Search Results (10)

Background and Clinical Significance: Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment but may underlie diverse and potentially life-threatening immune-related adverse events (irAEs). They may cause various conditions leading to respiratory failure, including myasthenic syndromes and myositis. However, diaphragmatic paralysis (DP) has rarely been reported. To describe patients with diaphragmatic paralysis in a pharmacovigilance registry, we searched the prospective REISAMIC registry at the Gustave Roussy Cancer Center (Villejuif, France) for cases of diaphragmatic palsy (DP) occurring from September 2014 to December 2021. Case Presentation: We identified three patients, in whom DP was confirmed by diaphragmatic ultrasonography, pulmonary function tests, and/or diaphragmatic electroneuromyogram. Diaphragmatic palsy was life-threatening in all patients, as it caused respiratory failure requiring mechanical ventilation. In all cases, a pre-existing subclinical paraneoplastic syndrome was detected. Onconeural antibodies (anti-titin and anti-VGCC) were detected in these patients before and after the initiation of ICI therapy, suggesting a mixed paraneoplastic syndrome with features overlapping those of myasthenic syndrome (myasthenia gravis in one patient and Lambert–Eaton syndrome in another) and myositis. Conclusions: Diaphragmatic palsy is a severe irAE potentially resulting from different mechanisms, including myositis and neuromuscular junction involvement (myasthenia gravis, Lambert–Eaton). Antineuronal antibodies associated with such conditions were already present in our patients prior to immunotherapy initiation, suggesting ICIs could trigger flare-ups of pre-existing silent paraneoplastic autoimmune conditions. Full article

Background: New oncologic therapies, including immune checkpoint inhibitors (ICIs), have revolutionized the survival and prognosis of cancer patients. However, these therapies are often complicated by immune-related adverse effects (irAEs) that may impact quality of life and potentially limit their use. Among these adverse events are psoriasis and psoriatic arthritis that may develop de novo or flare under treatment with ICIs. Given the exceptional immune status of patients receiving ICIs, managing these conditions without interfering with the effect of the oncologic treatment may prove very challenging. Aim: To review the literature data on ICI-induced psoriasis exacerbation or development, to present our own experience, and to discuss the pathogenic mechanisms underlying this association and the optimal therapeutic approach for these patients. Case Reports: We report three cases of ICI-induced de novo psoriasis and two cases of ICI-induced psoriasis exacerbation that required systemic treatment. Oral acitretin treatment successfully controlled psoriasis lesions in three cases and allowed for the continuation of immunotherapy. Literature Review: We performed a medical literature search across several databases (PubMed, Medline, Google Scholar) using the search terms “immune checkpoint inhibitor-induced psoriasis/psoriasiform dermatitis/psoriasis arthritis”. We identified and revised 80 relevant publications that reported 1102 patients with psoriasis and/or psoriasis arthritis induced or exacerbated by ICIs. We assessed the type of cancer, the therapeutic agent involved, the clinical form of psoriasis, the presence or absence of psoriatic arthritis, the personal and family history of psoriasis, the age, the gender, the time until onset or exacerbation of skin lesions, the specific treatment recommended, the need for ICI discontinuation, and the patient’s outcome. Conclusions: As ICIs represent a fairly novel therapy, the association with several adverse effects is only now unraveling. Psoriasis exacerbation or onset following the initiation of immunotherapy is one such example, as more and more reports and case series are being published. Awareness of the relationship between psoriasis and treatment with ICIs, prompt recognition, and initiation of adequate skin-directed therapies are essential for the avoidance of skin lesions worsening, the need for systemic treatments that may interfere with ICIs’ effects, or the discontinuation of the latter. In the absence of generally accepted guidelines, it is advisable to treat patients with severe, widespread psoriasis with drugs that do not impair the effects of immunotherapy and thus do not alter the patient’s prognosis. Full article

