Severe radiation thyroiditis after radioactive iodine for treatment of Graves’ disease

Radiation thyroiditis resulting from radioactive iodine-131 treatment for Graves’ disease is an uncommon complication. Although a majority of patients are asymptomatic or manifest mild symptoms that can be managed conservatively, published literature describing severe radiation thyroiditis resulting in significant morbidity is lacking. We herein report on six patients with severe radiation thyroiditis that resulted in hospitalisation, including an unusual complication of myopericarditis.     

SARS-CoV-2 receptor binding domain radio-probe: a non-invasive approach for angiotensin-converting enzyme 2 mapping in mice

The spike protein of SARS-CoV-2 interacts with angiotensin-converting enzyme 2 (ACE2) of human respiratory epithelial cells, which leads to infection. Furthermore, low-dose radiation has been found to reduce inflammation and aid the curing of COVID-19. The receptor binding domain (RBD), a recombinant spike protein with a His tag at the C-terminus, binds to ACE2 in human body. We thus constructed a radioiodinated RBD as a molecule-targeted probe to non-invasively explore ACE2 expression in vivo, and to investigate radiotherapy pathway for inhibiting ACE2. RBD was labeled with [¹²⁴I]NaI using an N-bromosuccinimide (NBS)-mediated method, and ¹²⁴I-RBD was obtained after purification with a specific activity of 28.9 GBq/nmol. Its radiochemical purity was (RCP) over 90% in saline for 5 days. The dissociation constant of ¹²⁴I-RBD binding to hACE2 was 75.7 nM. The uptake of ¹²⁴I-RBD by HeLa^ACE+ cells at 2 h was 2.96% ± 0.35%, which could be substantially blocked by an excessive amount of RBD, and drop to 1.71% ± 0.23%. In BALB/c mice, the biodistribution of ¹²⁴I-RBD after intravenous injection showed a moderate metabolism rate, and its 24 h-post injection (p.i.) organ distribution was similar to the expression profile in body. Micro-PET imaging of mice after intrapulmonary injection showed high uptake of lung at 1, 4, 24 h p.i.. In conclusion, the experimental results demonstrate the potential of ¹²⁴I-RBD as a novel targeted molecular probe for COVID-19. This probe may be used for non-invasive ACE2 mapping in mammals.     

The role of radioactive iodine in the management of patients with differentiated thyroid cancer – An oncologic surgical perspective

With improved understanding of the biology of differentiated thyroid carcinoma its management is evolving. The approach to surgery for the primary tumour and elective nodal surgery is moving from a “one-size-fits-all” recommendation to a more personalised approach based on risk group stratification. With this selective approach to initial surgery, the indications for adjuvant radioactive iodine (RAI) therapy are also changing. This selective approach to adjuvant therapy requires understanding by the entire treatment team of the rationale for RAI, the potential for benefit, the limitations of the evidence, and the potential for side-effects.This review considers the evidence base for the benefits of using RAI in the primary and recurrent setting as well as the side-effects and risks from RAI treatment. By considering the pros and cons of adjuvant therapy we present an oncologic surgical perspective on selection of treatment for patients, both following pre-operative diagnostic biopsy and in the setting of a post-operative diagnosis of malignancy.     

Identification of novel prognostic factors focusing on clinical outcomes in patients with non-small cell lung cancer after stereotactic body radiotherapy

Stereotactic body radiotherapy (SBRT) has attracted extensive attention as an effective treatment for patients with early-stage non-small cell lung cancer. However, the factors affecting prognosis after SBRT have not been fully elucidated. The aim of the present study was to investigate the prognostic factors associated with overall survival (OS) and local control (LC) after SBRT. Between March 2003 and March 2020, 497 patients with primary or oligo-metastatic lung cancer who underwent SBRT treatment were retrospectively reviewed. Univariate analysis was performed against various factors related to patient and tumor characteristics using Kaplan-Meier method. Furthermore, the factors with statistically significant differences identified via univariate analysis underwent a stratified Cox proportional hazard regression analysis. The median follow-up period for all patients was 26.17 months (range, 0.36-194.37), and the 5-year OS and LC rates were 66.3 and 86.0%, respectively. Multivariate analysis showed that surfactant protein-D (SP-D), tumor CT values (TCTV) and iodine density values (IDV) were independent prognostic factors for OS, and histology, TCTV and IDV were for LC. Although histology was not selected as a prognostic factor related to OS, it was indicated that patients with squamous cell carcinoma were associated with the SP-D high group compared with the SP-D normal group. In addition, TCTV was correlated to water density values, which tended to decrease with increasing IDV. From these findings, SP-D and TCTV were identified as potential new candidate prognostic factors after SBRT, and it is possible that combining SP-D and histology, and TCTV and IDV may improve the accuracy of prognostic prediction.     

