A fifth subtype of Kaposi's sarcoma, classic Kaposi's sarcoma in men who have sex with men: a cohort study in Paris.

BACKGROUND: Classic Kaposi's sarcoma (CKS) occurs predominantly among elderly men and is associated with Kaposi's sarcoma-associated herpesvirus (KSHV). In low-endemic countries, KSHV infects predominantly men having sex with men (MSM). OBJECTIVES: To describe a cohort of classic Kaposi sarcoma in a low-endemic area for KSHV, to highlight the features of CKS in MSM and identify prognostic factors. METHODS: Retrospective single-centre study of CKS cases. We compared MSM to heterosexual patients. Then, we divided the patients into two subgroups, those requiring a systemic treatment and the others, and we performed univariate and multivariate analyses to determine aggressiveness of CKS. RESULTS: Between 2006 and 2015, seventy-four patients were included. Mean age at diagnosis was 68.9 years; sex ratio (M/F) was 6.4, and 28% were MSM; MSM patients were younger (P = 0.02), less often originated from endemic areas (P < 0.0001). KS was less severe (P = 0.04), required more often a local treatment than a systemic one (P = 0.03). On multivariate analysis, CD4 T-cell count > 500/mm3 at baseline was associated with a reduced risk of severe evolution. CONCLUSION: First CKS cohort in low-endemic zone. We describe a fifth subtype of KS: KS in MSM. The CD4 T-cell count was found to correlate with prognosis.

Vemurafenib pharmacokinetics and its correlation with efficacy and safety in outpatients with advanced BRAF-mutated melanoma.

Vemurafenib is a BRAF kinase inhibitor approved for first-line treatment of metastatic BRAF (V600) -mutant melanoma. However, data on the pharmacokinetic/pharmacodynamic (PK/PD) relationship are lacking. The aim of this prospective, multicenter study was to explore the PK/PD relationship for vemurafenib in outpatients with advanced BRAF-mutated melanoma. Fifty-nine patients treated with single-agent vemurafenib were prospectively analyzed. Vemurafenib plasma concentration (n = 159) was measured at days 15, 30, 60, and 90 after treatment initiation. Clinical and biological determinants (including plasma vemurafenib concentration) for efficacy and safety were assessed using Cox's model and multivariate stepwise logistic regression. Median progression-free survival (PFS) and overall survival were 5.0 (95 % confidence interval [95 % CI] 2.0-6.0) and 11.0 (95% CI 7.0-16.0) months, respectively. Twenty-nine patients (49 %) experienced any grade ≥3 toxicity and the most frequent grade ≥2 toxicity was skin rash (37 %). Severe toxicities led to definitive discontinuation in seven patients (12 %). Grade ≥2 skin rash was not statistically associated with better objective response at day 60 (p = 0.06) and longer PFS (hazard ratio 0.47; 95 % CI 0.21-1.08; p = 0.075). Grade ≥2 skin rash was statistically increased in patients with ECOG ≥ 1 (odds ratio 4.67; 95 % CI 1.39-15.70; p = 0.012). Vemurafenib concentration below 40.4 mg/L at day 15 was significantly associated with a shorter PFS (1.5 [0.5-5.5] vs. 4.5 [2-undetermined] months, p = 0.029). Finally, vemurafenib concentration was significantly greater in patients developing grade ≥2 rash (61.7 ± 25.0 vs. 36.3 ± 17.9 mg/L, p < 0.0001). These results suggest that early plasma drug monitoring may help identify outpatients at high risk of non-response or grade ≥ 2 skin rash.

Late occurrence of Histoplasma duboisii cutaneous and pulmonary infection 18 years after exposure.

We report an imported case of Histoplasma capsulatum var. duboisii (H. duboisii) infection in a white French woman revealed by cutaneous lesions of the scalp, 18 years after her last stay in West and Central Africa. Asymptomatic bilateral pulmonary infiltrates were discovered on thoracic computed tomography. Skin biopsy allowed the positive diagnosis showing the typical yeasts; culture of biopsy specimens was positive for H. capsulatum. In the absence of criteria of severity, the patient was treated for one year with oral itraconazole 400mg/day. The outcome was favourable, skin and pulmonary lesions resolved slowly. The follow up is 5 years without relapse after the end of treatment. This case illustrates the possibility of late occurrence of H. duboisii infection, many years after exposure and the major importance of asking any patient for travelling or residency in tropical countries.

Acute kidney injury in patients with severe rash on vemurafenib treatment for metastatic melanomas.