Immune checkpoint inhibitors (ICIs) are the standard of care for a growing number of malignancies. Unfortunately, they are associated with a broad range of unique toxicities that mimic the presentations of primary autoimmune conditions. These adverse events are termed immune-related adverse events (irAEs), of which ICI-lupus erythematosus (ICI-LE) constitutes a small percentage. Our review aims to describe the available literature on ICI-LE and ICI treatment for patients with pre-existing lupus. Most diagnoses of ICI-LE had findings of only cutaneous lupus; four diagnoses of ICI-LE had systemic lupus manifestations. Over 90% (27 of 29) of cases received anti-PD-1/PDL-1 monotherapy, 1 received combination therapy, and 1 received only anti-CTLA-4 treatment. About three-fourths (22 of 29 or 76%) of patients with ICI-lupus were managed with topical steroids, 13 (45%) received hydroxychloroquine, and 10 (34%) required oral corticosteroids. In our case series, none of the patients with pre-existing lupus receiving ICI therapy for cancer had a flare of their lupus, but few had de novo irAE manifestations, all of which were characterized as low-grade. The review of the literature yielded seven ICI-LE flares from a total of 27 patients with pre-existing lupus who received ICI. Most flares were manageable without need for ICI cessation. Full article

This paper reports on the first daily global monitoring program for natural gas flaring and industrial sites producing waste heat based on satellite observed infrared emissions. The Visible Infrared Imaging Radiometer Suite (VIIRS) collects nightly global infrared data in spectral bands ranging from near infrared (NIR) to longwave infrared (LWIR), providing a unique capability to detect and characterize infrared emitters at night. The VIIRS nightfire (VNF) algorithm identifies infrared (IR) emitters with multiple spectral bands and calculates the temperature, source area, and radiant heat via Planck curve fitting and physical laws. VNF data are produced nightly and extend from 2012 to the present. The most common infrared emitter is biomass burning, which must be filtered out. Industrial IR emitters can be distinguished from biomass burning based on temperature and persistence. The initial filtering to remove biomass burning was performed with 15 arc second grids formed from eleven years of VIIRS data, spanning 2012–2022. The locations and shapes of the remaining features were used to guide the generation of super-resolution pixel center clouds. These data clouds were then analyzed to define bounding vectors for single emitters and to split larger clusters into multiple emitters. A total of nearly 20,000 IR emitters were identified; each was assigned an identification number, and the type of emitter was recorded. Nightly temporal profiles were produced for each site, revealing activity patterns back to 2012. Nightly temporal profiles were kept current with weekly updates. Temporal profiles from individual sites were aggregated by country to form monthly profiles extending back to 2012. The nightly and monthly temporal profiles were suitable for analyzing industrial production, identifying disruption events, and tracking recovery. The data could also be used in tracking progress in energy conservation and greenhouse gas emission inventories. Full article

Patients with pre-existing autoimmune disorders and cancer considering immune checkpoint inhibitors (ICIs) need to receive balanced information about the benefits and risk of developing immune-related adverse events (irAEs) and flare-ups of their autoimmune disease. To assess the learning needs of patients with cancer and pre-existing autoimmune disease regarding ICI treatment, we interviewed 29 patients with autoimmune disease and cancer from a comprehensive cancer center, of whom 20 had received ICI and 9 were candidates to receive ICI at a US Cancer Center. In-depth semi-structured interviews were conducted from August 2021 and January 2022. Interviewee’s opinions and preferences about content and information delivery methods were collected. We recorded and transcribed interviews and analyzed them using thematic analysis. Half of the participants were female, and their median (SD) age was 62.9 (±10.9) years. The identified health information needs included the following: (1) information on irAEs and autoimmune disease flare-ups; (2) benefits of ICI; (3) ICI mechanism in the context of autoimmune disease; (4) management of flare-ups; (5) reasons for stopping or modifying cancer or autoimmune disease treatment; (6) likelihood of autoimmune disease progression or organ damage; and (7) lifestyle changes that could help avoid irAEs. Patients who had received ICI and those who had not yet received treatment reported similar needs, although patients who had received ICI had more questions about cancer treatment modifications. Patients also expressed the need to better understand when to contact their provider and how to share information with multiple providers. Most patients wanted to receive information in visual formats for review at home and at their own pace. Patients expressed interest in having educational tools to facilitate shared decision-making with their physicians, and they identified several areas of health information concerning therapy with ICI. They also highlighted the importance of communication among their various providers. Full article

