Mallath Mohandas K , Chawla Tanuj. Curing more colorectal cancer. National Medical Journal of India. 2016 May-Jun; 29(3): 155-157.

Dalerba P, Sahoo D, Paik S, Guo X, Yothers G, Song N, WilcoxFogel N, Forgó E, Rajendran PS, Miranda SP, Hisamori S, Hutchison J, Kalisky T, Qian D, Wolmark N, Fisher GA, van de Rijn M, Clarke MF. (Herbert Irving Comprehensive Cancer Center and the Departments of Pathology and Cell Biology and Medicine, Columbia University, New York, USA; Institute for Stem Cell Biology and Regenerative Medicine and the Departments of Pathology and Medicine, Division of Oncology, Stanford University, Stanford, and the Departments of Pediatrics and Computer Science and Engineering, University of California San Diego, San Diego, California, USA; Faculty of Engineering, BarIlan University, Ramat Gan, Israel; the National Surgical Adjuvant Breast and Bowel Project, NRG Oncology and the Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, USA; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea; Department of Biochemistry and Molecular Biology, Medical School of Henan University, Kaifeng, China.) CDX2 as a prognostic biomarker in stage II and stage III colon cancer. N Engl J Med 2016;374:211–22.

Impact of Total Contact Plaster Boot via off Loading Practice in Trophic Ulcers of the Feet: Case Series

Trophic ulcers have emerged as one of the major complications following diabetes mellitus (DM) and Hansen’s diseases (HD). In this case series, the study attempted total contact plaster boot using a readily available plaster of Paris to treat trophic ulcer for 10 subjects. A total of five subjects with DM and five subjects with HD were included based on the study criteria. Pre and post test measure of wound measurement size following total contact plaster boot were taken as an outcome measure. All ten subjects showed decrease in size of wound following fifteen days of treatment. No adverse effects were associated with this type of treatment. Subjects with trophic ulcer may benefit from the application of total contact plaster boot.

Analysis of the morphometry and variations in the extensor digitorum brevis muscle: an anatomic guide for muscle flap and tendon transfer surgical dissection / 대한해부학회지

The extensor digitorum brevis muscle (EDB) is a practical option for use as an island flap or free flap when reconstructing soft tissue defects in the ankle as well as in the entire lower limb. It is frequently used to correct crossover toe deformity and other painful toe disorders. We evaluated the morphometry of the EDB in 44 formalin-fixed limbs. Length and width of the muscles were measured. Surface area was calculated as the product of length and width of the muscle. The length of each tendon was also measured from its origin to the point of distal attachment. Presence of any additional tendons was noted. Mean length, width, and surface area of the muscle were 7.39+/-0.71 cm, 4.1+/-0.37 cm, and 30.5+/-4.78 cm2 on the right side and 7.2+/-0.84 cm, 3.9+/-0.37 cm, and 28.4+/-5.35 cm2 on the left side, respectively. Morphometry of the tendons revealed that the tendon of the great toe had the highest mean length (9.5 cm) and the tendon of the fourth toe had the lowest mean length (6.3 cm). Four of the limbs studied (9.09%) had only three tendons. Three of the limbs studied (6.81%) had five tendons, and in one exceptional case (2.27%), six tendons were detected. These observations have significant value and are applicable to plastic and orthopedic surgery.

Costodorsalis ­ an Additional Slip of Pectoralis Major Muscle: a Case Report / Costodorsal ­ un Fascículo Adicional del Músculo Pectoral Mayor: Reporte de un Caso

Occurrence of variant muscular slips from pectoralis major muscle is rare. In this report, we present a rare case of aberrant muscular slip associated with the pectoralis major muscle which we call costodorsalis. This muscular slip originated from the 6th rib near the costochondral junction and ran along the lower border of pectoralis major muscle. It crossed the axilla from medial to lateral side and merged with the latissimus dorsi muscle. This type of origin and insertion is unique and has not been reported earlier. The knowledge of this muscle variation may be of special importance to the anesthesiologists, physiotherapists and plastic surgeons.

Es poco frecuente la aparición de variaciones de un fascículo muscular desde el músculo pectoral mayor . En este trabajo, presentamos el caso de un fascículo muscular aberrante asociado con el músculo pectoral mayor que denominamos costodorsal. Este fascículo muscular se originó en la 6 costilla cerca de la unión costocondral y corrió a lo largo del margen inferior del músculo pectoral mayor. Cruzó la axila de medial a lateral y se fusionó con el músculo latísimo del dorso. Este tipo de origen y la inserción es único y no se ha informado anteriormente. El conocimiento de esta variación muscular puede ser de especial importancia para los anestesistas, fisioterapeutas y cirujanos plásticos.