Vemurafenib, a selective BRAF (v-raf murine sarcoma viral oncogene homologue B1) kinase inhibitor, is a new targeted biotherapy that improves survival in patients with metastatic melanomas harbouring the BRAF V600E mutation. However, this drug has significant dermatological adverse effects. We report a new severe cutaneous reaction to this drug associated with acute kidney injury (AKI). Four patients presented a generalized grade 3 (Common Terminology Criteria for Adverse Events) erythematous eruption with hyperkeratosis pilaris, 5-14 days after the introduction of vemurafenib. These symptoms were associated with AKI in all cases and transitory hypereosinophilia in two cases. Vemurafenib treatment was stopped in three patients and the dose was reduced in the fourth, leading to a gradual improvement of skin symptoms and renal function. Positron-emission tomography scans showed a complete response in three cases and a major response in one case. Vemurafenib was reintroduced at a lower dose, without a relapse of the rash, but renal function again deteriorated. Thus, we report a cluster of four cases of AKI associated with similar, severe, grade 3 cutaneous drug reactions related to vemurafenib.

Factors associated with severe skin infections in patients treated with biologic therapies for inflammatory rheumatic diseases.

BACKGROUND: The incidence of severe infections is increased under biologic therapies and the skin is the second localization. OBJECTIVE: To appraise the factors associated with severe skin infections (SSI) in patients under biologic therapies for inflammatory rheumatic diseases (IRD). METHODS: We performed a case-control (ratio 1:3) study nested in a prospective cohort of patients with IRD. SSI was defined as requiring hospitalization or intravenous anti-infectious therapy. We defined two imbedded periods: period A was the time window between the first biologic therapy and the SSI; period B was the last 3 or 12 months (for tumor necrosis factor blockers or rituximab, respectively) before the SSI. RESULTS: Among 4,361 patients with IRD, 29 had a SSI under biologic therapy. In multivariate analyses, SSI were significantly associated with smoking, baseline C-reactive protein and gammaglobulinemia, non-steroidal anti-inflammatory drugs before biologic therapy, cumulative dose of steroids, concomitant steroids during period A, number of different biologic therapies during period A, treatment with infliximab during period A, period B or as first biologic therapy and treatment at high dose during period B. CONCLUSION: In patients under biologic therapies for IRD, the risk of SSI is associated with several factors including tobacco, treatment with infliximab or high dose range.

Photon extrabunching in ultrabright twin beams measured by two-photon counting in a semiconductor.

For many years twin beams originating from parametric down-converted light beams have aroused great interest and attention in the photonics community. One particular aspect of the twin beams is their peculiar intensity correlation functions, which are related to the coincidence rate of photon pairs. Here we take advantage of the huge bandwidth offered by two-photon absorption in a semiconductor to quantitatively determine correlation functions of twin beams generated by spontaneous parametric down-conversion. Compared with classical incoherent sources, photon extrabunching is unambiguously and precisely measured, originating from exact coincidence between down-converted pairs of photons, travelling in unison. These results strongly establish that two-photon counting in semiconductors is a powerful tool for the absolute measurement of light beam photon correlations at ultrashort timescales.

[Primary effusion lymphoma in two kidney transplant recipients]. / Lymphome des séreuses chez le transplanté rénal: deux cas.

BACKGROUND: Primary effusion lymphoma (PEL) is a highly malignant non-Hodgkin lymphoma associated with Kaposi's sarcoma-associated herpesvirus/human herpesvirus-8 infection (KSHV/HHV-8). It is chiefly seen in HIV patients and is rare in transplant recipients, possibly going unrecognized. OBSERVATION: We describe two male kidney transplant recipients, aged 47 and 51 years, followed for Kaposi's sarcoma in skin, lymph nodes, gastrointestinal (GI) tract and lung whose disease was poorly controlled by sirolimus and chemotherapy. Recurrent pleural effusion contrasted with reduction of cutaneous Kaposi lesions. KHSV viral loads were negative or very low in plasma, were negative or very low, whereas those in pleural effusion were high. Lymphoma cells were discovered only seven to nine months after the initial effusion despite repeated needle biopsies. In one patient, tumour cells were co-infected with Epstein-Barr virus. CONCLUSION: The contrast between a very low KHSV viral load in plasma and a very high viral load pleural effusion should alert physicians and prompt suspicion of PEL in Kaposi's sarcoma patients with recurrent serous effusion. The potential inhibitory role of sirolimus on PEL progression is discussed.

Passive mode locking of optical parametric oscillators: an efficient technique for generating sub-picosecond pulses.

We show that optical parametric generation in a nonlinear crystal with a large group velocity mismatch between the pump and nearly-degenerate signal and idler is analogous to laser amplification in the medium with a gain recovery time comparable to the walk-off time. Based on this conclusion we propose to combine an OPO with a nonlinear saturable absorber or Kerr lens to generate directly high peak power sub-picosecond pulses using pump pulses ranging from tens of picoseconds to quasi-CW. Our analytical model predicts better than 80% photon conversion efficiency and pulse lengths that are of the order of a few hundred femtoseconds. Numerical simulations confirm our predictions and show that repetitive passive mode locking is feasible with a quasi-CW pump.

Passively mode-locked slow pump optical parametric oscillators.

We predict that employing a Bragg grating to simultaneously phase match and induce large temporal walk-off between the signal and slow propagating pump in a nonlinear crystal can be conducive to development of passively mode locked optical parametric oscillators in which cw near-infrared pump is efficiently converted into short middle-infrared pulses.

Optical transitions in single-wall boron nitride nanotubes.

Optical transitions in single-wall boron nitride nanotubes are investigated by means of optical absorption spectroscopy. Three absorption lines are observed. Two of them (at 4.45 and 5.5 eV) result from the quantification involved by the rolling up of the hexagonal boron nitride (h-BN) sheet. The nature of these lines is discussed, and two interpretations are proposed. A comparison with single-wall carbon nanotubes leads one to interpret these lines as transitions between pairs of van Hove singularities in the one-dimensional density of states of boron nitride single-wall nanotubes. But the confinement energy due to the rolling up of the h-BN sheet cannot explain a gap width of the boron nitride nanotubes below the h-BN gap. The low energy line is then attributed to the existence of a Frenkel exciton with a binding energy in the 1 eV range.

Random quasi-phase-matching in bulk polycrystalline isotropic nonlinear materials.

Three-wave mixing in nonlinear materials--the interaction of two light waves to produce a third--is a convenient way of generating new optical frequencies from common laser sources. However, the resulting optical conversion yield is generally poor, because the relative phases of the three interacting waves change continuously as they propagate through the material. This phenomenon, known as phase mismatch, is a consequence of optical dispersion (wave velocity is frequency dependent), and is responsible for the poor optical conversion potential of isotropic nonlinear materials. Here we show that exploiting the random motion of the relative phases in highly transparent polycrystalline materials can be an effective strategy for achieving efficient phase matching in isotropic materials. Distinctive features of this 'random quasi-phase-matching' approach are a linear dependence of the conversion yield with sample thickness (predicted in ref. 3), the absence of the need for either preferential materials orientation or specific polarization selection rules, and the existence of a wavelength-dependent resonant size for the polycrystalline grains.

Mid-infrared high-resolution absorption spectroscopy by use of a semimonolithic entangled-cavity optical parametric oscillator.

By recording low-pressure absorption lines of N2O around 3.9 microm, we fully qualify a pulsed entangled-cavity doubly resonant optical parametric oscillator as a power tool for high-resolution spectroscopy. This compact source runs at a high repetition rate (>10 kHz) with a low threshold of oscillation (<8 microJ), is mode-hop-free tunable over 5 cm(-1), and displays single-frequency Fourier-transformed-limited operation (linewidth <0.005 cm(-1)). A high potential for nonlinear spectroscopy is also expected given the high peak power (70 W) and the good quality (M2 < 2) of the output beam.

Widely tunable single-frequency pulsed optical parametric oscillator.

The spectral output of a nanosecond dual-cavity doubly resonant optical parametric oscillator has been investigated versus the relative length of the signal and idler cavities. Regions of stable single-frequency operation are determined by use of a type II phase-matched KTP crystal and compared with the predictions of a mode-overlap model. A wide mode-hop-free tuning range is obtained over 40 GHz, limited only by piezoelectric biases. Furthermore, discrete tuning is investigated over the full parametric gain curve. For demonstration purposes, experiments are performed in the domain that is most inclined to multifrequency emission, i.e., near degeneracy.

Entangled-cavity optical parametric oscillator for mid-infrared pulsed single-longitudinal-mode operation.

We report a pulsed doubly resonant optical parametric oscillator that uses an original entangled-cavity geometry. This compact source (total volume of 1 L, including the pump laser) displays single-frequency operation (linewidth, <100 MHz), a high repetition rate (>10 kHz), low threshold (<10 muJ), and wide tuning in the mid-infrared. These properties qualify pulsed doubly resonant optical parametric oscillators as powerful tools for applications in such fields as nonlinear spectroscopy, lidar, and pollutant detection.

Tunable ultraviolet intracavity tripled Ti:sapphire laser.

We present what we believe to be the first intracavity tripled Ti:sapphire laser. This source is tunable in the 275-285-nm range and will be useful for applications in the detection of important atmospheric species such as OH and NO radicals. Single-frequency operation and high optical yield (>50%) are obtained in this system after it has been injected by a laser diode.

5.2-5.6-microm source tunable by frequency conversion in a GaAs-based waveguide.

A tunable mid-IR source obtained by difference-frequency generation is demonstrated in a selectively oxidized GaAsAlAs multilayer waveguide. We designed the waveguide to present the required form birefringence for phase matching of the nonlinear interaction. We took special care to lower losses for the mid-IR radiation. IR tunability from 5.2 to 5.6 mum was achieved by variation of the waveguide temperature and one pump wavelength. IR output power as great as 0.12 muW was obtained with the product of two pump powers of 7 mW(2). Losses of ~50 cm(-1) were measured for the mid-IR radiation. These losses are attributed to surface scattering.