Brachytherapy: An emblematic example of extreme hypofractionated regimen

In order to provide more convenient irradiation regimens for patient comfort, radiation facility organization and health expenses, new hypofractionated protocols have been evaluated. Moderately (dose/fraction: 2.3 to 3 Gy), then ultra (dose/fraction: 5.2 to 6.1 Gy) hypofractionated irradiations were first validated. The current question is: is it possible to go forward using extreme hypofractionated regimens (EHR) based on 1 to 3 fractions. Different irradiation techniques are under investigation. However, brachytherapy remains the smartest way to deliver a high dose in a small volume. We report prospective and retrospective study results which evaluated EHR for breast and prostate brachytherapy. While oncological outcome and toxicity profile appear extremely encouraging for low-risk breast cancer after a 1 to 4 fractions (6.25 to 20 Gy/fraction), the use of a single fraction of 19 to 23 Gy appears debatable for prostate cancer. Brachytherapy represents an emblematic example of EHR but longer follow-up and more mature results are awaited in order to specify the right indications and refine the EQD2 calculation method including new biological and technical factors.     

Single-dose replicating poxvirus vector-based RBD vaccine drives robust humoral and T cell immune response against SARS-CoV-2 infection

1. Download : Download high-res image (90KB)
2. Download : Download full-size image

     

Enlarged high frequency oscillations of the median nerve somatosensory evoked potential and survival in amyotrophic lateral sclerosis

ObjectiveA large N20 and P25 of the median nerve somatosensory evoked potential (SEP) predicts short survival in amyotrophic lateral sclerosis (ALS). We investigated whether high frequency oscillations (HFOs) over N20 are enlarged and associated with survival in ALS.MethodsA total of 145 patients with ALS and 57 healthy subjects were studied. We recorded the median nerve SEP and measured the onset-to-peak amplitude of N20 (N20o-p), and peak-to-peak amplitude between N20 and P25 (N20p-P25p). We obtained early and late HFO potentials by filtering SEP between 500 and 1 kHz, and measured the peak-to-peak amplitude. We followed up patients until endpoints (death or tracheostomy) and analyzed the relationship between SEP or HFO amplitudes and survival using a Cox analysis.ResultsPatients showed larger N20o-p, N20p-P25p, and early and late HFO amplitudes than the control values. N20p-P25p was associated with survival periods (p = 0.0004), while early and late HFO amplitudes showed no significant association with survival (p = 0.4307, and p = 0.6858, respectively).ConclusionsThe HFO amplitude in ALS is increased, but does not predict survival.SignificanceThe enlarged HFOs in ALS might be a compensatory phenomenon to the hyperexcitability of the sensory cortex pyramidal neurons.     

Robust antibody response after a third BNT162b2 vaccine compared to the second among immunocompromised and healthy individuals,a prospective longitudinal cohort study

PurposeAs protection from COVID-19 following two doses of the BNT162b2 vaccine showed a time dependent waning, a third (booster) dose was administrated. This study aims to compare the antibody response following the third dose versus the second and to evaluate post-booster seroconversion.MethodsA prospective observational study conducted in Maccabi Healthcare Services. Serial SARS-CoV-2 Spike IgG tests, 1,2,3 and 6 months following the second vaccine dose and one month following the third were obtained. Neutralizing antibody levels were measured in a subset of participants. Per individual SARS-CoV-2 Spike IgG titer ratios were calculated one month after the booster administration compared to titers one month following the second dose and prior to booster.ResultsAmong 110 participants, 56 (51%) were women. Mean age was 61.7 ± 1.9 years and 66 (60%) were immunocompromised. One month after third dose, IgG titers were induced 7.83 (95 %CI 5.25–11.67) folds and 2.40 (95 %CI 1.90–3.03) folds compared to one month after the second, in the immunocompromised and immunocompetent groups, respectively. Of the 17 immunocompromised participants who were seronegative after the second dose, 4 (24%) became seropositive following the third. Comparing the titers prior to the third dose, an increase of 50.7 (95 %CI 32.5–79.1) fold in the immunocompromised group and 25.7 (95 %CI 19.1–34.7) fold in and immunocompetent group, was observed.ConclusionA third BNT162b2 vaccine elicited robust humoral response, superior to the response observed following the second, among immunocompetent and immunocompromised individuals.     

