Evaluation of the early adverse effects of radiotherapy in breast cancer patients with COVID-19: Prospective single institutional study

The COVID-19 caused by the SARS-CoV-2 coronavirus is at the origin of a global pandemic. This pandemic has prompted the current health system to reorganize and rethink the care offered by health establishments. We report the early toxicity in patients infected with COVID-19 treated at the same time for early-stage breast cancer (BC). This is a monocentric prospective study of patients treated in our hospital between March 2020 and June 2020 and were diagnosed with COVID-19 infection. The inclusion criteria were to be irradiated for early-stage BC and to have a positive COVID-19 diagnosis on a PCR test and/or a lung computed tomography (CT) scan and/or suggestive clinical symptoms. Radiotherapy (RT) consisted of breast or chest wall irradiation with or without lymph node irradiation, with protocols adapted to pandemic situation. The treatment-related toxicity was graded according to the CTCAE (version 4.03). All 350 patients treated for early-stage BC were studied. Of them, 16 were presented with clinical symptoms of COVID-19 infection and of them, 12 had clinical, CT scan, and PCR confirmation. This entire cohort of 12 pts with median age of 56 (42–72) underwent their RT. During the radiotherapy, there were 9 pts presented radiation dermatitis, 8 (66%) were grade 1 and one was (8%) grade 2. Two patients with lymph nodes irradiation presented esophagitis grade 2. This prospective COVID-19 cohort, treated for early-stage BC demonstrated an acceptable toxicity profile with few low-grade adverse events. Longer follow-up is needed to confirm these findings.     

Dual antibiotic loaded bone cement in patients at high infection risks in arthroplasty: Rationale of use for prophylaxis and scientific evidence

In view of the demographic changes and projected increase of arthroplasty procedures worldwide, the number of prosthetic joint infection cases will naturally grow. Therefore, in order to counteract this trend more rigid rules and a stricter implementation of effective preventive strategies is of highest importance. In the absence of a "miracle weapon" priorities should lie in evidence-based measures including preoperative optimization of patients at higher infection risks, the fulfilment of strict hygiene rules in the operating theatre and an effective antibiotic prophylaxis regimen. Instead of a "one size fits all" philosophy, it has been proposed to adjust the antibiotic prophylaxis protocol to major infection risks taking into account important patient-and procedure-related risk factors. A stronger focus on the local application mode via use of high dose dual antibioticloaded bone cement in such risk situations may have its advantages and is easy to apply in the theatre. The more potent antimicrobial growth inhibition in vitro and the strong reduction of the prosthetic joint infection rate in risk for infection patients with aid of dual antibiotic-loaded bone cement in clinical studies align with this hypothesis.     

Extracellular vesicles released from irradiated neonatal mouse cheek tissue increased cell survival after radiation

Alopecia is one of the common symptoms after high-dose radiation exposure. In our experiments, neonatal mice that received 7 Gy X-ray exhibited defects in overall hair growth, except for their cheeks. This phenomenon might suggest that some substances were secreted and prevented hair follicle loss in the infant tissues around their cheeks after radiation damage. In this study, we focused on exosome-like vesicles (ELV) secreted from cheek skin tissues and back skin tissues, as control, and examined their radiation protective effects on mouse fibroblast cell lines. We observed that ELV from irradiated cheek skin showed protective effects from radiation. Our results suggest that ELV from radiation-exposed cheek skin tissue is one of the secreted factors that prevent hair follicle loss after high-dose radiation.     

