Frequency of Programmed Death Receptor Ligand 1 Expression and Clinicopathological Factors Associated With Metastatic Triple-Negative Breast Cancer at a Tertiary Cancer Care Centre in South India.

Purpose Triple-negative breast cancer (TNBC) has a poor outcome compared to other subtypes. Immune checkpoint inhibitors (ICIs) have changed the treatment paradigm in metastatic diseases as well as in neoadjuvant setting. The response to these agents is affected by programmed death ligand 1 (PDL1) receptor expression which are reported objectively as a score. PDL1 is a prognostic marker also. Here, we present clinicopathological characteristics of metastatic TNBCs, report the proportion of PDL1 expression and its association with clinicopathological factors as well as survival. Methods This is a prospective study carried out at a tertiary cancer care centre in South India. Case records of all breast cancer patients treated in two years between August 2021 and July 2023 were reviewed, patients with metastatic TNBC were selected. Patient's characteristics, histological features, molecular profile, and treatment were analyzed. PDL1 testing was carried out on pretreatment tumor tissue sections with immunohistochemistry (IHC) (Dako 22C3). PDL1 staining was interpreted as negative or positive based on combined positive score (CPS), with an expression less than 10 considered negative. Results A total of 118 patients were analyzed. With a median age of 46 years (36-65 years), 52.5% (62/118) were premenopausal. Family history of Ca Breast was seen in 22% (26/118) patients. A majority of patients had left-sided tumor 55.9% (66/118). Visceral metastasis was more common 96.6% (82/118) than skeletal. Radical intent of treatment was adopted in 10% as patients had oligometastatic disease at presentation. As front-line treatment, anthracycline-based chemotherapy was administered to the majority 54.2% (64/118). The PDL1 expression with CPS more or equal to 10 was seen in 32.2% (38/118) patients. Survival was associated with menopausal status (p value=0.000) and family history (p value=0.028) but not with PDL1 nor sidedness in our study. Estimated survival at 12 months in PDL1 negative case is 10 ± 0.29 months, while in PDL1 positive case it is slightly more at 10 ± 0.75 months, but difference was not found to be statistically significant (p value=0.15). Conclusion TNBCs are highly aggressive subtype with limited treatment options and poorer outcomes. Our study shows PDL1 expression in 31.66% of the cases similar to other literature from India. Survival is associated with menopausal status and family history. No association was found between survival and PDL1 as well sidedness in our study.

Mortality Audit of Cancer Patients in the Department of Medical Oncology at a Tertiary Cancer Care Centre in South India.

Considerable advances in the diagnosis and treatment of cancer have made a huge impact on morbidity and mortality from neoplastic diseases. However, cancer remains the leading cause of death across the world. This is a retrospective study carried out at a tertiary cancer care centre (Kidwai Memorial Institute of Oncology, Bangalore) in South India. Case records of all cancer patients who died while receiving inpatient treatment between January 2022 and December 2022 under the Department of Medical Oncology were reviewed and studied. There was a total of 240 deaths. Out of these, the majority of deaths 147 (61.25%) were patients with haematological malignancies while the remaining 93 (38.75%) were patients with solid tumours. In patients with solid tumours, the majority 49 (52.7%) were in the age group of 40 to 60 years while only 18 (19.35%) patients were less than 40 years. The majority of patients were male sex i.e. 55(59.1%) and undergoing treatment with palliative intent 81 (87%). The most common organ was the lung in 21 patients (22.6%) followed by the breast while the most common system involved was the gastrointestinal tract in 28 (30.1%) patients. The most frequent cause of death was progressive disease in 72 (77.4%) while sepsis (11 patients; 11.8%) was the second most frequent cause of death in solid tumours. In haematological malignancies, also a significant number of 57 (38.8%) patients were in the age group of 40 to 60 years. Fifty-two (35.3%) patients were in the age group of 22 to 40 years. The majority were male sex (79 patients; 53.7%). About the phase of treatment, the majority of deaths 45 (30.6%) were during induction and under evaluation. Those with relapse/refractory disease were 38 (25.9%). A substantial number of patients had acute myeloid leukaemia 47 (32%) and five (3.4%) deaths were acute promyelocytic leukaemia patients. Twenty-three patients (15.6%) had acute lymphoblastic leukaemia. The most common cause of death was sepsis in 76 patients (51.7%) while intracranial bleeding was in 34 patients (23.1%). In some patients, there were multiple causes leading to death. Mortality audits are important to evaluate the services being provided at any centre. One can appreciate the lacunae in handling a particular disease or flaws in a treatment protocol or the staff delivering the treatment. Sepsis is the leading cause of death in patients with haematological malignancy; even in solid malignancy sepsis accounts for a substantial proportion of deaths and should be handled aggressively to save lives.

Stenotrophomonas maltophilia as a rare cause of meningitis and ventriculoperitoneal shunt infection.

Stenotrophomonas maltophilia is an extremely rare pathogen responsible for ventriculoperitoneal shunt infection and meningitis. This young female patient with history of multiple shunt revisions in the past, came to us with shunt dysfunction and exposure of the ventriculoperitoneal shunt tube in the neck. The abdominal end of the shunt tube was seen migrating into the bowel during shunt revision. The cerebrospinal fluid analysis showed evidence of Stenotrophomonas maltophilia growth. This is the first reported case of Stenotrophomonas maltophilia meningitis associated with ventriculoperitoneal shunt migration into the bowel.

A conductive self healing polymeric binder using hydrogen bonding for Si anodes in lithium ion batteries.

A ureido-pyrimidinone (UPy)-functionalized poly(acrylic acid) grafted with poly(ethylene glycol)(PEG), designated PAU-g-PEG, was developed as a high performance polymer binder for Si anodes in lithium-ion batteries. By introducing both a ureido-pyrimidinone (UPy) unit, which is capable of self-healing through dynamic hydrogen bonding within molecules as well as with Si, and an ion-conducting PEG onto the side chain of the poly(acrylic acid), this water-based self-healable and conductive polymer binder can effectively accommodate the volume changes of Si, while maintaining electronic integrity, in an electrode during repeated charge/discharge cycles. The Si@PAU-g-PEG electrode retained a high capacity of 1,450.2 mAh g-1 and a Coulombic efficiency of 99.4% even after 350 cycles under a C-rate of 0.5 C. Under a high C-rate of 3 C, an outstanding capacity of 2,500 mAh g-1 was also achieved, thus demonstrating its potential for improving the electrochemical performance of Si anodes.

Chitosan-grafted-poly(aniline-co-anthranilic acid) as a water soluble binder to form 3D structures for Si anodes.

We graft an electrically conductive poly(aniline-co-anthranilic acid) (PAAA) polymer capable of interacting with Si particles onto chitosan, a natural hydrophilic polymer, to form a chitosan-grafted-PAAA (CS-g-PAAA) copolymer, and use it as a new water soluble polymeric binder for Si anodes to relieve the physical stress resulting from Si volume change during charge/discharge cycles. The carboxylic acid functional groups within the PAAA structure, as well as the chitosan functional groups, bind to silicon particles to form a stable 3D network, resulting in high adhesion. Because the binder is conductive, the electrode using the CS-g-PAAA-8 : 1 with an optimal composition ratio of CS to PAAA of 8 : 1 shows a high initial capacity of 2785.6 mA h g-1, and maintains a high capacity of 1301.0 mA h g-1 after 300 cycles. We also extract chitosan directly from crab shells, and fabricate a Si@ECS-g-PAAA electrode by grafting PAAA onto the extracted-chitosan (ECS). This electrode records an initial capacity of 3057.3 mA h g-1, and maintains a high capacity of 1408.8 mA h g-1 with 51.4% retention after 300 cycles. Overall, we develop a polymeric binder with outstanding cell properties, ease of fabrication, and high water solubility for Si anodes by grafting a conductive PAAA onto chitosan.

Morphological Comparison of the Changes in the Gingiva of Albino Wistar Rats on Administering Tacrolimus and Sirolimus Separately: An Experimental Study.

AIM: To morphologically evaluate the effects and compare the magnitude of enlargement in the gingiva of male albino wistar rats, on the administration of tacrolimus and sirolimus. MATERIALS AND METHODS: The experiment was performed on 6-week-old, male Albino Wistar rats, weighing 150-220 g. The animals were housed in pairs, in plastic bottomed cages, with husk as a bedding; in well ventilated rooms subjected to normal atmospheric conditions at 21°C and the same regimen of lighting (12 hours of light/ dark cycle) at the central animal house and fed with a standard pellet diet and water ad libitum. The rats were divided into three groups with 10 rats each and administered 1.5 mg/kg tacrolimus, 2 mg/kg sirolimus and normal saline, respectively for 12 weeks. An impression was made of the rat mandibular incisal region at the end of every third week in polysiloxane impression material, using prefabricated impression trays. The vertical height, buccolingual width and mesiodistal width of the inter-dental papilla and the keratinized gingiva were measured on the study cast using a digital caliper. Statistical analysis was then carried out, and simultaneous comparisons, between the group and within the group were made by using the analysis of variance (ANOVA) repeated measures test. RESULTS: The administration of both tacrolimus and sirolimus resulted in the enlargement of the gingiva, of the albino wistar rats in both the test groups (p <0.001). However, rats administered tacrolimus, showed a greater percentage increase in the gingival dimensions, compared to the sirolimus administered group and the control group, in all the measured dimensions, i.e., vertical height, mesiodistal width and buccolingual width at the end of every third week, in comparison to the baseline (p <0.001). CONCLUSION: Both drugs, tacrolimus and sirolimus, induced gingival enlargement in the male albino wistar rats. However, the tacrolimus administered group showed a two-fold greater increase in the gingival dimensions compared to the sirolimus administered group. CLINICAL SIGNIFICANCE: This study evaluates the effects of tacrolimus and sirolimus on the gingiva of albino wistar rats. Both the drugs are prime members of the immunosuppressive therapy given post-transplantation. Cyclosporine is substituted with tacrolimus to reduce the incidence and intensity of gingival enlargement in such subjects, even though both belong to the same class of drugs, namely calcineurin inhibitors. This study demonstrates that tacrolimus induces gingival enlargement whereas sirolimus does not. There is insufficient literature regarding the effects of sirolimus on gingival tissues. As per the results of this study, Sirolimus may be considered as a better substitute for cyclosporine, than tacrolimus, from a periodontal standpoint.

Treatment patterns and comparative analysis of non-intensive regimens in elderly acute myeloid leukemia patients-a real-world experience from India.

Elderly patients with acute myeloid leukemia have a poor prognosis. Data from developing countries is sparse in the literature. In this retrospective study, 402 patients aged ≥ 60 years, diagnosed between Jan 2013 and Dec 2017, were analyzed for treatment patterns and survival. Median age of the whole cohort was 68 years (range 61-84). A total of 213 patients (53.3%) refused care; 188 patients (46.7%) received either BSC, LDAC, or HMA. