HYPofractionated Adjuvant RadioTherapy in 1 versus 2 weeks in high-risk patients with breast cancer (HYPART): a non-inferiority, open-label, phase III randomised trial

BACKGROUND

Breast cancer is the most common cancer in women. Radiotherapy is an important part of breast cancer treatment after surgery. Breast cancer radiotherapy is usually delivered in 3-5 weeks. This is a long duration for women with breast cancer to stay away from the family and work. We wanted to reduce this duration so that the wages loss and the logistics can be minimised for these patients. Hypofractionation, i.e. high dose per fraction, is delivered in a smaller number of days. In this study, we will compare a 1-week schedule of hypofractionated adjuvant whole breast/chest wall and/or regional nodal radiotherapy against 2 weeks for locoregional disease control, toxicities, quality of life (QoL), survival and second cancers after primary surgery in patients with breast cancer.

METHODS

Eligible patients with breast cancer after mastectomy or breast conserving surgery (BCS) will be treated with a radiotherapy dose of 26 Gy in 5 fractions over 1 week in the study arm and 34 Gy in 10 fractions over 2 weeks in the control arm. The primary endpoint of this noninferiority study will be locoregional tumour control. Secondary endpoints will be early and late radiation toxicities, quality of life, contralateral primary tumours, regional and distant metastases, survival and second cancers. A total of 1018 patients will be randomised (1:1) to receive 1 week or 2 weeks of radiotherapy. An event-driven analysis will be performed after at least 94 patients have documented locoregional recurrences. Acute radiation toxicity will be assessed and scaled according to the RTOG grading system. Late radiation toxicity will be assessed with the Radiation Therapy Oncology Group and the European Organisation for Research and Treatment of Cancer late radiation morbidity scale. Cosmetic assessment will be done using Harvard/NSABP/RTOG breast cosmesis grading scale at baseline and 3 and 5 years. QoL will be assessed with EORTC QLQ-30 and EORTC QLQ-BR 23 at baseline and 3 and 5 years.

DISCUSSION

Hypofractionation reduces treatment time to half while maintaining breast cosmesis and gives control rates equal to conventional fractionation. This is possible because breast tissue can tolerate high dose per fraction. In this study, we presume that 1-week radiotherapy will be non-inferior to 2 week radiotherapy, i.e. disease control will be similar with both the schedules without additional side effects, and QoL of these patients will be maintained. If we are able to achieve these outcomes, then patients will be able to complete their radiotherapy in less duration. There is not much data on regional nodal irradiation with hypofraction in breast cancer. We have used hypofraction for regional nodal irradiation in the past and not encountered any safety issue. If we are able to prove that late-term effects are comparable in the two schedules, it will make the radiation oncologist confident about hypofractionation in breast cancer. As breast cancer is a leading cancer in females and radiation therapy is an integral part of its local management, hypofractionation will help radiation centres worldwide to meet the growing need for radiation treatment in breast cancer, particularly in developing countries where resources are limited. It will also reduce the financial burden on the patient and family. Since we will treat these patients with both simple and complex radiotherapy techniques, it will also be possible for the low-income countries to follow this trial without needing a high-end or expensive radiotherapy equipment as the planning and treatment process will be very simple.

TRIAL REGISTRATION

The trial is registered with ClinicalTrials.gov ID NCT04472845 and CTRI with REF/2020/09/037050.

Left main stem stenosis angioplasty with intravascular ultrasound optimisation criteria guidance using a new generation everolimus drug-eluting stent

INTRODUCTION

Intravascular ultrasound (IVUS) is recommended in the use of left main stem (LMS) percutaneous coronary intervention (PCI). Since the LMS diameter is usually larger than other coronary arteries, a new generation everolimus drug-eluting stent (DES), Synergy Megatron DES (Boston Scientific) has better axial and radial strength allowing more post implant overexpansion and consequently better suited for LMS lesions. We performed a study to evaluate the clinical outcomes of PCI using 1) an improved IVUS protocol with optimisation targets and 2) the use of Megatron stents.