A phase IIA extension study evaluating the effect of booster vaccination with a fractional dose of RTS,S/AS01E in a controlled human malaria infection challenge

BackgroundWe previously demonstrated that RTS,S/AS01_B and RTS,S/AS01_E vaccination regimens including at least one delayed fractional dose can protect against Plasmodium falciparum malaria in a controlled human malaria infection (CHMI) model, and showed inferiority of a two-dose versus three-dose regimen. In this follow-on trial, we evaluated whether fractional booster vaccination extended or induced protection in previously protected (P-Fx) or non-protected (NP-Fx) participants.Methods49 participants (P-Fx: 25; NP-Fx: 24) received a fractional (1/5th dose-volume) RTS,S/AS01_E booster 12 months post-primary regimen. They underwent P. falciparum CHMI three weeks later and were then followed for six months for safety and immunogenicity.ResultsOverall vaccine efficacy against re-challenge was 53% (95% CI: 37–65%), and similar for P-Fx (52% [95% CI: 28–68%]) and NP-Fx (54% [95% CI: 29–70%]). Efficacy appeared unaffected by primary regimen or previous protection status. Anti-CS (repeat region) antibody geometric mean concentrations (GMCs) increased post-booster vaccination. GMCs were maintained over time in primary three-dose groups but declined in the two-dose group. Protection after re-challenge was associated with higher anti-CS antibody responses. The booster was well-tolerated.ConclusionsA fractional RTS,S/AS01_E booster given one year after completion of a primary two- or three-dose RTS,S/AS01 delayed fractional dose regimen can extend or induce protection against CHMI.Clinical Trial Registration: NCT03824236.A video linked to this article can be found on the Research Data as well as Figshare https://figshare.com/s/ee025150f9d1ac739361     

Prevention of hepatitis B mother-to-child transmission in Namibia: A cost-effectiveness analysis

Despite access to a safe and effective vaccine, mother-to-child transmission (MTCT) of hepatitis B virus (HBV) persists in Africa. This is of concern since perinatally-infected infants are at highest risk of developing hepatocellular carcinoma, a life-threatening consequence of chronic HBV infection. While tools to prevent HBV MTCT are available, the cost implications of these interventions need consideration prior to implementation. A Markov model was developed to determine the costs and health outcomes of (1) universal HBV birth dose (BD) vaccination, (2) universal BD vaccination and targeted hepatitis B immunoglobulin (HBIG), (3) maternal antiviral prophylaxis using sequential HBV viral load testing added to HBV BD vaccination and HBIG, and (4) maternal antiviral prophylaxis using sequential HBeAg testing combined with HBV BD vaccination and HBIG. Health outcomes were assessed as the number of paediatric infections averted and disability-adjusted life years (DALYs) averted. Primary cost data included consumables, human resources, and hospital facilities. HBV epidemiology, transitions probabilities, disability weights, and the risks of HBV MTCT were extracted from the literature. Incremental cost-effectiveness ratios (ICERs) were calculated to compare successive more expensive interventions to the previous less expensive one. One-way sensitivity analyses were conducted to test the robustness of the model’s outputs. At the Namibian cost/DALY averted threshold of US$3 142, the (1) BD vaccination + targeted HBIG, and (2) maternal antiviral prophylaxis with sequential HBeAg testing interventions were cost-effective. These interventions had ICERs equal to US$1909.03/DALY and US$2598.90/DALY averted, respectively. In terms of effectiveness, the maternal antiviral prophylaxis with sequential HBeAg testing intervention was the intervention of choice. The analysis showed that elimination of HBV MTCT is achievable using maternal antiviral prophylaxis with active and passive immunization. There is an urgent need for low cost diagnostic tests to identify those women who will most benefit from drug therapy to attain this laudable goal.     

基于Mapcheck2的调强放射治疗计划剂量验证分析

目的探讨基于Mapcheck2的调强放射治疗计划剂量验证与靶区均匀性指数(HI)、靶区适形指数(CI)及等中心点剂量梯度(D_Gref)的关系。方法选取2018年6月至2020年2月于医院行调强放射治疗计划的497例患者作为研究对象,采用Mapcheck2进行剂量验证,以剂量误差3%、吻合距离3 mm下的γ通过率≥90%且中心点累积剂量偏差绝对值(Dacc)≤3%为限定条件,在合格的462例计划中随机选取18例设为对照组,将不合格的35例分为A组(Dacc≤3%但γ通过率<90%,11例)、B组(γ通过率<90%且Dacc>3%,9例)、C组(γ通过率≥90%但Dacc>3%,15例),计算并比较4组的HI、CI及D_Gref值。结果 A组各指标与对照组比较,C组HI、CI值与对照组比较,差异均无统计学意义(P>0.05);B组各指标与对照组比较,C组D_Gref值与对照组比较,差异均有统计学意义(P<0.05)。对35例不合格计划进行优化设计后,经验证均合格,且优化后计划的HI、CI及D_Gref值与优化前比较,差异均无统计学意义(P>0.05)。结论调强放射治疗计划设计前,应选取合理的射野数目、方向,优化参数、算法,并尽量将射野等中心点置于靶区内剂量梯度较小的位置,以减少影响剂量验证的不良因素。     

