MR-guided SBRT boost for patients with locally advanced or recurrent gynecological cancers ineligible for brachytherapy: feasibility and early clinical experience

Background and purpose Chemoradiotherapy (CRT) followed by a brachytherapy (BT) boost is the standard of care for patients with locally advanced or recurrent gynecological cancer (LARGC). However, not every patient is suitable for BT. Therefore, we investigated the feasibility of an MR-guided SBRT boost (MRg-SBRT boost) following CRT of the pelvis. Material and methods Ten patients with LARGC were analyzed retrospectively. The patients were not suitable for BT due to extensive infiltration of the pelvic wall (10%), other adjacent organs (30%), or both (50%), or ineligibility for anesthesia (10%). Online-adaptive treatment planning was performed to control for interfractional anatomical changes. Treatment parameters and toxicity were evaluated to assess the feasibility of MRg-SBRT boost. Results MRg-SBRT boost was delivered to a median total dose of 21.0 Gy in 4 fractions. The median optimized PTV (PTVopt) size was 43.5ccm. The median cumulative dose of 73.6Gy10 was delivered to PTVopt. The cumulative median D2ccm of the rectum was 63.7 Gy; bladder 72.2 Gy; sigmoid 65.8 Gy; bowel 59.9 Gy (EQD23). The median overall treatment time/fraction was 77 min, including the adaptive workflow in 100% of fractions. The median duration of the entire treatment was 50 days. After a median follow-up of 9 months, we observed no CTCAE ≥ °II toxicities. Conclusion These early results report the feasibility of an MRg-SBRT boost approach in patients with LARGC, who were not candidates for BT. When classical BT-OAR constraints are followed, the therapy was well tolerated. Long-term follow-up is needed to validate the results.

The usefulness of dual mobility cups in primary total hip arthroplasty patients at a risk of dislocation

This study aimed to evaluate the early results of primary total hip arthroplasty (THA) using dual mobility (DM) cups in patients at a risk of dislocation and compare them with that of fixed bearing (FB) THA. This retrospective study included patients who had undergone primary THA between January 2016 and December 2018 and were at a risk of dislocation. A propensity score-matched analysis was conducted for 63 THA procedures with vitamin-E infused highly cross-linked polyethylene (VEPE) DM bearing and 63 THA procedures performed with FB from the same manufacturer for a mean follow-up period of 3.1 and 3.5 years, respectively. The radiologic outcomes at the last follow-up and incidence of postoperative complications were evaluated and compared statistically between the two groups. The modified Harris hip score (mHHS) was used to assess patient-reported outcomes. Postoperative dislocation occurred in 4 cases (6.3%) in the FB group, but did not occur in the DM group (p = 0.042). There was no difference in the radiologic outcomes and postoperative complications between the two groups. The mHHS at the last follow-up showed satisfactory outcomes in both the groups (DM group, 90.5; FB group, 88.1), without a statistical difference between the groups. The early results of THA using VEPE DM bearing showed better outcomes than that of THA with FB for patients at a risk of dislocation. A longer follow-up period is recommended to assess the stability and overall outcomes.

Early outcome of surgical treatment of 20 cases of postinfartion ventricular septal rupture by extended sandwich patch technique via right ventricle approach

Objective: Different techniques have been described to repair post myocardial infarction ventricular septal rupture (VSR), each method may result in residual shunting, bleeding, and post-operative mortality. The aim of this report is to describe early results of extended sandwich technique through right ventricle in 20 consecutive patients. Patients and Methods: A retrospective, cross-sectional and descriptive study on 20 patients underwent surgery for myocardial infarction VSR by extended sandwich technique through right ventricle from 12/2018 to 3/2021 in Hanoi Heart Hospital. Result: 20 consecutive patients (10 women and 10 men) with postinfarction ventricular septal rupture (mean age 72 years, range 48-84) underwent surgical repair for by extended sandwich technique performed through right ventricle from December 2018 to August 2021 in our institute. Reconstruction of the septum was performed by two patches according to the method described by Asai et al. The mean aortic clamp time was 101. The mean extracorporeal circulation time was 143 min. Postoperative intensive care unit (ICU) stay averaged 4 days (range, 1-10 days). There was 30% hospital mortality. 10% postoperative residual shunting was detected, and no patient needed reoperation for bleeding. Conclusion: This method of extended sandwich technique through right ventricle was safe, simple, and it could be performed in acute phase of myocardial infarction.