MATERIALS AND METHODS

This was a study involving LMS PCI coronary lesions using the Synergy Megatron DES. An IVUS protocol using predefined optimisation targets to evaluate for stent malapposition, longitudinal stent deformation, optimal stent expansion >90% of reference lumen and appropriate distal landing zone was used in all cases. The primary end-point was procedural success, defined by successful stent implantation with <30% residual stenosis. The secondary end-point was in-hospital and 30-day major adverse cardiovascular event (MACE).

RESULTS

Eight patients with significant LMS stenosis were successfully treated with the Megatron stent. The primary end-point was achieved in all patients. There were no cases of stent malapposition or longitudinal stent deformation, one case did not have optimal LMS stent expansion and one case did not have an appropriate distal landing zone. IVUS optimisation criteria were met in 6 (75%) cases. There were no complications of coronary dissection, slow or no reflow, stent thrombosis or vessel perforation. None of the patients suffered in-hospital or 30-day MACE. The average LMS MLD at baseline was 2.1 ± 0.1mm and the post-PCI LMS MLD was 4.0 ± 0.5mm, with a significant acute luminal gain of 1.9 ± 0.7mm (p<0.01). A post-PCI MSA of 17 ± 3.9 mm2 was numerically superior compared to those documented in other LMS PCI trials.

CONCLUSION

This study demonstrates low rates of shortterm major adverse cardiovascular events among patients with LMS PCI using the Megatron stents. It highlights the usefulness of IVUS-guided optimisation in LMS PCI. With the use of intravascular imaging, the new generation stent technology can improve the treatment of large proximal vessels and PCI of LMS lesions.

Bio-fabrication of porous magnetic Chitosan/Fe3O4 nanocomposite using Azolla pinnata for removal of chromium - Parametric effects, surface characterization and kinetics

In this research, a novel porous nanocomposite, namely Chitosan-iron-oxide @ Azolla pinnata nanocomposite, has been synthesized by co-precipitation and hydrothermal method. The effect of process parameter on adsorption process was investigated. Batch removal of chromium (Cr) was optimized with respect to solution pH, batch stirring time, sorbent dose, initial chromium concentration and temperature. The maximum removal efficiency was found to be 98.58%. The Fourier transform infrared (FTIR) spectroscopy and scanning electron microscope (SEM) analysis of the nano composite confirmed the presence of characteristic functional groups and porous structure of synthesized nanocomposite. The adsorption data fitted well with Langmuir adsorption isotherm (R² = 0.996) confirming mono layer sorption and the maximum uptake was found to be 294.12 mg/g. The adsorption was found to follow pseudo second order model (R² = 0.997). Thermodynamic studies revealed that adsorption is endothermic and spontaneous. Reusability studies have confirmed that removal efficiency attained was 85% after completion of five adsorption-desorption cycles. Electrostatic attraction, ion exchange, coordination bonding and reduction are the major mechanisms responsible for removal of chromium. Surface modification of Azolla pinnata with chitosan and iron oxide improved the ability of Azolla in the adsorption of chromium from aqueous media. The combined effects of facile synthesis, improved adsorption features and easier magnetic separation promotes Chitosan-iron-oxide @ Azolla pinnata nanocomposite as a novel adsorbent.

Optimal sizing method with sensitivity analysis for hybrid energy storage system in electric vehicle using hybrid technique

This manuscript proposes a hybrid method for optimum sizing and energy management (EM) of hybrid energy storage systems (HESSs) in Electric vehicle (EV). The proposed hybrid method is combined performance of Honey Badger Algorithm (HBA) and recalling-enhanced recurrent neural network (RERNN), commonly called HBA-RERNN method. The major objective of proposed system is reducing the vehicle life time cost. The HESSs are incorporated with battery and super capacitor (SC). The proposed method is utilized to solve combined energy management and optimization size. Based on the variables, such as size of battery pack and super capacitor pack, HESS size is reflected. Depend on various sensitivity factors, the analysis of optimum hybrid energy storage systems size and financial costs are performed. At last, the performance of proposed system is implemented on MATLAB site and likened with several existing systems. From this simulation outcome, it concludes that the proposed system diminishes the overall cost and battery degradation cost as 66625 USD than the existing systems. The efficiency of the proposed system achieves 94.8763% .