小剂量红霉素治疗小儿毛细支气管炎的效果

目的研究基层医院使用小剂量红霉素治疗小儿毛细支气管炎的可行性和安全性。方法将广东省江门市新会区第二人民医院收治的毛细支气管炎患儿140例,按照治疗方法分为观察组和对照组,每组各70例。两组患儿同时给予雾化吸入、吸氧、平喘、抗病毒、糖皮质激素等常规治疗,疗程10~14 d。观察组患儿入院的第1天给予红霉素,剂量为10 mg/(kg·d),静脉滴注,1次/d,疗程为5 d。对照组患儿给予等剂量的注射用5%葡萄糖液,1次/d,疗程为5 d。比较两组的治疗总有效率、住院总时间、肺部啰音的消失时间及不良反应发生率。结果观察组总有效率为95.71%,明显高于对照组的82.86%,差异有统计学意义(P<0.05)。观察组肺部啰音的消失时间及住院总时间短于对照组,差异均有统计学意义(P<0.05)。两组患儿在住院期间发生皮疹、呕吐、恶心、腹泻等不良反应发生率比较,差异无统计学意义(P>0.05)。结论基层医院小剂量红霉素治疗小儿毛细支气管炎的疗效好,安全性高,能促使患儿早日康复。     

巴中市室外γ辐射水平调查及其相关因素分析

目的 了解巴中市室外γ辐射剂量水平,探索室外地表γ辐射剂量率相关因素。方法 按照《环境地表γ辐射剂量率测定规范》（GB/T14583—1993）布点和检测,使用RStudio 1.2.5033软件进行统计分析,多组均数的比较使用单因素方差分析,相关因素分析使用多重线性回归。结果 本次调查对巴中市辖区432个点的室外地表γ辐射剂量率进行巡测。巴中市室外地表γ辐射剂量率均值为113.04nGy/h,室外天然γ辐射所致居民人均年有效剂量当量为0.14mSv。不同县区、不同地点类型室外地表γ辐射剂量率分析结果显示巴州区（120.72nGy/h）、平昌县（119.65nGy/h）和通江县（121.45nGy/h）地表γ辐射剂量率均值高于南江县（98.08nGy/h）和恩阳区（103.74nGy/h）,一般道路γ辐射剂量率均值（115.57nGy/h）大于荒地（109.98nGy/h）。多重线性回归结果显示室外地表γ辐射剂量率可能的相关因素有县区和道路类型。结论 巴中市室外地表γ辐射属于正常本底水平。     

亚稀褶红菇对大鼠致死毒性分级研究

目的 为了解亚稀褶红菇对大鼠的半数致死量（LD50）,进行毒性分级。方法 采用急性毒性试验经典方法寇氏法,设亚稀褶红菇175、248、350、495、700 mg/kgBW共 5个剂量组和阴性对照组(等体积生理盐水),每组大鼠12只,雌雄各半,腹腔注射,连续观察14 d大鼠的毒性反应和死亡情况。并对试验大鼠进行病理组织学检查。结果 根据试验结果,经计算,亚稀褶红菇对SD大鼠腹腔注射LD50为406 mg/kgBW,95%可信限为348～473 mg/kgBW。病理学检查显示大鼠心脏、肝脏、肾脏均有损害,随剂量增加损害程度加重。结论 按照大鼠急性毒性（LD50）剂量分级亚稀褶红菇为中等毒性,相当于人的致死量为5 g/人。