Production of immunogenic human papillomavirus-16 major capsid protein derived virus like particles.

Background & objective: Recombinant DNA technology allows expression of the human papillomavirus (HPV) major capsid protein (L1) in heterologous expression systems and the recombinant protein self assembles to virus-like particles (VLP). We took up this study to produce recombinant HPV-16 L1 in yeast, establish the process of recombinant L1 derived VLP preparation and develop an ELISA using VLP as the antigen for serological evaluation of anti HPV-16 L1 antibody status. Methods: Complete HPV-16 L1 was amplified from genomic DNA of an esophageal cancer biopsy, cloned and the protein was expressed in a galactose-inducible Saccharomyces cerevisiae expression system. Self assembled VLP was purified by a two-step density gradient centrifugation process and the VLP preparation used to test its suitability in developing an ELISA. Results: The recombinant protein was predominantly a ~55 KD species with distinct immunoreactivity and formed VLP as confirmed by electron microscopy. An ELISA using the VLP showed its efficacy in appropriate immunoreactivity to serum/plasma IgG. Interpretation & conclusions: Recombinant HPV-16 capsid protein derived VLP was produced and the VLP antigen based ELISA can be used to probe serological association of HPV with different clinical conditions. The VLP technology can be improved further and harnessed for future vaccine development efforts in the country.

Infusion chemotherapy with cisplatinum and fluorouracil in the treatment of locally-advanced and metastatic gallbladder cancer.

BACKGROUND: Gallbladder cancer (GBC) has a poor prognosis. Chemotherapy is traditionally considered to be ineffective. The goal of the current study was to evaluate the efficacy of infusional 5-fluorouracil (5-FU) and cisplatinum (CDDP) in patients with inoperable GBC. MATERIALS AND METHODS: A total of 65 patients with inoperable GBC received palliative chemotherapy with CDDP and 5-FU. All the patients had clinically measurable disease as well as adequate bone marrow, hepatic, and renal function. Response was assessed after three cycles of chemotherapy. RESULTS: A total of 19 patients had locally advanced unresectable cancer and 46 patients had metastatic cancer. There were 39 females and 26 males, with a median age of 50 years. A total of 212 chemotherapy cycles were administered to the patients. Response evaluation after three cycles of chemotherapy revealed complete response in five patients [7.69%; 95% confidence interval (95% CI): 2.87-16.22], partial response in 17 patients (26.15%; 95% CI: 16.57-37.81), stabilization of disease in 9 patients (13.85%; 95% CI: 6.96-23.88), and progression in 21 patients (32.30%; 95% CI: 21.80-44.35). At 6 months 44.6% patients were alive and 18.5% patients were alive at 12 months. The median overall survival was 5.7 months and the median time to disease progression was 3.1 months. This chemotherapy combination was well tolerated. There were no chemotherapy-related deaths. CONCLUSIONS: Infusion chemotherapy with CDDP and 5-FU appears to have a fair amount of activity in patients of inoperable GBC, with acceptable toxicity. Tumor shrinkage following treatment with this regimen enabled surgical resection in two patients. We believe that this promising combination must be tested against gemcitabine-based combinations in patients with inoperable GBC.

Treatment with Centalla asiatica [Linn] fresh leaf extract enhances learning ability and memory retention power in rats

To investigate the role of Centella asiatica [CeA] fresh leaf extract treatment on the behavior, especially learning and memory, of adult rats. Adult rats [2.5 months old] were fed with 2, 4, and 6 ml/kg body of fresh leaf extract of CeA for 2, 4, and 6 weeks. After the treatment period the rats were subjected to spatial learning [T-Maze] and passive avoidance tests along with age matched normal and saline control rats. The data were compared with those of age matched control rats. The study was conducted at the Melaka Manipal Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India between December 2001 and February 2005. The rats treated with a higher dose [6 ml] of CeA showed improvement in spatial learning performance, namely, increased [p<0.001] number of alternations and decreased [p<0.001] percentage bias during spontaneous alternation test and increased [p<0.001] percentage bias during rewarded alternation test. They also showed enhanced memory retention power, namely, less [p<0.001] time spent in the small compartment during the retention period of passive avoidance test. This indicates that treatment with higher doses of CeA fresh leaf extract enhances learning ability and memory retention power in adult rats

Cholecystectomy for asymptomatic gallstones can reduce gall bladder cancer mortality in northern Indian women.