Analysis of SARS-CoV-2 Omicron Neutralization Data up to 2021-12-22

The rapid spread of the Omicron SARS-CoV-2 variant (B.1.1.529) resulted in international efforts to quickly assess its escape from immunity generated by vaccines and previous infections. Numerous laboratories published Omicron neutralization data as preprints and reports. The understandable limitations and variability in such rapid reporting of early results however made it difficult to make definitive statements about the data. Here, we aggregate and analyze Omicron neutralization data from 23 reporting laboratories up to 2021-12-22. There are enough data to identify multiple trends and make two definitive points. First, in twice-vaccinated individuals, titer fold drop of Omicron relative to wild type is more than 19x, likely substantially more given the number of measurements below the limit of detection of the assay. Second, out to one month post third vaccination with an mRNA vaccine, or twice vaccinated after an earlier infection, the titer fold drop to Omicron is substantially less at approximately 7x. This substantially lower fold drop and somewhat higher titers after 3rd vaccination are strong early evidence for the utility of booster vaccination.

Comments of results after surgical replacement of mechanical mitral and aortic valve in children at Hanoi Heart Hospital

Objective: Assessment of early results after surgical treatment of mechanical mitral valve and aortic valve replacement in children at Hanoi Heart Hospital from 2004 to June 2019. Methods: Analysis and evaluation based on data collected from patients undergoing surgery and from the results of follow-up examination. Results: The total number of patients was 50, in which 34 cases of simple mechanical mitral valve replacement, 16 cases of simple mechanical aortic valve replacement. Average age of surgery: 7.58 ± 6.01 years (The lowest age is 7 months, the highest is 15 years). Male: 29 patients (58%), female: 21 patients (42%). Ultrasound before discharge and after 3 months, we found similar results: mean EF: mechanical mitral valve: 56.28 ± 10.67 %; Aortic valve: 54.72 ± 9.66% .Mean pressure : Mitral valve: 3.18 ± 1.25; Aortic valve: 12.12 ± 3.25 mmHg. INR index: mitral valve : 2.58 ± 1.20; Aortic valve: 2.34 ± 0.92. Complications of valve replacement: 2 cases of mitral valve replacement after surgery 3 years and 4 years; There was 1 case of aortic valve 5 years after surgery. Death immediately after surgery: mitral valve: 2 cases (5.88%); aortic valve: 1 case (6.25%); Late death: After 2 years, there was 1 case of death after mitral valve replacement; After 4 years, there was 1 case of death after aortic valve replacement. Conclusion: The results of heart valve replacement surgery in children are positive. It is necessary to have better equipment and experience in open heart surgery in low-birth-weight children in order to operate the disease as early and effectively as possible, in which the treatment of complications of heart failure and post-operative coagulopathy should be considered important.

Results of minimally invasive aortic valve replacement surgery through right thoracotomy at Hanoi Heart Hospital

Objectives: To evaluate results of minimally invasive aortic valve replacement surgery through right thoracotomy with some techinque improvements in Hanoi Heart Hospital. Methods: Surgery was performed via a small right thoracotomy in the second intercostal space. The third rib was detached by a wedge-shaped way using sternum saw. Cannulation approaches were central or peripheral depended on patients’ condition. Preoperative, perioperative, early results and follow-up data was collected and analysed. Results: There was 48 patients in the research. Mean age was 60,94 ± 11,53 (25-82), and 52,1% was male. 29,2% of patients had peripheral vascular disease. 22,9% underwent central arterial cannulation. 3 patients (6,3%) had pericardial adhesion. There was no early mortality, 2 patients had redo surgery due to excess bleeding. 1 patients had intestinal infarction. Mean follow-up time was 13,4 months. 91,3% of patients had NYHA I. 1 patients was dead due to intracerebral hemorrhage. Conclusions: With some improvements in techniques, minimally invasive aortic valve replacement surgery through right thoracotomy gave good early and midterm results in our center.

Evaluation of early results of patients with permanent peacemakers implantation at Bai Chay Hospital from 2016 to 2020

Objectives: Review the results of pacing and some early complications of patients Who implanted pacemaker at Bai Chay Hospital from 2016 to 2020. Subjects and research methods: A descriptively prospective study longitudinal follow-up study on 31 bradyarrhythmia patients who were permanently paced at Bai Chay Hospital from 2016 to October 2020. Results: After implantation of pacemaker, the rate of symptoms improved markedly, the change was statistically significant with p = 0.0001. Medium heart rate before and after implantation (47.84 ± 7.712 with 65.61 ± 4.425, 95%CI: 17.77 ± 7.173, p = 0.000). Change in QRS width after implantation (153.52 ± 11,963ms vs 91.81 ± 10,882ms, 95%CI 61.71 ± 12,947, p = 0.000). Pacing threshold changed after 6 months (0.68 ± 0.146V; 0.73 ± 0.149; p=0.001). Received R wave and electrode wire impedance did not changing after 6 months of follow-up. The rate of complications right after the procedure accounted for a total of 6.45%. The rate of complications after 6 months of follow-up accounted for 6.45%. Complications were all minor complications and were well managed. The successful rate of the procedure reached 100%, the pacing parameter was assessed as good, accounting for 70.97%. Conclusion: The method is considered effectively in the symptom improvement, safety, low complication rate and should be applied and deployed for patients with bradyarrhythmias with indications for permanent pacemaker implantation.