71 research outputs found
Influenza vaccination and myocarditis among patients receiving immune checkpoint inhibitors
No full textBackground: influenza vaccination (FV) is recommended for patients with cancer. Recent data suggested that the administration of the FV was associated with an increase in immune-related adverse events (irAEs) among patients on immune checkpoint inhibitors (ICIs). Myocarditis is an uncommon but serious complication of ICIs and may also result from infection with influenza. There are no data testing the relationship between FV and the development of myocarditis on ICIs.Methods: patients on ICIs who developed myocarditis (n = 101) (cases) were compared to ICI-treated patients(n = 201) without myocarditis (controls). A patient was defined as having the FV if they were administered the FV from 6 months prior to start of ICI to anytime during ICI therapy. Alternate thresholds for FV status were also tested. The primary comparison of interest was the rate of FV between cases and controls. Patients with myocarditis were followed for major adverse cardiac events (MACE), defined as the composite of cardiogenic shock, cardiac arrest, hemodynamically significant complete heart block and cardiovascular death.Results: the FV was administered to 25% of the myocarditis cases compared to 40% of the non-myocarditis ICI- treated controls (p = 0.01). Similar findings of lower rates of FV administration were noted among myocarditis cases when alternate thresholds were tested. Among the myocarditis cases, those who were vaccinated had 3-fold lower troponin levels when compared to unvaccinated cases (FV vs. No FV: 0.12 [0.02, 0.47] vs. 0.40 [0.11, 1.26] ng/ml,p = 0.02). Within myocarditis cases, those administered the FV also had a lower rate of other irAEs when compared to unvaccinated cases (36 vs. 55% p = 0.10) including lower rates of pneumonitis (12 vs. 36%, p = 0.03). During follow-up (175 [IQR 89, 363] days), 47% of myocarditis cases experienced a MACE. Myocarditis cases who received the FV were at a lower risk of cumulative MACE when compared to unvaccinated cases (24 vs. 59%, p = 0.002).Conclusion: the rate of FV among ICI-related myocarditis cases was lower than controls on ICIs who did not develop myocarditis. In those who developed myocarditis related to an ICI, there was less myocardial injury and a lower risk of MACE among those who were administered the FV
Modeling of gas flow in confined formations at different scales
No full textGas flow in fractured nano-porous shale formations is complicated by a hierarchy of structural features, ranging from nanopores to hydraulic fractures, and by several transport mechanisms that differ from standard viscous flow used in reservoir modeling. The use of accurate simulation techniques that honor the physical complexity of these reservoirs and capture the associated dynamics of nanopores is required. However, these simulations often necessitate a large amount of computational resources for field scale models and therefore require upscaling. Usually, the upscaling techniques are based on idealizations that do not reflect the discrete features of the reservoir. In this work, we first incorporate the physics model that describe dynamics of shale gas into a numerical Discrete Fracture and Matrix (DFM) model. The formulation of our DFM model applies an unstructured control volume finite difference approach with a two-point flux approximation. We then propose to upscale these detailed descriptions using two different techniques, with the major difference in their coarse-grid geometry. The first approach, referred to as Embedded DFM upscaling, relies on a structured Cartesian coarse grid. The second method, which we call the Multiple Sub-Regions (MSR) upscaling, introduces a flow based coarse grid to replicate the diffusive character of the pressure in the matrix. The required parameters for the coarse-scale model in both methods and the geometry of the subregions in the second method are determined using numerical homogenization of the underlying discrete fracture model. An accurate comparison with the fine-scale representation indicates an existence of an additional transient phenomenon at coarse scale. To account for this effect, the transmissibility of both types of coarse models is related to the pressure in our approach. Both upscaling methods are applied to simulate a shale-gas flow in 2D fractured reservoir models and are shown to provide results in close agreement with the underlying fine-scale model and with a considerable reduction in the computational time.Reservoir Engineerin
Modeling and Upscaling of Shale Gas Using a Discrete Fracture Modeling Approach
No full textGas flow in fractured nano-porous shale formations is complicated by a hierarchy of structural features, ranging from nanopores to microseismic and hydraulic fractures, and by several transport mechanisms that differ from standard viscous flow used in reservoir modelling. In small pores, self-diffusion becomes more important than advection, also slippage effect and Knudsen diffusion becomes relevant at this scale. The characteristics and properties of the fracture networks plays a major role in the performance of shale gas reservoirs, therefore the use of accurate simulation technique that honor the complexity of these reservoirs and capture the associated dynamics of nanopores is strongly required. However, these accurate simulations often necessitate a large amount of computations for field scale models and therefore require upscaling. Yet the upscalling techniques generally in use are based on idealizations that do not reflect the discrete features of the reservoir. In this work, we first incorporate the formulations of a statistical bundle of dual tube model to describe the dynamics of shale gas into a discrete fracture model. The formulation of the DFM model we use applies an unstructured control volume finite difference approach with a two point flux approximation. We then propose to upscale these detailed descriptions using two different techniques, with the major difference in their coarse grid geometry. The first approach, referred to as EDFM upscaling, relies on a structured Cartesian coarse grid. While the second method, which we call the multiple subregion (MSR) upscaling, introduces a flow based coarse grid to replicate the diffusive character of the pressure in the matrix. The required parameters for the coarse scale model in both methods and the geometry of the subregions in the second method are determined efficiently from global single-phase flow solution using the underlying discrete fracture model. The methods are applied to simulate single-phase gas flow in 2D fractured reservoir models, and are shown to provide results in close agreement with the underlying DFM and with considerable reduction in the computational time. We notice that in order to account for the prevailing transient effects in low permeability shale, the upscaled transmissibility need to be related to pressure for better results. Finally, we consider the EDFM upscaling we propose as an easier approach in its implementation, while the MSR technique as a more accurate method.Civil Engineering and GeosciencesGeoscience & Engineerin
Structural studies of some mixed metal oxides
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LATE GADOLINIUM ENHANCEMENT IN PATIENTS WITH MYOCARDITIS FROM IMMUNE CHECKPOINT INHIBITORS
No full textDECREASED GLOBAL LONGITUDINAL STRAIN WITH MYOCARDITIS FROM IMMUNE CHECKPOINT INHIBITORS AND OCCURRENCE OF MAJOR ADVERSE CARDIAC EVENTS
No full textAuthor Correction: High-coverage whole-genome analysis of 1220 cancers reveals hundreds of genes deregulated by rearrangement-mediated cis-regulatory alterations
No full textSurveillance for cardiotoxicity in patients receiving potentially cardiotoxic chemotherapy
No full text
Author Correction: Genomic basis for RNA alterations in cancer
No full textAuthor Correction: Genomic basis for RNA alterations in cance
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