply primarily to MicroCT data acquired in the HEAFCAT Facility at LLNL, these procedures may also be applied to data acquired at Tyndall from the YXLON cabinet and at TSL from the HEXCAT system. This SOP also provides the procedural steps for preparing the tables and graphs to be used in the reporting of analytical results. This SOP applies to production work - for R and D there are two other semi-automated methods as given in [4, 5]

Rapid disease progression in a patient with mismatch repair-deficient and cortisol secreting adrenocortical carcinoma treated with pembrolizumab

Context: Metastatic adrenocortical carcinoma (ACC) is an aggressive malignancy with a poor prognosis and limited therapeutic options. A subset of ACC is due to Lynch syndrome, an inherited tumour syndrome resulting from germline mutations in mismatch repair (MMR) genes. It has been demonstrated that several cancers characterised by MMR-deficiency are sensitive to immune checkpoint inhibitors that target PD-1. Here, we provide the first report of PD-1 blockade by pembrolizumab in a patient with Lynch syndrome and progressive cortisol-secreting metastatic ACC. Case report: A 58-year old female with known Lynch syndrome who presented with severe Cushing’s syndrome was diagnosed with a cortisol-secreting ACC. Three months following surgical resection and adjuvant mitotane therapy the patient developed metastatic disease and persistent hypercortisolaemia. She commenced pembrolizumab, but her second cycle was delayed due to a transient transaminitis. Computed tomography performed after twelve weeks and 2 cycles of pembrolizumab administration revealed significant disease progression and treatment was discontinued. Seven weeks later, the patient became jaundiced and died rapidly with fulminant liver failure. Conclusion: Treatment of MMR-deficient cortisol-secreting ACC with pembrolizumab may be ineffective due to supra-physiological levels of circulating corticosteroids, which may in turn mask severe drug-induced organ damage

MicroCT: Automated Analysis of CT Reconstructed Data of Home Made Explosive Materials Using the Matlab MicroCT Analysis GUI

This Standard Operating Procedure (SOP) provides the specific procedural steps for analyzing reconstructed CT images obtained under the IDD Standard Operating Procedures for data acquisition [1] and MicroCT image reconstruction [2], per the IDD Quality Assurance Plan for MicroCT Scanning [3]. Although intended to apply primarily to MicroCT data acquired in the HEAFCAT Facility at LLNL, these procedures may also be applied to data acquired at Tyndall from the YXLON cabinet and at TSL from the HEXCAT system. This SOP also provides the procedural steps for preparing the tables and graphs to be used in the reporting of analytical results. This SOP applies to production work - for R and D there are two other semi-automated methods as given in [4, 5]

Rapid disease progression in a patient with mismatch repair-deficient and cortisol secreting adrenocortical carcinoma treated with pembrolizumab

Context: Metastatic adrenocortical carcinoma (ACC) is an aggressive malignancy with a poor prognosis and limited therapeutic options. A subset of ACC is due to Lynch syndrome, an inherited tumour syndrome resulting from germline mutations in mismatch repair (MMR) genes. It has been demonstrated that several cancers characterised by MMR-deficiency are sensitive to immune checkpoint inhibitors that target PD-1. Here, we provide the first report of PD-1 blockade by pembrolizumab in a patient with Lynch syndrome and progressive cortisol-secreting metastatic ACC. Case report: A 58-year old female with known Lynch syndrome who presented with severe Cushing’s syndrome was diagnosed with a cortisol-secreting ACC. Three months following surgical resection and adjuvant mitotane therapy the patient developed metastatic disease and persistent hypercortisolaemia. She commenced pembrolizumab, but her second cycle was delayed due to a transient transaminitis. Computed tomography performed after twelve weeks and 2 cycles of pembrolizumab administration revealed significant disease progression and treatment was discontinued. Seven weeks later, the patient became jaundiced and died rapidly with fulminant liver failure. Conclusion: Treatment of MMR-deficient cortisol-secreting ACC with pembrolizumab may be ineffective due to supra-physiological levels of circulating corticosteroids, which may in turn mask severe drug-induced organ damage