Immune checkpoint inhibitors (ICIs) have improved cancer outcomes but can cause severe immune-related adverse events (irAEs) and flares of autoimmune conditions in cancer patients with pre-existing autoimmune disease. The objective of this study was to identify the information physicians perceived as most useful for these patients when discussing treatment initiation with ICIs. Twenty physicians at a cancer institution with experience in the treatment of irAEs were interviewed. Qualitative thematic analysis was performed to organize and interpret data. The physicians were 11 medical oncologists and 9 non-oncology specialists. The following themes were identified: (1) current methods used by physicians to provide information to patients and delivery options; (2) factors to make decisions about whether or not to start ICIs in patients who have cancer and pre-existing autoimmune conditions; (3) learning points for patients to understand; (4) preferences for the delivery of ICI information; and (5) barriers to the implementation of ICI information in clinics. Regarding points to discuss with patients, physicians agreed that the benefits of ICIs, the probability of irAEs, and risks of underlying autoimmune condition flares with the use of ICIs were most important. Non-oncologists were additionally concerned about how ICIs affect the autoimmune disease (e.g., impact on disease activity, need for changes in medications for the autoimmune disease, and monitoring of autoimmune conditions). Full article

Biomass burning is a coupled exothermic/endothermic system that transfers carbon in several forms to the atmosphere, ultimately leaving mineral ash. The exothermic phases include flaming and smoldering, which produce the heat that drives the endothermic processes. The endothermic components include pre-heating and pyrolysis, which produce the fuel consumed by flaming and smoldering. These components can be broadly distinguished from each other based on temperature. For several years, we have researched the subpixel analysis of two temperature phases present in fire pixels detected in nighttime VIIRS data. Here, we present the flaming subtractive method, with which we have successfully derived temperatures and source areas for two infrared (IR) emitters and a cooler background. This is developed as an add-on to the existing VIIRS nightfire algorithm version 3 (VNF v.3) which uses Planck curve fitting to calculate temperatures and source areas for a single IR emitter and background. The flaming subtractive method works with data collected in four spectral ranges: near-infrared (NIR), short-wave infrared (SWIR), mid-wave infrared (MWIR) and long-wave infrared (LWIR). With sunlight eliminated, the NIR and SWIR radiances can be fully attributed to the primary IR emitter. The analysis begins with Planck curve modeling for the primary emitter based on the NIR and SWIR radiances, yielding temperature, source area and primary emitter radiances in all spectral bands. The primary emitter radiances are subtracted from each spectral band and then the residual radiance is analyzed for a secondary IR emitter and the background. Spurious results are obtained in pixels lacking a discernable secondary emitter. These misfit pixels revert back to the single IR emitter analysis of VNF v.3. In tests run for two California megafires, we found that the primary emitters straddle the temperature ranges for flaming and smoldering, the exothermic portions of biomass burning, which are apparently commingled on the ground. The secondary emitter temperatures span 350–750 K, corresponding to pre-heating and slow pyrolysis. The natural gas flare test case had few numbers of successful secondary emitter retrievals and a wide range of secondary emitter temperatures. The flaming subtractive analysis is the key addition to VNF version 4, which will commence production later in 2021. In 2022, we will seek validation of the VNF v.4 from nighttime Landsat and other data sources. Full article

For the past two decades, many research groups have investigated new methods for reducing the size and cost of safe and arm-fire systems, while also improving their safety and reliability, through batch processing. Simultaneously, micro- and nanotechnology advancements regarding nanothermite materials have enabled the production of a key technological building block: pyrotechnical microsystems (pyroMEMS). This building block simply consists of microscale electric initiators with a thin thermite layer as the ignition charge. This microscale to millimeter-scale addressable pyroMEMS enables the integration of intelligence into centimeter-scale pyrotechnical systems. To illustrate this technological evolution, we hereby present the development of a smart infrared (IR) electronically controllable flare consisting of three distinct components: (1) a controllable pyrotechnical ejection block comprising three independently addressable small-scale propellers, all integrated into a one-piece molded and interconnected device, (2) a terminal function block comprising a structured IR pyrotechnical loaf coupled with a microinitiation stage integrating low-energy addressable pyroMEMS, and (3) a connected, autonomous, STANAG 4187 compliant, electronic sensor arming and firing block. Full article

