Recurrence of Lymphedema and Related Characteristics in Discharged Breast Cancer Patients During The COVID-19 Pandemic: A Multicenter, Cross-Sectional Survey (preprint)

Background: To evaluate recurrence of lymphedema and its influencing factors in discharged breast cancer patients with treated lymphedema during the COVID-19 pandemic and to propose feasible improvements. Methods: A multicenter, cross-sectional, hospital-based survey of discharged breast cancer patients was conducted during the COVID-19 pandemic in eight first-class hospitals in Wuhan city, China. Norman Questionnaire was used for assessing lymphedema, and multivariable binary logistic regression was performed to risk factors of moderate or severe lymphedema. Difference in living characteristics, anxiety and depression between no or mild group and moderate or severe group were compared. Preference in management of lymphedema were collected. Results: 202 valid patients were included. 191 participants reported recurred lymphedema (prevalence: 94.6%, 95%CI 90.5% to 97.3%). 134 of them was mild and 57 were moderate/severe. In the 191 patients, the main symptom was swelling (140, 69.3%) and pain (56, 27.7%). Multivariable regression showed that age (odds ratio, 1.06, 95%CI: 1.02-1.10), radical surgery (OR=4.35, 95%CI: 1.54-12.50) and fully complete radiotherapy (OR=2.62, 95%CI: 1.17-5.87, P=0.019) was associated with the risk of moderate or severe lymphedema. No significant difference in lifestyles was observed but moderate or severe group experienced higher rate of anxiety and depression. patients preferred treatment in hospital and self-care at home equally. Conclusion: The high recurrence rate of lymphedema in breast cancer patients with during COVID-19 should draw our great attention, continuous efforts should be made to identify patient at risk of lymphedema and distribute feasible guidance and education for self-management for these patients.

Safety and Efficacy of Antiviral Therapy for Chronic Hepatitis B Throughout Entire Pregnancy (preprint)

Background: The data of antiviral therapy throughout the entire pregnancy are relatively scarce. The aim of the present study was to evaluate the safety and efficacy of antiviral therapy for chronic HBV infection throughout the entire pregnancy.Methods: This was a single-center, prospectively study. Fifty-five women received antiviral therapy (TDF or LDT) from pre-conception to the entire pregnancy. Sixty-four women did not receive antiviral therapy during pre-conception and the entire pregnancy. All infants in the two groups had received immunoprophylaxis on schedule. Mother-infant pairs were followed up at least 7 months postpartum. The outcome was the safety and efficacy of antiviral therapy for mothers and offspring.Findings: All mothers tolerated antiviral therapy (TDF or LDT) well. The mean maternal HBV DNA level in the antiviral therapy group was less than that of the control group before delivery as well as in the three months postpartum (P<0.05). Before delivery, the mean maternal serum ALT level in the antiviral group (15.47±8.36 U/L) was slightly higher than that of the control group (12.67±9.42 U/L) (P=0.010). However, in 3 months postpartum, there was not a statistically significant difference in the maternal serum ALT level between the two groups (P=0.185). There was not a statistically significant difference in the pregnancy complications, the gestational weeks, and the mode of delivery between the two groups, respectively (P>0.05). Furthermore, there was not a statistically significant difference in the birth weight, the birth length, and the congenital diseases of infants between the two groups, respectively (P>0.05). In 7 months postpartum, none of infants who tested HBV status in the two groups was positive for HBsAg.Interpretation: Antiviral therapy (TDF or LDT) from pre-conception to the entire pregnancy could be safe and effective for pregnant women with HBV infection and their fetuses/ infants.Trial Registration: The present study was registered in ClinicalTrials.gov (No. NCT03181607).Funding Statement: The present study was funded by the National Key Research and Development Program of China (2017YFC1001402, 2018YFC1002900), National Natural Science Foundation of China (81401306, 81830045), Clinical Research Project of Guangzhou Medical University (No. 2017[160]) and Sino-German Center for Research Promotion (SGC)'s Rapid Response Funding Call for Bilateral Collaborative Proposals between China and Germany in COVID-19 Related Research (No. C-0032).Declaration of Interests: All authors declare no financial, potential personal or commercial conflict of interest.Ethics Approval Statement: The present study was approved by the Institutional Ethics Committee of the Third Affiliated Hospital of Guangzhou Medical University, and was carried out in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed written consent was obtained from each participant in the present study.

COVID-19 early warning score: a multi-parameter screening tool to identify highly suspected patients (preprint)

BACKGROUND Corona Virus Disease 2019 (COVID-19) is spreading worldwide. Effective screening for patients is important to limit the epidemic. However, some defects make the currently applied diagnosis methods are still not very ideal for early warning of patients. We aimed to develop a diagnostic model that allows for the quick screening of highly suspected patients using easy-to-get variables. METHODS A total of 1,311 patients receiving severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleicacid detection were included, whom with a positive result were classified into COVID-19 group. Multivariate logistic regression analyses were performed to construct the diagnostic model. Receiver operating characteristic (ROC) curve analysis were used for model validation. RESULTS After analysis, signs of pneumonia on CT, history of close contact, fever, neutrophil-to-lymphocyte ratio (NLR), Tmax and sex were included in the diagnostic model. Age and meaningful respiratory symptoms were enrolled into COVID-19 early warning score (COVID-19 EWS). The areas under the ROC curve (AUROC) indicated that both of the diagnostic model (training dataset 0.956 [95%CI 0.935-0.977, P < 0.001]; validation dataset 0.960 [95%CI 0.919-1.0, P < 0.001] ) and COVID-19 EWS (training dataset 0.956 [95%CI 0.934-0.978, P < 0.001] ; validate dataset 0.966 [95%CI 0.929-1, P < 0.001]) had good discrimination capacity. In addition, we also obtained the cut-off values of disease severity predictors, such as CT score, CD8+ T cell count, CD4+ T cell count, and so on. CONCLUSIONS The new developed COVID-19 EWS was a considerable tool for early and relatively accurately warning of SARS-CoV-2 infected patients.