Incidence of lymph node metastases in clinical early-stage mucinous and seromucinous ovarian carcinoma: a retrospective cohort study

Objective: The use of lymph node sampling during staging procedures in clinical early-stage mucinous ovarian carcinoma (MOC) is an ongoing matter of debate. Furthermore, the incidence of lymph node metastases (LNM) in MOC in relation to tumour grade (G) is unknown. We aimed to determine the incidence of LNM in clinical early-stage MOC per tumour grade. Design: Retrospective study with data from the Dutch Pathology Registry (PALGA). Setting: The Netherlands, 2002–2012. Population or sample: Patients with MOC. Methods: Histology reports on patients with MOC diagnosed in the Netherlands between 2002 and 2012 were obtained from PALGA. Reports were reviewed for diagnosis, tumour grade and presence of LNM. Clinical data, surgery reports and radiology reports of patients with LNM were retrieved from hospital files. Main outcome measures: Incidence of LNM, disease-free survival (DFS). Results: Of 915 patients with MOC, 426 underwent lymph node sampling. Cytoreductive surgery was performed in 267 patients. The other 222 patients received staging without lymph node sampling. In eight of 426 patients, LNM were discovered by sampling. In four of 190 (2.1%) patients with G1 MOC, LNM were present, compared with one of 115 (0.9%) patients with G2 MOC and three of 22 (13.6%) patients with G3 MOC. Tumour grade was not specified in 99 patients. Patients with clinical early-stage MOC had no DFS benefit from lymph node sampling. Conclusions: LNM are rare in early-stage G1 and G2 MOC without clinical suspicion of LNM. Therefore, lymph node sampling can be omitted in these patients

Magnetoacoustic shocks as driver of quiet Sun mottles

We present high spatial and high temporal resolution observations of the quiet Sun in H-alpha obtained with the Swedish 1-m Solar Telescope on La Palma. We observe that many mottles, jet-like features in the quiet Sun, display clear up- and downward motions along their main axis. In addition, many mottles show vigorous transverse displacements. Unique identification of the mottles throughout their lifetime is much harder than for their active region counterpart, dynamic fibrils. This is because many seem to lack a sharply defined edge at their top, and significant fading often occurs throughout their lifetime. For those mottles that can be reliably tracked, we find that the mottle tops often undergo parabolic paths. We find a linear correlation between the deceleration these mottles undergo and the maximum velocity they reach, similar to what was found earlier for dynamic fibrils. Combined with an analysis of oscillatory properties, we conclude that at least part of the quiet Sun mottles are driven by magnetoacoustic shocks. In addition, the mixed polarity environment and vigorous dynamics suggest that reconnection may play a significant role in the formation of some quiet Sun jets.Comment: 12 pages, 4 figures. ApJ Letters, in pres

A tilted interference filter in a converging beam

Context. Narrow-band interference filters can be tuned toward shorter wavelengths by tilting them from the perpendicular to the optical axis. This can be used as a cheap alternative to real tunable filters, such as Fabry-P\'erot interferometers and Lyot filters. At the Swedish 1-m Solar Telescope, such a setup is used to scan through the blue wing of the Ca II H line. Because the filter is mounted in a converging beam, the incident angle varies over the pupil, which causes a variation of the transmission over the pupil, different for each wavelength within the passband. This causes broadening of the filter transmission profile and degradation of the image quality. Aims. We want to characterize the properties of our filter, at normal incidence as well as at different tilt angles. Knowing the broadened profile is important for the interpretation of the solar images. Compensating the images for the degrading effects will improve the resolution and remove one source of image contrast degradation. In particular, we need to solve the latter problem for images that are also compensated for blurring caused by atmospheric turbulence. Methods. We simulate the process of image formation through a tilted interference filter in order to understand the effects. We test the hypothesis that they are separable from the effects of wavefront aberrations for the purpose of image deconvolution. We measure the filter transmission profile and the degrading PSF from calibration data. Results. We find that the filter transmission profile differs significantly from the specifications.We demonstrate how to compensate for the image-degrading effects. Because the filter tilt effects indeed appear to be separable from wavefront aberrations in a useful way, this can be done in a final deconvolution, after standard image restoration with MFBD/Phase Diversity based methods. We illustrate the technique with real data

Quiet-Sun imaging asymmetries in NaI D1 compared with other strong Fraunhofer lines

Imaging spectroscopy of the solar atmosphere using the NaI D1 line yields marked asymmetry between the blue and red line wings: sampling a quiet-Sun area in the blue wing displays reversed granulation, whereas sampling in the red wing displays normal granulation. The MgI b2 line of comparable strength does not show this asymmetry, nor does the stronger CaII 8542 line. We demonstrate the phenomenon with near-simultaneous spectral images in NaI D1, MgI b2, and CaII 8542 from the Swedish 1-m Solar Telescope. We then explain it with line-formation insights from classical 1D modeling and with a 3D magnetohydrodynamical simulation combined with NLTE spectral line synthesis that permits detailed comparison with the observations in a common format. The cause of the imaging asymmetry is the combination of correlations between intensity and Dopplershift modulation in granular overshoot and the sensitivity to these of the steep profile flanks of the NaI D1 line. The MgI b2 line has similar core formation but much wider wings due to larger opacity buildup and damping in the photosphere. Both lines obtain marked core asymmetry from photospheric shocks in or near strong magnetic concentrations, less from higher-up internetwork shocks that produce similar asymmetry in the spatially averaged CaII 8542 profile.Comment: Accepted by Astron & Astrophys. In each in-text citation the year links to the corresponding ADS abstract pag

Nivolumab and ipilimumab in the real-world setting in patients with mesothelioma

Objectives: Nivolumab (anti-PD-1) plus ipilimumab (anti-CTLA-4) is a new first-line treatment combination for patients with pleural mesothelioma. Nivolumab-ipilimumab improved the survival, however, 30.3% of the patients suffered from grade 3–4 treatment related adverse events (TRAE's) and TRAE's led to discontinuation in 23.0% of all patients. Here, we present the first real-world data of nivolumab plus ipilimumab in patients with malignant mesothelioma treated in two mesothelioma expert centers. Methods: Clinical data of patients with mesothelioma treated with nivolumab and ipilimumab were prospectively collected. Clinical parameters were obtained every visit, CT scans were evaluated every 12 weeks and adverse events were assessed continuously during the treatment. Data on grade 2–5 TRAE's and activity (overall response rate (ORR), duration of response (DOR), disease control rate (DCR), median progression-free survival (mPFS) and median overall survival (mOS) were reported. Results: Between January 2021 and August 2022, 184 patients were treated with nivolumab plus ipilimumab. The median follow-up was 12.1 months (95 %CI 11.1 – 13.1). Grade 3–4 TRAEs were seen in 27.7 % of the patients and 25.0 % discontinued immunotherapy treatment early because of TRAE's. ORR was 21.7 % (95 % CI 15.7–27.7), median DOR was 5.7 months (IQR 3.2–8.7) and DCR at 12 weeks 56.0 % (95 % CI 48.8–63.2). The mPFS was 5.5 months (95 %CI 4.1–6.9), mOS was 14.1 months (95 % CI 11.1–18.2). Conclusions: Nivolumab plus ipilimumab had an equal efficacy in a real-world comparable population but also a high risk of TRAE's, leading to discontinuation of treatment in 25% of the patients.</p