Impact of COVID-19 pandemic on a developing STEMI care system from a low-middle income country- a prospective observational study

Background

COVID-19 pandemic has produced a great impact in the STEMI (ST Elevation Myocardial Infarction) care systems across the world. Patient hesitancy to seek medical attention for suspected STEMI, necessity of the health care systems to prioritize COVID-19 care, safety concerns of health care workers etc., have brought in unprecedented times for both patients and health care workers. The impact of COVID-19 pandemic on the establishment of a STEMI care system is less known

Purpose

To identify the impact of COVID-19 pandemic on a developing public STEMI care system in a low-middle income country in Asia, with reference to the type of reperfusion offered and outcome.

Methods

Data on number of STEMI admissions, type of reperfusion therapy and outcome are being collected from 12 teaching hospitals as a part of a developing public regional STEMI care system based on a hub and spoke model in a low middle-income country from August 2018. These 12 “thrombolysis only” hospitals were being upgraded as “primary percutaneous coronary intervention (PPCI) capable hub hospitals” in 2019. Though the hassles of COVID-19 pandemic affected this process significantly, daily data collection in our STEMI care system continued. The maximal COVID impacted period in 2020 was identified from the online database (1) as from April to December 2020. The number, type of reperfusion and outcome of the STEMI patients treated during this period were compared to the same data collected during April-December 2019.

Results

A total of 13,137 STEMI patients were treated in our system during the two time periods “April to December 2019” and “April to December 2020”. There was a 13.3% drop in the number of STEMI treated in 2020, compared to the number treated in 2019 (6101 vs 8925; P&lt;0.001). This drop was in proportion to the number of new cases of COVID-19 reported in our state (Fig. 1a)

We also noted a significant drop in the rate of PPCI and Pharmaco-invasive therapy (PIT) offered for STEMI in 2020 compared to 2019 in the same period (PPCI: 0.13% vs 5.9%-P&lt;0.001 and PIT 0.64% vs 11%- P&lt;0.001). This decrease in PPCI and PIT for STEMI also corresponded to the increase in number of new cases of COVID-19 reported (Fig. 1b). More patients received thrombolytic therapy for STEMI in 2020 compared to 2019 (73.6 vs 61.2% P&lt;0.001). There was no change in the mortality of STEMI during this period. (Fig. 2)

Conclusion

We found a significant drop in number of patients seeking medical care for STEMI during COVID-19 pandemic. There was significant drop in the rate of PPCI and PIT offered in our STEMI care system. Thrombolytic therapy remained the predominant mode of reperfusion as before, but with a significant increased rate of thrombolysis. There was no change in mortality rate in STEMI patients. Thrombolytic therapy is an acceptable mode of reperfusion, when the balance of a STEMI care system is disturbed by extraneous influences like the COVID-19 pandemic.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Tamil Nadu Innovation Initiative- Department of Planning and development, Govt of Tamil NaduNational Health Mission, Government of India

Twisted intramolecular motion arrested in aggregated state emission and the nonlinear optical properties of pyrene pyrazoline derivatives

Heterocyclic pyrene pyrazoline moieties containing similar structures but with differences in thiophene (PPT), furan (PPF) and pyridine (PPP) substitutions at the terminal molecules were synthesized. Their aggregation behaviour in THF-water mixtures was investigated and results demonstrated that PPT and PPP exhibited aggregation-induced emission (AIE), whereas PPF exhibited aggregation-induced blue-shifted emission (AIBSE). PPT and PPP provided red-shifted emission, while PPF had observed blue-shifted emission at high water fractions of 70-90%, confirming that aggregation effects played a major role in the molecular structure. Two emission peaks from locally excited and twisted intramolecular charge transfer confirmed the twisted nature from the dihedral angle values of the free reorganized molecules that were completely restricted in high water fractions due to molecular aggregation. This was further confirmed from colour Commission Internationale de l'Eclairage values as well as dynamic light scattering analysis. Third-order nonlinear optical properties were studied using a Nd:Yag laser beam Z-scan technique at 532 nm. The open aperture Z-scan revealed that PPT and PPF towards the peak point endured strong saturable absorption, whereas PPP indicated a strong reverse saturable absorption process. The AIE and AIBSE mechanisms from undergoing restricted twisting intramolecular motion in the aggregated luminogens provide great insight into new developments in AIEgen materials for these optoelectronic materials.

