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Background and objective: The literature indicates that patients who had previously had COVID-19 are reporting ongoing symptoms. The objective of this study was to examine ongoing symptoms, functional limitations and quality of life over time in a cohort of individuals who were deemed to have recovered. Methods: This was a prospective observational study on biopsychosocial outcomes at enrolment and again one month later. Results: In a cohort of 59 participants, ongoing symptoms were reported by 73% at 4.5 months (standard deviation = 1.4) post diagnosis, with 45% reporting difficulty with pre-illness activities of daily living. Of the 52 participants who completed the follow-up survey (mean 5.6 months post diagnosis), 42% reported ongoing symptoms, lower physical quality of life (12-Item Short Form Health Survey) and higher levels of anxiety, depression and stress (Depression, Anxiety and Stress Scale). Discussion: Ongoing symptoms such as fatigue, pain and limb weakness as well as functional impairment post initial diagnosis were common. Improved understanding of this cohort can assist general practitioners in providing care.

Introduction Pulmonary vein (PV) isolation has been shown to reduce atrial fibrillation (AF) burden and symptoms in patients. However, to date previous studies have been unblinded raising the possibility of a placebo effect to account for differences in outcomes. Hypothesis & Methods The objective of this study is to compare PV isolation to a sham procedure in patients with symptomatic AF. The SHAM‐PVI study is a double blind randomized controlled clinical trial. 140 patients with symptomatic paroxysmal or persistent AF will be randomized to either PV isolation (with cryoballoon ablation) or a sham procedure (with phrenic nerve pacing). All patients will receive an implantable loop recorder. The primary outcome is total AF burden at 6 months postrandomisation (excluding the 3 month blanking period). Key secondary outcomes include (1) time to symptomatic and asymptomatic atrial tachyarrhythmia (2) total atrial tachyarrhythmia episodes and (3) patient reported outcome measures. Results Enrollment was initiated in January 2020. Through April 2023 119 patients have been recruited. Results are expected to be disseminated in 2024. Conclusion This study compares PV isolation using cryoablation to a sham procedure. The study will estimate the effect of PV isolation on AF burden. The SHAM‐PVI study timeline. One hundred forty patients will be enrolled and randomized in a 1:1 ratio to receive cryoablation or a sham procedure. All patients will receive an implantable loop recorder. Outcomes will be assessed at 3 and 6 months post‐randomisation with the first 3 months constituting the blanking period.

ObjectivesTo update the 2012 ESGAR consensus guidelines on the acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for clinical staging and restaging of rectal cancer.MethodsFourteen abdominal imaging experts from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) participated in a consensus meeting, organised according to an adaptation of the RAND-UCLA Appropriateness Method. Two independent (non-voting) Chairs facilitated the meeting. 246 items were scored (comprising 229 items from the previous 2012 consensus and 17 additional items) and classified as ‘appropriate’ or ‘inappropriate’ (defined by ≥ 80 % consensus) or uncertain (defined by < 80 % consensus).ResultsConsensus was reached for 226 (92 %) of items. From these recommendations regarding hardware, patient preparation, imaging sequences and acquisition, criteria for MR imaging evaluation and reporting structure were constructed. The main additions to the 2012 consensus include recommendations regarding use of diffusion-weighted imaging, criteria for nodal staging and a recommended structured report template.ConclusionsThese updated expert consensus recommendations should be used as clinical guidelines for primary staging and restaging of rectal cancer using MRI.Key Points• These guidelines present recommendations for staging and reporting of rectal cancer.• The guidelines were constructed through consensus amongst 14 pelvic imaging experts.• Consensus was reached by the experts for 92 % of the 246 items discussed.• Practical guidelines for nodal staging are proposed.• A structured reporting template is presented.

Radiotherapy before mastectomy and autologous free-flap breast reconstruction can avoid adverse radiation effects on healthy donor tissues and delays to adjuvant radiotherapy. However, evidence for this treatment sequence is sparse. We aimed to explore the feasibility of preoperative radiotherapy followed by skin-sparing mastectomy and deep inferior epigastric perforator (DIEP) flap reconstruction in patients with breast cancer requiring mastectomy. We conducted a prospective, non-randomised, feasibility study at two National Health Service trusts in the UK. Eligible patients were women aged older than 18 years with a laboratory diagnosis of primary breast cancer requiring mastectomy and post-mastectomy radiotherapy, who were suitable for DIEP flap reconstruction. Preoperative radiotherapy started 3–4 weeks after neoadjuvant chemotherapy and was delivered to the breast, plus regional nodes as required, at 40 Gy in 15 fractions (over 3 weeks) or 42·72 Gy in 16 fractions (over 3·2 weeks). Adverse skin radiation toxicity was assessed preoperatively using the Radiation Therapy Oncology Group toxicity grading system. Skin-sparing mastectomy and DIEP flap reconstruction were planned for 2–6 weeks after completion of preoperative radiotherapy. The primary endpoint was the proportion of open breast wounds greater than 1 cm width requiring a dressing at 4 weeks after surgery, assessed in all participants. This study is registered with ClinicalTrials.gov, NCT02771938, and is closed to recruitment. Between Jan 25, 2016, and Dec 11, 2017, 33 patients were enrolled. At 4 weeks after surgery, four (12·1%, 95% CI 3·4–28·2) of 33 patients had an open breast wound greater than 1 cm. One (3%) patient had confluent moist desquamation (grade 3). There were no serious treatment-related adverse events and no treatment-related deaths. Preoperative radiotherapy followed by skin-sparing mastectomy and immediate DIEP flap reconstruction is feasible and technically safe, with rates of breast open wounds similar to those reported with post-mastectomy radiotherapy. A randomised trial comparing preoperative radiotherapy with post-mastectomy radiotherapy is required to precisely determine and compare surgical, oncological, and breast reconstruction outcomes, including quality of life. Cancer Research UK, National Institute for Health Research.

Antibody responses to SARS-CoV-2 can be detected in most infected individuals 10–15 d after the onset of COVID-19 symptoms. However, due to the recent emergence of SARS-CoV-2 in the human population, it is not known how long antibody responses will be maintained or whether they will provide protection from reinfection. Using sequential serum samples collected up to 94 d post onset of symptoms (POS) from 65 individuals with real-time quantitative PCR-confirmed SARS-CoV-2 infection, we show seroconversion (immunoglobulin (Ig)M, IgA, IgG) in >95% of cases and neutralizing antibody responses when sampled beyond 8 d POS. We show that the kinetics of the neutralizing antibody response is typical of an acute viral infection, with declining neutralizing antibody titres observed after an initial peak, and that the magnitude of this peak is dependent on disease severity. Although some individuals with high peak infective dose (ID 50  > 10,000) maintained neutralizing antibody titres >1,000 at >60 d POS, some with lower peak ID 50 had neutralizing antibody titres approaching baseline within the follow-up period. A similar decline in neutralizing antibody titres was observed in a cohort of 31 seropositive healthcare workers. The present study has important implications when considering widespread serological testing and antibody protection against reinfection with SARS-CoV-2, and may suggest that vaccine boosters are required to provide long-lasting protection. Neutralizing antibody responses of patients infected with SARS-CoV-2 peak at 3–4 weeks post onset of symptoms, then decline to low levels over the course of 3 months in some individuals.

The Gynecologic Cancer InterGroup (GCIG) sixth Ovarian Cancer Conference on Clinical Research was held virtually in October, 2021, following published consensus guidelines. The goal of the consensus meeting was to achieve harmonisation on the design elements of upcoming trials in ovarian cancer, to select important questions for future study, and to identify unmet needs. All 33 GCIG member groups participated in the development, refinement, and adoption of 20 statements within four topic groups on clinical research in ovarian cancer including first line treatment, recurrent disease, disease subgroups, and future trials. Unanimous consensus was obtained for 14 of 20 statements, with greater than 90% concordance in the remaining six statements. The high acceptance rate following active deliberation among the GCIG groups confirmed that a consensus process could be applied in a virtual setting. Together with detailed categorisation of unmet needs, these consensus statements will promote the harmonisation of international clinical research in ovarian cancer.

This research evaluates the mechanical properties of a variety of binary In-Sn alloys as potential candidates for low temperature electronic joints. The tensile and hardness tests of as-cast In-5Sn, In-12.5Sn, In-25Sn, In-30Sn, In-35Sn, In-40Sn, In-50Sn, In-60Sn, In-80Sn (wt.%) were assessed at room temperature and compared to those of pure In and Sn. The ultimate tensile strength (UTS) increased from 4.2 MPa to 37.8 MPa with increasing tin content in the alloys under the testing condition of 18 mm/min and the results showed little difference under a lower strain rate (1.8 mm/min). Most compositions showed good ductility in tensile testing with an average of 40% elongation. A melting point range of 119.3 °C to 194.9 °C for tested alloys was measured using differential scanning calorimetry (DSC). The microstructure investigated by scanning electron microscopy (SEM) was discussed with respect to the mechanical properties and it has been found that the presence of the Sn-rich γ-InSn4 phase in the microstructure has a significant impact on mechanical properties. The fundamental data from this study can be used for the development of new low temperature In-Sn alloys.

Objectives To develop guidelines describing a standardised approach regarding the acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for clinical staging and restaging of rectal cancer. Methods A consensus meeting of 14 abdominal imaging experts from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) was conducted following the RAND-UCLA Appropriateness Method. Two independent (non-voting) chairs facilitated the meeting. Two hundred and thirty-six items were scored by participants for appropriateness and classified subsequently as appropriate or inappropriate (defined by ≥ 80 % consensus) or uncertain (defined by < 80 % consensus). Items not reaching 80 % consensus were noted. Results Consensus was reached for 88 % of items: recommendations regarding hardware, patient preparation, imaging sequences, angulation, criteria for MRI assessment and MRI reporting were constructed from these. Conclusions These expert consensus recommendations can be used as clinical guidelines for primary staging and restaging of rectal cancer using MRI. Key Points • These guidelines recommend standardised imaging for staging and restaging of rectal cancer. • The guidelines were constructed through consensus amongst 14 abdominal imaging experts. • Consensus was reached by in 88 % of 236 items discussed.