Molecular subtypes of invasive breast carcinoma of no special type, their correlation with histopathological features, Ki 67 index and tumor budding: A retrospective comparative study

Context: Tumor budding (TB), poorly differentiated clusters (PDCs), and Ki 67 index are proven adverse prognostic factors in breast carcinoma. Though the relation of Ki 67 index with molecular subtypes of breast carcinoma have been extensively studied, there is very limited information on the role of TB and PDCs. Aims: To grade TB, PDCs, and Ki 67 index and assess histological features and relationship of all these with molecular subtypes of invasive breast carcinoma of no special type. Methods and Material: Retrospective study of 148 cases from 1/1/2019 to 30/12/2019. Division of molecular groups – Luminal A, Luminal B, Her2 neu positive, and triple-negative breast carcinomas (TNBC), and Ki 67 index grades based on St Gallen criteria, intratumoral and peritumoral TB and PDC grades as per the International Tumor Budding Consensus Conference (ITBCC) criteria for colon and correlation between these and other histological features with the molecular subtypes were done. Statistical Analysis: Chi-square test, univariate and multivariate logistic regression models were used. Results: Significant correlation was seen between TB and lymphovascular emboli, Luminal B tumors with high-grade TB and PDCs, Her 2 neu positive and TNBC tumors with low-grade TB, circumscribed tumor margins, tumor necrosis, and Luminal B, Her 2 neu positive and TNBC tumors with larger tumor size and high nuclear grades.Conclusions: TB and PDCs are useful in the prognostication of Luminal A and B tumors when the Ki 67 index values are low/intermediate. Her 2 neu positive and TNBC tumors have a high nuclear grade with necrosis and no association with TB or PDCs.

Computerized tomography based evaluation of level I and II axillary lymph nodes by high conventional tangential fields in carcinoma breast

Background: Axillary radiation and surgery have provided equivalent local control in early breast cancer patients. It is believed that tangential field (TF) radiation that was used to treat the breast coincidently delivered radiation treatment to the lower axilla and eradicated the disease. In the era of CT-based three dimensional- (3D) radiotherapy planning, however concerns have been raised about the adequacy of coverage of the axillary levels in the tangential fields. In this study, author evaluated the coverage of the axillary nodal levels I and II using high conventional tangential fields in patients with or without axillary dissection.Methods: A prospective study was conducted which included 18 cases for a period of one year, radiation therapy was planned to the chest wall or whole breast by using the high conventional tangential field using 2D radiation portals. Central lung distance (CLD) and the distance of superior border was measured form the head of the humerus and were recorded. CECT chest was done in the same position alike during conventional simulation. All the images were shifted to the treatment planning system. The Contouring of Axillary lymph nodes level I and II was done on Oncentra contouring software.Results: The coverage of the axillary nodes was not related to central lung distance (CLD). However, some with CLD of 1cm had more coverage of the level I nodes than with CLD of 2 cm and the maximum CLD in the field was 2.5 cm. Of the 18 patients in the study, 13 patients had <2 cm distance from the humeral head and all the axillary level II LN covered in the field. Whereas 5 patients having distance >2 cm did not have adequate coverage of level II axillary LN’s.Conclusions: The distance of the cranial border of the tangent portal from the head of the humerus shows a relationship with coverage of level II nodes cranially. As the distance decreases the coverage of level II nodes cranially keeps increasing. In majority of the patients a distance of 2 cm or less than 2 cm ensured good coverage of level II nodes cranially. Similarly, no correlation was found between volumetric coverage of the axillary nodes with central lung distance.

Analysis of drug promotional literature and its abidance to WHO guidelines

Background: Drug promotional literature (DPL) is used by the pharmaceutical companies for promotion of their drug. It is the commonest source for providing information about the drug to the physician. According to WHO promotional literature should be reliable, truthful, informative, balanced and up to date.Methods: Study was conducted in Department of Pharmacology, Muzaffarnagar Medical College. 200 drug promotional literatures like advertisements published in medical journal, package insert of medicinal products and brochures were collected and analysed according to WHO criteria.Results: Total 200 promotional literatures were analysed. 100 promotional literatures were from the medical journal, 50 were package inserts of medicinal products and 50 were medicinal brochures. On assessing DPL using WHO criteria, all DPL mentioned brand names and dosage form (100%). Most of them published the generic name (98.5%), therapeutic uses (78%), side- effects (75%), dosage regimen (70%), contraindication (62.5%), warnings (55%), drug interaction (54%), precaution (50%), reference to scientific literature (45%), name of manufacture and distributor (99%), address of manufacturer and distributor (50%). Out of 200 DPL only 151 DPL contain references to scientific literature, 88 DPL references were retrievable and 63 were non retrievable.Conclusions: Our study shows although pharmaceutical companies are trying to adhere to the WHO criteria it is not fulfilled. As DPL are an important source of seeking information by the medical practitioner who rely on them to impart treatment to the patient, strict steps to regulate fulfilment of the WHO criteria should be taken by the government and authorities.

Automated percutaneous lumbar discectomy in patients suffering from prolapsed intervertebral disc: a prospective study

Background: A variety of minimally invasive techniques [chemonucleolysis, laser, automated percutaneous discectomy, percutaneous manual nucleotomy] have been invented over the years, as treatment of low back pain related to disc disease. Automated percutaneous lumbar dissectomy [APLD], being one of these techniques, is a modality in which removal of nucleus pulposus, reduces intradiscal pressure thus relieves the nerve root compression and subsequently reduces radicular pain. This technique was introduced by Onik in 1985, referred to as 'automated' since it involves a mechanical probe, working by a 'suction and cutting action for removal of the nucleus pulposus

Methodology: After meeting the inclusion criteria, minimal invasive procedure - APLD, performed in between 2012 to 2015 on 120 patients on outdoor basis. Radicular discogenic pain was confirmed by MRI and clinical finding, procedure is being performed using nucleotome under fluoroscopic guidance

Result: Based on patient satisfaction, 72 [60%] patients had excellent pain relief [75 - 100%], 34 [28.3%] had good pain relief [51-74%] whereas 14 [11.7%] patients had poor pain relief. Two [1.6%] patient developed discitis, which was the only complication and it resolved within fifteen days without sequelae

Conclusion: Percutaneous decompression [APLD] techniques for intervertebral disc herniation are safe and cost-effective techniques with significant and long lasting results concerning pain reduction and mobility improvement. They can be proposed as initial treatment or attractive alternatives prior to major surgery

Dilute acid pretreatment and enzymatic hydrolysis of sorghum biomass for sugar recovery—A statistical approach.

Sorghum is one of the commercially feasible lignocellulosic biomass and has a great potential of being sustainable feedstock for renewable energy. As with any lignocellulosic biomass, sorghum also requires pretreatment which increases its susceptibility to hydrolysis by enzymes for generating sugars which can be further fermented to alcohol. In the present study, sorghum biomass was evaluated for deriving maximum fermentable sugars by optimizing various pretreatment parameters using statistical optimization methods. Pretreatment studies were done with H2SO4, followed by enzymatic saccharification. The efficiency of the process was evaluated on the basis of production of the total reducing sugars released during the process. Compositional analysis was done for native as well as pretreated biomass and compared. The biomass pretreated with the optimized conditions could yield 0.408 g of reducing sugars /g of pretreated biomass upon enzymatic hydrolysis. The cellulose content in the solid portion obtained after pretreatment using optimised conditions was found to be increased by 43.37% with lesser production of inhibitors in acid pretreated liquor.

Hypoxia influences expression profile of Pleckstrin homology-like domain, family A, member 2 in Indian catfish, Clarias batrachus (Linnaeus, 1758): A new candidate gene for hypoxia tolerance in fish.

Several physiologically important genes were found to be regulated by hypoxia at the transcriptional level. The Pleckstrin homology-like domain, family A, member 2 (PHLDA2) gene was previously identified as an imprinted gene. The present study was aimed to determine the structure of complete cDNA and the deduced protein of PHLDA2 along with analysing the changes in its mRNA expression in Clarias batrachus tissues under hypoxic conditions. The complete cDNA of CbPHLDA2 gene consisted of 1009 nucleotides with an open reading frame of 417 nucleotides. The deduced CbPHLDA2 protein of 139 amino acids shared high homology with PHLD2A of other fishes as well as that of vertebrates. Importantly, a single amino acid (asparagine/lysine) insertion was identified in the PH domain of CbPHLDA2 and other fishes, which was absent in other vertebrates studied. Furthermore, under normoxic conditions, CbPHLDA2 was constitutively expressed with varying levels in analysed tissues. Short- and long-term hypoxia exposure resulted in significant changes in the expression of CbPHLDA2 in liver, spleen, head kidney, brain and muscle in a time-dependent manner. The results suggested that CbPHLDA2 might play an important role for adaptive significance under hypoxia.

Müllerian duct anomalies and their effect on the radiotherapeutic management of cervical cancer / 癌症

Radiotherapy plays a major role in the treatment of cervical cancer. A successful radiotherapy program integrates both external beam and brachytherapy components. The principles of radiotherapy are strongly based on the anatomy of the organ and patterns of local and nodal spread. However, in patients with distorted anatomy, several practical issues arise in the delivery of optimal radiotherapy, especially with brachytherapy. Müllerian duct anomalies result in congenital malformations of the female genital tract. Though being very commonly studied for their deleterious effects on fertility and pregnancy, they have not been recognized for their potential to interfere with the delivery of radiotherapy among patients with cervical cancer. Here, we discuss the management of cervical cancer among patients with Müllerian duct anomalies and review the very sparse amount of published literature on this topic.

Advances in genetics and molecular breeding of three legume crops of semi-arid tropics using next-generation sequencing and high-throughput genotyping technologies.

Molecular markers are the most powerful genomic tools to increase the efficiency and precision of breeding practices for crop improvement. Progress in the development of genomic resources in the leading legume crops of the semi-arid tropics (SAT), namely, chickpea (Cicer arietinum), pigeonpea (Cajanus cajan) and groundnut (Arachis hypogaea), as compared to other crop species like cereals, has been very slow. With the advances in next-generation sequencing (NGS) and high-throughput (HTP) genotyping methods, there is a shift in development of genomic resources including molecular markers in these crops. For instance, 2,000 to 3,000 novel simple sequence repeats (SSR) markers have been developed each for chickpea, pigeonpea and groundnut. Based on Sanger, 454/FLX and Illumina transcript reads, transcriptome assemblies have been developed for chickpea (44,845 transcript assembly contigs, or TACs) and pigeonpea (21,434 TACs). Illumina sequencing of some parental genotypes of mapping populations has resulted in the development of 120 million reads for chickpea and 128.9 million reads for pigeonpea. Alignment of these Illumina reads with respective transcriptome assemblies have provided >10,000 SNPs each in chickpea and pigeonpea. A variety of SNP genotyping platforms including GoldenGate, VeraCode and Competitive Allele Specific PCR (KASPar) assays have been developed in chickpea and pigeonpea. By using above resources, the first-generation or comprehensive genetic maps have been developed in the three legume speciesmentioned above. Analysis of phenotyping data together with genotyping data has provided candidate markers for drought-tolerance-related root traits in chickpea, resistance to foliar diseases in groundnut and sterility mosaic disease (SMD) and fertility restoration in pigeonpea. Together with these traitassociated markers along with those already available, molecular breeding programmes have been initiated for enhancing drought tolerance, resistance to fusarium wilt and ascochyta blight in chickpea and resistance to foliar diseases in groundnut. These trait-associated robust markers along with other genomic resources including genetic maps and genomic resources will certainly accelerate crop improvement programmes in the SAT legumes.

Evaluation of anti-apoptotic activity of different dietary antioxidants in renal cell carcinoma against hydrogen peroxide

<p><b>OBJECTIVE</b>To evaluate the anti-apoptotic and radical scavenging activities of dietary phenolics, namely ascorbic acid,α-tocopherol acetate, citric acid, salicylic acid, and estimate H2O2-induced apoptosis in renal cell carcinoma cells.</p><p><b>METHODS</b>The intracellular antioxidant potency of antioxidants was investigated. H2O2-induced apoptosis in RCC-26 was assayed with the following parameters: cell viability (% apoptosis), nucleosomal damage and DNA fragmentation, bcl-2 levels and flow cytometery analysis (ROS production evaluation).</p><p><b>RESULTS</b>The anticancer properties of antioxidants such as ascorbic acid, α-tocopherol acetate, citric acid, salicylic acid with perdurable responses were investigated. It was observed that these antioxidants had protective effect (anti-apoptotic activity) against hydrogen peroxide (H2O2) in renal cell carcinoma (RCC-26) cell line.</p><p><b>CONCLUSIONS</b>This study reveals and proves the anticancer properties. However, in cancer cell lines anti-apoptotic activity can indirectly reflect the cancer promoter activity through radicals scavenging, and significantly protect nucleus and bcl-2.</p>

Impact of HIV/AIDS on quality of life of people living with HIV/AIDS in Chitradurga district, Karnataka.

Background: HIV/AIDS is fatal illness which leaves the victim vulnerable. Quality of life in individuals living with HIV/AIDS is becoming crucial for measuring commonly used endpoints. The study of psychosocial factors also influences the health outcome of People Living with HIV/AIDS. Aim: To assess the Quality of life of PLHA in relation to various socio-demographic and clinical correlates. Setting and Design: A community care center in Chitradurga district and it is a Cross sectional study. Methods and Materials: About 395 PLHAs registered in the centre constituted the sample. WHOQOL - 120 instrument was used for assessing quality of life. The socio demographic factors were also obtained in pre designed proforma. Statistical Analysis Used: Proportions, Mean, Std deviation, One way Analysis of Variance (ANOVA). Results and Conclusion: The Quality of Life scores for all domains were intermediate for the PLHAs between (10 - 14). The mean scores were highest for psychological domain. There was a significant difference in QOL of PLHA who were on ART and Not on ART in some domains. PLHAs who were literates, married, Single, employed, income more than 1500 not on ART, CD4 count more than 200, earlier stages of HIV, living with spouse and students had high mean scores. Mean difference of QOL scores with duration of ART intake were statistically significant in psychological and Spirituality domains. QOL was found to be determined by education, income, occupation, ART status, duration of taking ART and clinical categories of the disease.

Surgical management of a pial arteriovenous fistula with giant varix in an infant.

A seven-month-old infant presented with a generalized seizure. The radiological evaluation revealed a large arteriovenous fistula in the left sylvian region. The fistula connected the left middle cerebral artery and the vein of Trolard. A giant varix was present at the venous end. The child underwent craniotomy, complete disconnection of the fistula and excision of the varix. Except for recurrent seizures, which were eventually controlled on anticonvulsants, the child's neurological development has been good on long-term follow-up of three years. Pial arteriovenous fistulae are rare intracranial vascular malformations. Though significant operative risks exist, they can be successfully managed surgically with good long-term prognosis.

Management of neuroleptic malignant syndrome--a series of eight cases.

Neuroleptic Malignant Syndrome (NMS) is a rare and life threatening complication of treatment with Neuroleptic medication. Phenothiazine and butyrophenones are most frequently implicated in this syndrome even though there are case reports with other drugs. In this paper we describe the classical presentation of this syndrome in eight cases who had been on either a butyrophenone, a phenothiazine or a combination of these drugs. In addition some of our patients were also on either Lithium and/or Amitrytiline for control of depressive symptoms. Fever, muscule rigidity and elevated CPK are the important criteria for diagnosis and they were noted in all our patients. In addition four of our patients fulfilled five of the six minor criteria laid down by Levenson. Both Sinemet and Bromocriptine were found to be effective in the treatment of seven of the eight cases. However treatment with Dantroline sodium was associated with severe muscle wasting in one of our cases and the drug had to be discontinued. Two of our patients developed suspected myoglobinuria with dark coloured urine and progressive renal failure. One patient died after development of renal failure, pulmonary edema and hyperkalemia as a consequence of this disorders.