Gall bladder cancer (GBC) is a leading cause of cancer-related mortality in the northern parts of the Indian subcontinent. A majority of patients with GBC are middle-aged women, who normally would have substantial family responsibilities. Most patients are diagnosed with advanced cancer and are suitable for palliative care only. There is a strong association between long-standing gallstone disease and the development of GBC. Although randomized trials are lacking, prospective population-based data from low-risk and high-risk regions reveal that cholecystectomy reduces the mortality from GBC. Prophylactic cholecystectomy is recommended in populations with high incidence of GBC. The morbidity and mortality of laparoscopic cholecystectomy in uncomplicated gallstone disease is very low in India. Because of these reasons we argue that prophylactic cholecystectomy should be offered to young healthy women from high-risk regions of India whenever they are diagnosed to have asymptomatic gallstones. Simultaneously, population-based observational studies could be undertaken to generate more evidence.

Subjective global assessment: a simple and reliable screening tool for malnutrition among Indians.

BACKGROUND AND AIMS: Subjective global assessment (SGA) is a simple and reliable malnutrition-screening tool. The SGA has not been evaluated in India or in populations where chronic energy deficiency (CED) is rampant. We evaluated the value of preoperative nutrition, determined using the SGA, in predicting postoperative adverse outcomes in cancer patients. METHODS: Two hundred and ninety-four cancer patients undergoing elective surgery were screened for malnutrition using a modified version of the SGA, and 266 patients (aged 14-73 years [median 50]; 165 male) were eligible. All patients were followed up till discharge, and number of days on antibiotics, length of postoperative stay, occurrence of major adverse events, and death within 30 days were recorded. The association of preoperative SGA scores (A, B, or C) and BMI groups (< 18.5, 18.5-20 or> 20 Kg/m2) and four outcome variables were tested for statistical significance. RESULTS: The cancer sites included head and neck region in 112, gastrointestinal tract in 53, thoracic organs in 28, and other sites in 73 patients. The SGA scores were A in 152, B in 98, and C in 16 patients. The BMI was < 18.5 in 110 (41.8%) patients. The length of postoperative stay and the number of antibiotic days revealed a significant trend from SGA-A to SGA-C (p=0.000). Pre-defined adverse events occurred in 7.9%, 17.3% and 25% of SGA groups A, B, and C, respectively (p=0.025). The risk for adverse events was significantly higher in SGA-C group (OR 5.27, 95% CI 1.35-20.51, p< 0.016) compared to SGA-A group. Three patients in SGA-B group and one in SGA-C group died within 30 days (p=0.04). No significant association was detected between the three BMI groups and duration of antibiotic use, length of postoperative stay, adverse events or mortality. CONCLUSION: SGA is a simple and inexpensive way to identify clinically relevant malnutrition in Indian patients undergoing cancer surgery. Low BMI was not associated with postoperative adverse outcomes, and its use for nutritional screening is likely to overestimate severe malnutrition in Indian patients.

Impact of intra-operative ultrasonography in liver surgery.

BACKGROUND/OBJECTIVE: Intra-operative ultra-sonography (IOUS) during surgery for primary and metastatic hepatic tumors identifies additional lesions and helps in determining the most optimal surgical strategy. We assessed the impact of IOUS in liver surgery at our hospital, a tertiary-care cancer center. METHODS: Patients with potentially resectable hepatic tumors underwent surgical exploration. The relationship of the tumor with regard to the intrahepatic vasculature was determined by IOUS. A search was also made for additional lesions not detected by pre-operative imaging modalities. In appropriate cases, IOUS was also used to assist resection and radiofrequency ablation/ethanol injection. RESULTS: Between January 2003 and January 2005, 52 patients underwent surgery for primary or secondary hepatic tumors. IOUS was performed in 48 of these patients. It detected additional hepatic lesions in 14 patients (29.2%). IOUS contributed to changing the operative plan in 21 patients (43.8%). It was directly responsible for avoiding resection or ablation in 7 patients (14.6%), 5 of whom had multiple bilobar lesions, 1 had IOUS-guided biopsy that revealed caseating granuloma on frozen section, and 1 patient had no lesion on IOUS. Three patients had extent of resection changed based on IOUS findings. IOUS also guided radiofrequency ablation in 8 patients and ethanol injection in one patient. CONCLUSION: IOUS is an essential tool in surgery for hepatic tumors. In addition to accurate staging, it also aids in safe resection and radiofrequency ablation in appropriate cases.