The Visible Infrared Imaging Radiometer Suite (VIIRS) collects low light imaging data at night in five spectral bands. The best known of these is the day/night band (DNB) which uses light intensification for imaging of moonlit clouds in the visible and near-infrared (VNIR). The other four low light imaging bands are in the NIR and short-wave infrared (SWIR), designed for daytime imaging, which continue to collect data at night. VIIRS nightfire (VNF) tests each nighttime pixel for the presence of sub-pixel IR emitters across six spectral bands with two bands each in three spectral ranges: NIR, SWIR, and MWIR. In pixels with detection in two or more bands, Planck curve fitting leads to the calculation of temperature, source area, and radiant heat using physical laws. An analysis of January 2018 global VNF found that inclusion of the NIR and SWIR channels results in a doubling of the VNF pixels with temperature fits over the detection numbers involving the MWIR. The addition of the short wavelength channels extends detection limits to smaller source areas across a broad range of temperatures. The VIIRS DNB has even lower detection limits for combustion sources, reaching 0.001 m² at 1800 K, a typical temperature for a natural gas flare. Comparison of VNF tallies and DNB fire detections in a 2015 study area in India found the DNB had 15 times more detections than VNF. The primary VNF error sources are false detections from high energy particle detections (HEPD) in space and radiance saturation on some of the most intense events. The HEPD false detections are largely eliminated in the VNF output by requiring multiband detections for the calculation of temperature and source size. Radiance saturation occurs in about 1% of the VNF detections and occurs primarily in the M12 spectral band. Inclusion of the radiances affected by saturation results in temperature and source area calculation errors. Saturation is addressed by identifying the presence of saturation and excluding those radiances from the Planck curve fitting. The extremely low detection limits for the DNB indicates that a DNB fire detection algorithm could reveal vast numbers of combustion sources that are undetectable in longer wavelength VIIRS data. The caveats with the DNB combustion source detection capability is that it should be restricted to pixels that are outside the zone of known VIIRS detected electric lighting. Full article

The radiative power (MW) output of a gas flare is a useful metric from which the rate of methane combustion and carbon dioxide emission can be inferred for inventorying purposes and regular global surveys based on such assessments are now being used to keep track of global gas flare reduction efforts. Several multispectral remote sensing techniques to estimate gas flare radiative power output have been developed for use in such surveys and single band approaches similar to those long used for the estimation of landscape fire radiative power output (FRP) can also be applied. The MIR-Radiance method, now used for FRP retrieval within the MODIS active fire products, is one such single band approach—but its applicability to gas flare targets (which are significantly hotter than vegetation fires) has not yet been assessed. Here we show that the MIR-Radiance approach is in fact not immediately suitable for retrieval of gas flare FRP due to their higher combustion temperatures but that switching to use data from a SWIR (rather than MWIR) spectral channel once again enables the method to deliver unbiased FRP retrievals. Over an assumed flaring temperature range of 1600–2200 K we find a maximum FRP error of ±13.6% when using SWIR observations at 1.6 µm and ±6.3% when using observations made at 2.2 µm. Comparing these retrievals to those made by the multispectral VIIRS ‘NightFire’ algorithm (based on Planck Function fits to the multispectral signals) we find excellent agreement (bias = 0.5 MW, scatter = 1.6 MW). An important implication of the availability of this new SWIR radiance method for gas flare analysis is the potential to apply it to long time-series from older and/or more spectrally limited instruments, unsuited to the use of multispectral algorithms. This includes the ATSR series of sensors operating between 1991–2012 on the ERS-1, ERS-2 and ENVISAT satellites and such long-term data can be used with the SWIR-Radiance method to identify key trends in global gas flaring that have occurred over the last few decades. Full article