Isolation and analysis of the molecular epidemiology and zoonotic significance of Mycobacterium tuberculosis in domestic and wildlife ruminants from three states in India

The majority of tuberculosis cases in ruminants are caused by Mycobacterium bovis (MB). However, in this study, the authors reported the isolation of Mycobacterium tuberculosis (MT) from bovine milk, nasal swabs and post-mortem tissue samples (n = 841) collected from cattle and buffaloes in the states of Telangana, Maharashtra and Gujarat in India in the period from 2010 to 2015. The isolates (n = 7) were confirmed as Mycobacterium due to their growth characteristics and colony morphology in a commercial liquid medium Mycobacterial Growth Indicator Tube (MGIT)™ employing the BD BACTEC™ MGIT™ 960 system and the Löwenstein-Jensen (LJ) medium supplemented with glycerol but not with sodium pyruvate, and BD-DIFCO™ Middlebrook 7H10 agar containing oleic albumin dextrose catalase (OADC). These isolates were initially identified as members of the M. tuberculosis complex (MTC) using a commercial nested polymerase chain reaction (PCR) kit based on the IS6110 MTC specific nucleotide sequence. The isolates were confirmed as MT using three commercial line probe assay kits, were further genotyped, and the spoligotypes identified were of East African Indian (EAI) 3_IND, EAI5, Central-Asian (CAS) 1_DELHI, U and T1 lineages. Two MT isolates from one antelope (Antilope cervipara) andone gazelle (Gazella bennettii) from Gujarat, which were identified previously, were spoligotyped during this study and identified as belonging to EAI3_IND and EAI5 lineages, respectively. The epidemiological significance and zoonotic implications of regional presence and documentation of the same or two differents poligotypes in different species within the family Bovidae as well as humans is discussed.

Resemblances of experiment and theory on aryl substituted luminogenic polypyrazolines

Polyarylpyrazolines (PPB, PPA, PPT, PPBt) containing various aryl substituents emit light in a broad color range from orange to blue, making them suitable for optoelectronics.

Effectiveness of Pelvic Floor Muscle Training Alone and in Combination With Biofeedback, Electrical Stimulation, or Both Compared to Control for Urinary Incontinence in Men Following Prostatectomy: Systematic Review and Meta-Analysis

BACKGROUND

The efficacy of pelvic floor muscle training (PFMT) alone and in combination with biofeedback (BFB), electrical stimulation (ES), or both for urinary incontinence in men following prostatectomy is inconclusive.

PURPOSE

The purpose of this study was to determine whether PFMT works well alone or in combination with BFB, ES, or both in comparison with a control.

DATA SOURCES

The databases Ovid Medline, EMBASE, CENTRAL, Scopus, and Web of Science, and the specialized register of the Citroen Incontinence Review Group were searched from study inception to August 2017. Abstract proceedings from urological meetings, including the European Association of Urology and the American Urological Association, were also searched.

STUDY SELECTION

Randomized controlled trials that compared PFMT alone and PFMT with ES, BFB, or both and no treatment, placebo, or sham were included in the review.

DATA EXTRACTION, SYNTHESIS, AND QUALITY

Two independent reviewers completed data extraction and quality appraisal. The Grading of Recommendations, Assessment, Development, and Evaluation tool was used for quality appraisal. Meta-analysis was done with software used for preparing and maintaining Cochrane reviews.

LIMITATIONS

Methodological flaws in the included studies limited internal validity.

CONCLUSIONS

PFMT alone, PFMT plus BFB and ES, and PFMT plus ES were more effective than the control for urinary incontinence following prostatectomy. The effect of PFMT plus BFB on postprostatectomy incontinence remains uncertain.

Equilibrium model analysis of waste plastics gasification using CO2 and steam

Utilization of carbon dioxide (CO₂) in thermochemical treatment of waste plastics may significantly help to improve CO₂ recycling, thus simultaneously curtailing dioxins/furans and CO₂ emissions. Although CO₂ is not such an effective gasifying agent as steam, a few investigations have explored the utilization of CO₂ in conjunction with steam to achieve somewhat higher carbon conversion. This work presents a comparative evaluation study of CO₂ and steam gasification of a typical post-consumer waste plastics mixture using an Aspen Plus equilibrium model. The effect of flow rate of gasifying medium (CO₂ and/or steam) and gasification temperature on product gas composition, carbon conversion, and cold gas efficiency has been analyzed. Simulation results demonstrate that CO₂ can serve as a potential gasifying agent for waste plastics gasification. The resulting product gas was rich in CO whereas CO₂-steam blends yield a wider H₂/CO ratio, thus extending the applications of the product gas.

<b>A pre­liminary report on the impact of road kills on the herpetofauna species in Nilgiris, Tamil Nadu, India</b>

To know the situation of road hits of amphibians and reptile species, a survey was conducted during the period 02 June 2013 to 25 May 2014.  A total of 172 incidents of road kill of different species were noticed, representing 12 species of herpetofauna, including five amphibian species of the families Bufonidae, Dicroglossidae, Microhylidae and Rhacophoridae, and seven species of reptiles of the families Scincidae, Agamidae, Uropeltidae, Colubridae, Natricidae and Xenodermatidae.  Reptiles were the most affected group (60%), of which more than 79.61% of the road kills were snakes.  The most affected snake species were endemic Xylophis perroteti (64.63%). 

An Interesting Case Report of Hematohidrosis

Hematohidrosis or hematidrosis is a rare condition in which a human being sweats blood. Psychogenic cause is found to be the most frequent cause among other causes such as systemic disease and vicarious menstruation. This is a case report of a 10-year-old girl with oozing of blood from intact skin of scalp. Underlying intense fear secondary to psychosocial stressor was identified and a provisional diagnosis of mixed anxiety and depressive disorder was made. Pharmacotherapy and psychotherapy were followed by complete remission. It was inferred from this experience that hematohidrosis is a treatable condition if the underlying cause is correctly identified.

Molecular identification of Mycobacterium tuberculosis in cattle

Bovine tuberculosis continued to be a re-emerging problem in some countries especially in endemic areas due to the fact that human and animal health surveillance system is not adopted to diagnose the infection. This crisis can be attributed due to sharing of the same habitat especially in rural areas. In the present study, a total of 148 samples were collected from cattle for isolation over a period of 3 years from cattle with and without lesions, of which 67 isolates were obtained by culture. Fifty one isolates were identified as Mycobacterium tuberculosis complex (MTBC) by IS6110 PCR of which 43 (84.3%) were identified as M. tuberculosis and 08 (15.6%) were identified as M. bovis by using 12.7kb fragment multiplex PCR. Among this, 31 isolates which were positive for IS6110 PCR were subjected to spoligotyping and revealed 28 isolates belonging to MANU1 strain of M. tuberculosis. This study clearly indicates that high prevalence of M. tuberculosis than M. bovis in bovine was identified by means of culture and by molecular methods M. tuberculosis can affect cattle producing lesion in contradiction to the earlier thoughts. This study speculates that M. tuberculosis MANU1 strain infection in cattle could be due to spill over from human or other non specific hosts in tuberculosis endemic areas. Though bovine tuberculosis due to M. tuberculosis in cattle is not considered a serious threat worldwide, in countries where human TB is endemic, M. tuberculosis infection of cattle needs to be considered.

Road kills of the endemic snake Perrotet’s Shieldtail Plectrurus perrotetii, Dumeril, 1851 (Reptilia: Squamata: Uropeltidae) in Nilgiris, Tamil Nadu, India

Twenty seven road killed specimens of Plectrurus perrotetii were recorded in Emerald and its surrounding areas in the Nilgiris. Among the road kills, fourteen of them were females, seven were males and six are juveniles. Among the road kill female specimens of this species, it was observed that seven were gravid with fully developed young. Three to six developing young ones were observed

Change in the Quality of Life in Oropharyngeal, Laryngeal and Hypopharyngeal Cancer Patients treated with Volumetric Modulated Arc-Based Concomitant Boost Radiotherapy

OBJECTIVE

To assess the change in the quality of life (QOL) in Oropharyngeal, Laryngeal and Hypopharyngeal cancer patients treated with concomitant boost radiotherapy by Volumetric Intensity Modulated Arc Therapy (VMAT) technique.

METHODS

Thirty patients with oropharynx, larynx or hypopharynx cancers of stage II to IVA were treated with an Accelerated fractionation schedule using Concomitant boost. The dose given was 1.8Gy/fraction daily, 5 days a week to the large field for 28 fractions and a daily concomitant boost of 1.5Gy/fraction to the boost field over the last 12 treatment days for a total dose of 68.4Gy/40 fractions/5½weeks by VMAT technique with concurrent chemotherapy (in stage III and IV patients) using Cisplatin 100mg/m2 IV three weekly during week 1 and week 4 of irradiation. QOL was assessed using the European Organization of Research and Treatment of Cancer Quality of Life Core Questionnaire, version 3.0 (EORTC QLQC30) and EORTC head and neck module (EORTC QLQ-HN35) before treatment, at the end of treatment, 1 month, 3 months and 6 months post treatment. The QOL scores and their evolution over the five measurements were calculated.

RESULTS

The change in the QOL scores was acceptable in general. There was a significant reduction in quality of life scores at the end of treatment. The QOL improved in the followup period; and by 3 months post irradiation, there was a return of QOL scores to the baseline value.

CONCLUSION

The QOL scores indicate that concomitant boost radiotherapy by VMAT is well tolerated and helps in rapid return to baseline quality of life scores. We believe that this is one of the first papers which have combined concomitant boost radiotherapy with VMAT technique in head and neck cancers. VMAT based concomitant boost radiotherapy helps in rapid return to baseline quality of life.

Intra-cardiac Tumor in Newborn: An Echo Presentation

Cardiac tumors represent a relatively rare, yet challenging diagnosis. Echocardiography is the main diagnostic tool for the detection of a cardiac tumor. We report a case of congenital giant intra-cardiac tumor, in which echocardiography revealed a large well-defined hyperechoic homogenous intracardiac mass involving interventricular septum which mimicked like asymmetrical septal hypertrophic pattern and another two small masses attached to right ventricular part of interventricular septum.

Substitution effect on chalcone based materials for corrosion and photocrosslinking applications

Hydroxy (–OH) and benzyloxy (–OCH₂Ph) substituted chalcone based crystalline materials were synthesized and characterized; these materials exhibited high corrosion inhibitor efficiency and enhanced photo-crosslinking applications.

Diode-pumped femtosecond solid-state waveguide laser with a 4.9 GHz pulse repetition rate

We report on the first demonstration of a passively mode-locked, diode-pumped, monolithic Yb:glass channel waveguide laser that incorporates a semiconductor saturable absorber mirror. Stable and self-starting mode-locking is achieved in a Fabry-Perot cavity configuration producing a pulse repetition rate up to 4.9 GHz. The shortest pulse duration of 740 fs is generated with 30 mW of average output power at a center wavelength of 1058 nm. A maximum output power of 81 mW is produced during mode-locking with corresponding pulse duration of 800 fs.

Synthesis, characterization and electrocatalytic activity of fused gold nanoparticles

This paper describes the synthesis of fused spherical gold nanoparticles (AuNPs) and their electrocatalytic activity towards the oxidation of hydroxylamine (HA). Fused AuNPs were prepared by one-pot synthesis using 2-mercapto-4-methyl-5-thiazoleacetic acid (TAA) as a stabilizing agent and sodium borohydride (NaBH4) as a reducing agent. The HR-TEM images showed that two individual AuNP were joined via on its surface with a size range of approximately 7 nm and a length of approximately 15 nm diameter. The pH studies showed that the synthesized fused AuNPs was stable at pH > 8. This indicated that the carboxylate ion present on the TAA molecule stabilized the AuNPs from aggregation. Further, the fused AuNPs were utilized for the electrocatalytic oxidation of hydroxylamine (HA) after immobilized them on (3-mercaptopropyl)-trimethoxysilane (MPTS) sol-gel film modified Au electrode. The AuNPs modified electrode showed an excellent electrocatalytic activity towards the oxidation of HA in 0.2 M phosphate buffer solution (pH 7.2) by shifting its oxidation potential to 100 mV less positive and enhancing its oxidation current for more than three times when compared to bare Au electrode. Further, it was found that the fused AuNPs modified electrode showed greater electrocatalytic activity towards HA than the spherical AuNPs modified electrodes.