New clinical and biological insights from the international TARGIT-A randomised trial of targeted intraoperative radiotherapy during lumpectomy for breast cancer

BACKGROUND: The TARGIT-A trial reported risk-adapted targeted intraoperative radiotherapy (TARGIT-IORT) during lumpectomy for breast cancer to be as effective as whole-breast external beam radiotherapy (EBRT). Here, we present further detailed analyses. METHODS: In total, 2298 women (≥45 years, invasive ductal carcinoma ≤3.5 cm, cN0-N1) were randomised. We investigated the impact of tumour size, grade, ER, PgR, HER2 and lymph node status on local recurrence-free survival, and of local recurrence on distant relapse and mortality. We analysed the predictive factors for recommending supplemental EBRT after TARGIT-IORT as part of the risk-adapted approach, using regression modelling. Non-breast cancer mortality was compared between TARGIT-IORT plus EBRT vs. EBRT. RESULTS: Local recurrence-free survival was no different between TARGIT-IORT and EBRT, in every tumour subgroup. Unlike in the EBRT arm, local recurrence in the TARGIT-IORT arm was not a predictor of a higher risk of distant relapse or death. Our new predictive tool for recommending supplemental EBRT after TARGIT-IORT is at https://targit.org.uk/addrt . Non-breast cancer mortality was significantly lower in the TARGIT-IORT arm, even when patients received supplemental EBRT, HR 0.38 (95% CI 0.17-0.88) P = 0.0091. CONCLUSION: TARGIT-IORT is as effective as EBRT in all subgroups. Local recurrence after TARGIT-IORT, unlike after EBRT, has a good prognosis. TARGIT-IORT might have a beneficial abscopal effect. TRIAL REGISTRATION: ISRCTN34086741 (21/7/2004), NCT00983684 (24/9/2009)

Narcolepsy type 1 and Sydenham chorea - Report of 3 cases and review of the literature.

OBJECTIVES/BACKGROUND Narcolepsy type 1 (NT1) is an immune-mediated disorder characterized by excessive daytime sleepiness, cataplexy, low levels of hypocretin-1 in the cerebrospinal fluid, and a strong association with the HLA DQB1*06:02 allele. There is evidence for streptococcal infections as one pathogenic factor that may lead to NT1 as part of a multifactorial pathogenesis. Elevated titers of Antistreptolysin-O antibodies and increased inflammatory activity in response to streptococci antigens have been described in patients with NT1. Sydenham chorea (SC) results from a post-streptococcal autoimmune process targeting basal ganglia neurons. Despite this common trigger, SC has been interpreted as a misdiagnosis in a few described cases of patients who were first diagnosed with SC and later with NT1. Our goal was to analyze the association between SC and NT1. PATIENTS/METHODS We reviewed the literature and report three patients from three European sleep centers who were diagnosed with both SC and NT1 within a few months. RESULTS We describe the cases of one male (age 10) and two female (age 22 and 10) patients. CONCLUSIONS We argue that in those cases both diagnoses are justified, unlike reports of previous cases in which SC was considered a misdiagnosis in patients with NT1. It remains, however, unclear if the conditions occur independently or if there is an overlap disorder- an SC-like subtype of narcolepsy with a particular sequence of symptoms. Further studies need to clarify the causality of the relationship and the pathophysiology of the reported rare association

Connecting women in neurosciences (CWIN) - a networking project to sustain mutual empowerment in young, female, clinical neuroscientists.

Simultaneously acquiring broad clinical knowledge and scientific expertise is a major challenge for young clinical scientists. Female researchers may face additional hurdles in their career e.g. due to unconscious bias. We aimed to address clinical, research and gender-related challenges among young female clinical neuroscientists. We implemented a peer-lead networking group dedicated to increase clinical and scientific knowledge, improve soft skills and encourage exchange between fellow residents. In monthly meetings, two participants hold short presentations on a clinical topic or scientific method, followed by a discussion and feedback to the presenter. Afterwards, participants network and discuss challenges they face in their daily experience. Nine neurology residents at a Swiss University Hospital with ≤ 3 years of training participated in the "Connecting Women in Neurosciences" (CWIN) project from 08/2020 to 06/2021. In a qualitative evaluation, participants reported they felt empowered by these meetings and profited from their new network. We identified several challenges in combining clinical and research activities, some of which participants perceived to be gender-related. In addition to women-only meetings, we will promote events addressing all interested researchers. Peer-to-peer networking is an easy and low-budget intervention to encourage female residents to engage in research activities, profit from each other's expertise and promote interdisciplinary teamwork. It can provide a protected environment to discuss and overcome in particular gender-related challenges. We encourage young colleagues to regularly engage in structured networking activities with their local peers

Structural and vibrational properties of single crystals of Scandia, Sc2O3\mathrm{Sc_{2}O_{3}} under high pressure

We report the results of single-crystal X-ray diffraction and Raman spectroscopy studies of scandiumoxide, Sc$_{2}$O$_{3}$, at ambient temperature under high pressure up to 55 and 28 GPa, respectively.Both X-ray diffraction and Raman studies indicated a phase transition from the cubic bixbyitephase (so-called C-Res phase) to a monoclinic C2/m phase (so-called B-Res phase) at pressuresaround 25–28 GPa. The transition was accompanied by a significant volumetric drop by ~ 6.7%. Inaddition, the Raman spectroscopy detected a minor crossover around 10–12 GPa, which manifestedin the appearance of new and disappearance of some Raman modes, as well as in softening of oneRaman mode. We found the bulk modulus values of the both C-Res and B-Res phases as B$_{0}$ - 198.2(3) and 171.2(1) GPa (for fixed B' - 4), respectively. Thus, the denser high-pressure latticeof Sc$_{2}$O$_{3}$ is much softer than the original lattice. We discuss possible mechanisms that mightbe responsible for the pronounced elastic softening in the monoclinic high-pressure phase in this“simple” oxide with an ultra-wide band gap

The TARGIT-A randomized trial: TARGIT-IORT versus whole breast radiation therapy: long-term local control and survival

For assessing the efficacy of any cancer therapeutic approach, patients and clinicians want to know the chance of being free of disease as well as the likelihood of achieving long-term survival. Single-dose targeted intraoperative radiation therapy (TARGIT-IORT) during lumpectomy for patients with early breast cancer can avoid the inconvenience and toxicity of whole breast radiation therapy (external beam radiation therapy [EBRT]) and results in reduced pain, a better quality of life, a cosmetically superior outcome, and requires less traveling by the patient