Are We Missing Acute Toxicities Associated With Hypofractionated Breast Irradiation? A Report From a Large Multicenter Cohort Study.

PURPOSE: The efficacy and long-term safety of hypofractionated whole breast irradiation (HF-WBI) have been established through multiple randomized trials, yet data about acute toxicities remain more limited. Since 2013, our group has prospectively collected acute toxicity data from weekly treatment evaluations and additional assessment after completion. In 2016, we intentionally shifted the posttreatment assessment follow-up visit from 1 month to 2 weeks to evaluate for missed acute toxicity occurring in that immediate posttreatment window. Here, we report whether 2-week follow-up has resulted in increased detection of acute toxicities compared with 4-week follow-up. METHODS AND MATERIALS: We prospectively compared acute toxicity for patients treated with HF-WBI between January 1, 2013, and August 31, 2015 (4 week follow-up cohort) to patients treated between January 1, 2016, and August 31, 2018 (2 week follow-up cohort). Analyses included a multivariable model that adjusted for other factors known to correlate with toxicity. We prospectively defined acute toxicity as maximum breast pain (moderate or severe rating) and/or occurrence of moist desquamation reported 7 days before the completion of radiation therapy (RT) until 42 days after completion. RESULTS: A total of 2689 patients who received postlumpectomy radiation and boost were analyzed; 1862 patients in the 2-week follow-up cohort and 827 in the 4-week follow-up cohort. All acute toxicity measures assessed were statistically similar between follow-up cohorts when compared in an unadjusted fashion. Overall acute composite toxicity was 26.4% and 27.7% for patients in the 4-week follow-up and 2-week follow-up cohorts, respectively. Overall acute composite toxicity remained similar between follow-up cohorts in a multivariable, adjusted model and was significantly related to patient's age, body mass index, smoking status, and treatment technique (intensity-modulated RT vs 3-dimensional conformal radiation therapy) but not follow-up cohort. CONCLUSIONS: An earlier posttreatment follow-up for HF-WBI patients did not reveal a significant increased incidence of acute toxicities at 2 weeks compared with 4 weeks. This study provides physicians and patients with additional data on the safety and tolerability of HF-WBI for early stage breast cancer.

Differences in Social Hardships in Women and Men with Acute Myocardial Infarction: Impact on 30-Day Readmission.

Background: Studies have shown that women with acute myocardial infarction (AMI) have a higher prevalence of unfavorable social variables then men and have a worse outcome. Less is known regarding the impact of these social variables on 30-day readmission after AMI. Materials and Methods: We analyzed adult patients with AMI enrolled in a Quality Improvement Program intended to improve the peri-discharge care of patients with an AMI, and decrease all-cause 30-day unplanned readmissions. We compared clinical and social variables by gender. Multivariate logistic regression, with separate adjustment for clinical and for social variable, was used to measure adjusted odds for readmission by gender. Results: Among 208 patients included in our project 68 (32.7%) were women. Only 30.9% of women were married or had domestic partner at the time of the interview and only 16.2% were employed. Nearly half of women (48.5%) needed help with medical care, and 39.7% of women did not speak English as their first language. These variables were significantly different by gender. Rates of 30-day readmissions were higher in women than men (22.1% vs. 7.8%, p = 0.024). After adjusting for clinical variables this difference by gender in 30-day readmissions remained significant (odds ratio [OR] 3.34 95% confidence interval [CI] 1.1-11.1, p = 0.049). However, when adjusting for social variables, this difference was no longer noted (OR 0.87 95% CI 0.27-2.78, p = 0.822). Conclusion: Women with AMI are more likely than men to have unfavorable social factors that can impact recovery from AMI and women have a higher 30-day readmission rate. The higher 30-day readmissions in women appears to be influenced by these social factors. Health care interventions aimed at reducing 30-day readmission after AMI should focus on eliciting a detailed social history and providing aid for those requiring additional social support at home.

The risk and severity of stroke in patients with atrial fibrillation and gout: A National Representative Database study.

BACKGROUND: It has been shown that gout is associated with left atrium remodeling and a pro-inflammatory state leading to the development of atrial fibrillation (AF). There is limited evidence whether gout increases the risk of stroke in patients with AF. We assessed the incidence of gout and the risk of stroke in patients with AF. METHODS: This is a retrospective cohort study using the 2016 US National Inpatient Sample (NIS) based on ICD-10 codes. The outcomes of the study were the risk and severity of new stroke in patients with pre-existing AF and gout. RESULTS: In 2016, we identified 3 844 057 patients admitted to the hospitals in NIS with history of AF, of which 240 875 had history of gout. Patients with AF and gout have higher risk of new stroke (OR 2.07 [1.97-2.19], P < .001), and this risk remains significantly elevated after adjusting for CHADS2VASC score variables, chronic kidney disease, dyslipidemia, obesity, and race (OR 1.10 [1.01-1.11], P = .041). However, presence of gout in patients with AF was not associated with all-cause in-hospital mortality, need for mechanical ventilation, percutaneous gastrostomy tube insertion, or discharge to skilled nursing facility. CONCLUSION: Subjects with AF and gout compared to AF alone had an increased risk of new stroke, but presence of gout was not associated with stroke severity. There is a potential role of gout as a risk factor or a risk marker for stroke in subjects with AF.

Genetic Mapping of a new Hippo allele, HpoN.1.2, in Drosophila melanogaster.

Genetic screens provide a mechanism to identify genes involved with different cellular and organismal processes. Using a Flp/FRT screen in the Drosophila eye we identified mutations that result in alterations and de-regulation of cell growth and division. From this screen a group of undergraduate researchers part of the Fly-CURE consortium mapped and characterized a new allele of the gene Hippo, HpoN.1.2.

A case of complete heart block in a COVID-19 infected patient.

In the midst of the COVID-19 pandemic, we herein report the case of an elderly female with multiple comorbidities coming with typical symptoms of the viral infection in addition to the unusual presentation of bradycardia due to complete heart block requiring pacemaker placement. This may be a rare complication of the disease but one has to keep a high index of suspicion since this virus has an ability to affect multiple organ systems with many ways yet to be uncovered. .

Aerosol Optical Tweezers Elucidate the Chemistry, Acidity, Phase Separations, and Morphology of Atmospheric Microdroplets.

ConspectusAerosol particles represent unique chemical environments because of their high surface area-to-volume ratio that promotes the effects of interfacial chemistry in confined environments. Properties such as viscosity, diffusivity, water content, pH, and morphology-following liquid-liquid phase separation-can strongly alter how a particle interacts with condensable vapors and reactive trace gases, thus modifying its continual evolution and environmental effects. Our understanding of this chemical evolution of atmospheric particulate matter and its environmental impacts is largely limited by our ability to directly observe how these critical particle properties respond to the addition or reactive uptake of new chemical components. Aerosol optical tweezers (AOT) stably trap particles in focused laser beams, providing positional control and the retrieval of many of these critical properties required to understand and predict the chemistry of aerosolized microdroplets. The analytical power of the AOT stems from the retrieval of the cavity-enhanced Raman spectrum induced by the trapping laser. Analysis of the whispering gallery modes (WGMs) that resonate as a standing wave around the droplet's interface, provide high accuracy measurements of the droplet's size, refractive index (and thus a measurement of composition), and can distinguish between core-shell, partially engulfed, and homogeneous morphologies. We have advanced the ability to determine the properties of the core and shell phases in biphasic droplets, including obtaining high-accuracy pH measurements. These capabilities were applied to perform AOT physical chemistry experiments on authentic secondary organic aerosol (SOA) produced directly in the AOT chamber by ozonolysis of terpene vapors. The propensity of the SOA to phase separate as a shell from a wide range of nonpolar to polar core phases was observed, along with the discovery of a stable emulsified state of SOA particles in an aqueous salt droplet. Micron-thick SOA shells did not impede the gain or loss of water or squalane from the core to the surrounding air, indicating no significant diffusional limitations to condensational growth or partitioning even under dry conditions. These experiments formed the foundation of a new framework that predicts how the phase-separated morphology of complex aerosols containing organic carbon evolves during continual atmospheric oxidation processes. Increases in oxidation state will quickly drive conversion from a partially engulfed to core-shell morphology that has dramatically different chemical reactivity since the core phase is completely concealed by the shell. The recent advances in the experimental capabilities of the AOT technique such as presented here enable novel experimental methodologies that provide insights into the chemistry and multidimensional properties of aerosol microdroplets, and how these coevolve and respond to continual chemical reactions.