A 10-Year Impact Evaluation of the Universal Salt Iodization (USI) Intervention in Sarawak,Malaysia, 2008–2018

A universal salt iodization (USI) was introduced in Sarawak, Malaysia in 2008 to control the iodine deficiency disorders (IDD) among its population. The purpose of this study is to evaluate the impact of the USI among school children in Sarawak after 10 years of implementation. The data were extracted from 2008 and 2018 Sarawak state-wide IDD surveys. Briefly, both surveys were cross-sectional surveys covering information on the socio-demographic, status of goitre, urinary iodine, and the amount of iodine in the salt samples. A total of 1104 and 988 between the ages of 8 and 10 were involved in the 2008 and 2018 surveys, respectively. The overall prevalence of goitre among the school children in Sarawak was significantly lower in 2018 (0.1%) compared to 2008 (2.9%). The median urinary iodine concentration (UIC) in urine samples had risen significantly from 102.1 µg/L in 2008 to 126.0 µg/L in 2018. In terms of iodine content in salt samples, the median concentration improved significantly in 2018 (35.5 µg/L) compared to 2008 (14.7 µg/L). After 10 years of USI implementation in Sarawak, the results from both surveys confirmed the effectiveness of mandatory USI in increasing the nutritional iodine status of school children in Sarawak.     

尿碘评价哺乳期妇女碘营养的稳定性分析

目的分析哺乳期妇女尿碘浓度的稳定性,评价其碘营养。方法 2012年4~5月选择碘盐覆盖良好的甘肃省临夏县尹集乡,连续跟踪采集3次自然饮食和生活状态条件下哺乳期妇女间隔10 d随机1次性尿样。采用过硫酸铵消化-砷铈催化分光光度方法（WS/T 107-2006）检测尿碘含量。结果 3次尿碘中位数分别为188.13μg/L、185.0μg/L和172.9μg/L,尿碘中位数和频数构成无显著性差异（P〉0.05）;同一个体3次尿碘在同一水平的比例占9.2%（29/184）,两次尿碘浓度在同一水平的比例均〈20%;以第1次检测结果为基准,第2次尿碘浓度在〈150μg/L、150~250μg/L、250~500μg/L和〉500μg/L同一水平的符合率分别为53.2%、36.5%、31.3%和14.3%,第3次尿碘在〈150μg/L、150~250μg/L、250~500μg/L和〉500μg/L四个水平的符合率分别为44.2%、23.1%、16.7%和0.0%。结论在自然饮食和生活状态下,同一个体不同时间尿碘浓度的符合率低,一致性差,但总体3次尿碘处于一个稳定的状态,因此一次性尿碘浓度不能对个体碘营养作出正确评价,但能够反映群体的碘营养水平。根据尿碘浓度判定,在目前碘盐落实的情况下,调查点的哺乳期妇女碘营养适宜。     

杰雪消毒效果实验研究

目的验证杰雪消毒效果的可靠性,为临床应用提供科学的客观依据。方法选取30例患者,采用同体对照法,杰雪消毒患者右手背皮肤,为试验组;碘酊酒精消毒患者左手背皮肤,为对照组。检测2种消毒方法的细菌总数。选取30个瓶塞采用杰雪消毒,30个瓶塞采用碘酊酒精消毒,检测2种消毒方法的细菌总数。结果杰雪和碘酊酒精消毒后的细菌计数均显著少于消毒前,差异均有统计学意义。2种方法的消毒效果差异无统计学意义。结论杰雪对皮肤和瓶塞的消毒效果均可靠。