不同丙戊酸负荷量对癫痫持续状态的治疗效果分析

目的了解不同丙戊酸负荷量对癫痫持续状态患儿的治疗效果。方法收集2013年1月1日至2017年12月31日在浙江大学医学院附属儿童医院重症监护室住院治疗的癫痫持续状态患儿的病例资料,根据丙戊酸负荷量进行分组,了解各组患儿癫痫持续状态的控制情况。结果(1)66例癫痫持续状态患儿,包括癫痫36例(54.5%),颅内感染16例(24.2%),缺氧窒息3例(4.5%),颅内肿瘤2例(3.0%),脑发育异常2例(3.0%),颅内出血2例(3.0%),病因不明确5例(7.6%)。(2)所有癫痫持续状态患儿根据不同的丙戊酸负荷量(0 mg/kg,10~15 mg/kg,16~39 mg/kg,40 mg/kg)分为4组,各组间的性别、年龄差异无统计学意义,癫痫持续状态控制时间和癫痫控制情况差异无统计学意义(P=0.402、0.340)。(3)所有患儿予丙戊酸钠应用后都有监测肝功能,无一例患儿出现肝功能损害的表现。结论不同丙戊酸负荷量对于癫痫持续状态患儿的治疗效果无明显差异,并且接受负荷量为40 mg/kg治疗的癫痫持续状态患儿未出现相关不良反应。     

血府逐瘀汤合温胆汤加减联合西药治疗高血压颈动脉硬化的临床观察

目的:观察血府逐瘀汤合温胆汤加减联合西药治疗高血压颈动脉硬化的效果。方法:选取2017年6月至2018年6月聊城市中医院收治的高血压颈动脉硬化患者92例作为研究对象,按照随机数字表法随机分为对照组与观察组,每组46例。对照组患者给予左旋氨氯地平+阿托伐他汀口服,观察组在对照组基础上加用血府逐瘀汤合温胆汤加减口服。观察患者血压、血脂控制情况,测定颈动脉内膜中层厚度(IMT)、斑块面积、血管皮内皮功能、血清蛋白酶分子水平。结果:与对照组比较,观察组治疗后的血压SBP、DBP及血脂TG、TC、LDL-C等指标更低(P<0.05);颈动脉粥样硬化斑块IMT厚度、斑块面积明显缩小(P<0.05),血管内皮功能指标ET-1、AngⅡ、TXB2水平明显降低,NO水平明显升高(P<0.05);血清CatK、MMP-9水平明显降低(P<0.05);观察组不良反应发生率8.70%明显低于对照组不良反应发生率21.74%(P<0.05)。结论:血府逐瘀汤合温胆汤加减联合西药更利于控制高血压颈动脉硬化患者的血压,调节脂质代谢,改善血管内皮功能,降低血清蛋白酶分子的含量,用药安全。     

李延应用泽泻汤合温胆汤治疗舒张压高的临床经验

随着社会的发展,人类生活方式的改变,高血压病越来越高发,具有低龄化趋势,代谢综合征常伴随发生,此种情况下的高血压往往是以舒张压升高为主,临床表现常与“亚健康”状态混淆,未能引起患者甚至部分医生的重视,然而事实上越来越多的科学研究证实舒张压高之危害十分明显,不容忽视。尽管现代医学对舒张压高的病因及病理机制有明确的阐述,但是暂时没有特效的药物。李延教授在治疗高血压病方面有着丰富的临床经验,临床中运用泽泻汤合温胆汤加减治疗舒张压高之眩晕,切中病机,加减灵活,屡有良效。文中从中医角度阐述舒张压高的病因病机,介绍李师辨病辨证思路,组方用药特点,附三则典型验案,另加个人心得体会,以期为舒张压高的有效治疗提供思路。