"When did you decide to receive the Covid-19 vaccine?" Survey in a high-volume vaccination center.

Highly efficient and safe Covid-19 vaccines are available in Europe in amounts that theoretically allow for a high immune coverage. However, a notable proportion of the population is reluctant toward immunization. We aimed to determine, among people who chose to be vaccinated, when they made the decision and whether they would have preferred an earlier vaccination. A survey was conducted in a high-volume Covid-19 vaccination center in France from 28 May to 9 July 2021 through an anonymous questionnaire. The 2519 participants (54.1% males; median age 39 years) attributed lower efficacy and safety to Covid-19 vaccines than to vaccines in general. When asked when they decided to receive the vaccine, 15.5% and 16.0% answered "less than one month ago" and "less than one week ago," respectively; age <40 and female sex were independently associated with these responses. When asked whether they would have preferred to have been vaccinated earlier, 57.6% answered "definitely no," "rather no," or "neither yes nor no"; female sex (independently from age) was associated with these answers. When asked whether they would have preferred to receive the vaccine as early as January 2021, 65.2% answered "definitely no," "rather no," or "neither yes nor no"; age <40 and female sex were independently associated with these responses. In conclusion, one-third people had made the decision to be vaccinated only recently, while more than half would not have preferred an earlier vaccination, in particular women and those aged <40 years. Vaccine campaigns should take such short-term decision-making processes into account.

A p16-Ki-67-HMB45 immunohistochemistry scoring system as an ancillary diagnostic tool in the diagnosis of melanoma.

BACKGROUND: Melanoma is a skin cancer which treatment requires early diagnosis and large surgical removal. The histopathological diagnosis of a melanocytic tumour is sometimes difficult between a benign nevus and a malignant melanoma. We built an immunomarker-based score to differentiate nevi from melanomas. METHODS: Two independent sets of 308 (first set) and 62 (validation set) formalin-fixed and paraffin embedded tumour samples were studied using p16-Ki-67 and HMB45-MelanA dual-staining immunohistochemistry. RESULTS: In the first set of tumours, high Ki-67 index, low to null p16 immunohistochemistry and absence of HMB45 immunohistochemistry gradient were more frequent in melanomas (156 primary tumours and 78 metastases) than in nevi (74 tumours). Nevertheless, none of these single parameters was able to differentiate all primary melanomas from all nevi. We built a scoring system based on the addition of semi-quantitative scorings of Ki-67 (0: <2%; 1:2-5%; 2:6-10%, 3:11-20%; 4:>20%) and p16 (0:>50% stained cells; 1:11-50%; 2:1-10%; 3:0%) and HMB45 staining (0: gradient present; 1: doubtful/inconclusive gradient; 2: gradient absent). A p16-Ki-67-HMB45 total score from 0 to 9 permitted to classify nevi (score <4) and primary melanomas (score ≥4) with a sensitivity of 97.4% and a specificity of 97.3% in the first set of tumours. Sensibility and specificity of 100 % were obtained in a second set (validation set) of 62 tumours (46 melanomas and 16 nevi). The total scoring also allowed analyzing 11 difficult or initially misdiagnosed tumours in our files. CONCLUSIONS: We propose a valuable triple p16-Ki-67-HMB45 immunohistochemistry scoring system to help pathologists in the differential diagnosis of melanomas and nevi.

Dual NRASQ61R and BRAFV600E mutation-specific immunohistochemistry completes molecular screening in melanoma samples in a routine practice.

NRAS and BRAF mutational status has become mandatory to treat patients with metastatic melanomas. Mutation-specific immunohistochemistry (IHC) can help analyze challenging tumor samples. We report our experience integrating NRASQ61R (SP174) and BRAFV600E (VE1) IHC in routine practice in a cancer molecular genetic platform. All samples screened for BRAF and NRAS mutations during the year 2014 were analyzed by IHC and pyrosequencing, with an independent analysis of the 2 methods. Cases with first-line discordant results benefited from a complementary second-round IHC and next-generation sequencing (NGS) with a final interpretation taking into account the results of pyrosequencing, IHC, NGS, and quantification of the tumor cells. We analyzed 111 consecutive formalin-fixed and paraffin-embedded melanoma samples from 101 patients. Twenty-two and 11 samples were concordant for BRAFV600E and NRASQ61R mutations, respectively. Second-round analyses of 9 discordant and 1 molecularly inconclusive samples allowed conclusion in 4 further mutated samples (2 BRAFV600E and 2 NRASQ61R). A sample remained NRASQ61R IHC negative but NRASQ61R mutated with molecular methods. Overall, BRAFV600 and NRASQ61 mutation frequencies were 31.7% and 30.7%, respectively. When compared to molecular results, the sensitivity and specificity of IHC were 100% for BRAFV600E IHC and 92.3% and 98.9% for NRASQ61R IHC, respectively. IHC interpretation required a more stringent cutoff for BRAFV600E IHC than NRASQ61R to minimize false results. We conclude that NRASQ61R and BRAFV600E IHC coupled with NGS allow detection of mutations in melanoma challenging samples.

Statins: a new pharmacological agent for free flap surgery?

Microvascular free tissue transfer has become the standard for reconstruction in head and neck oncological surgery. Several pharmacological agents have been used in order to increase the success rate of this surgery, but there is currently no consensus for an ideal drug. We review the literature concerning the complications encountered in free flap surgery related to the ischaemia-reperfusion injury and detail the effects of statins relevant to this endothelial dysfunction. Statins, because of their pleiotropic effects such as preservation of vascular tone, anticoagulation and anti-inflammatory properties, appear to be useful in free flap surgery. This study highlights the benefits of statins in order to increase the success rate and the quality of the free flap. They should be included in the perioperative strategy, especially in patients with cardiovascular risk factors. A protocol is presented.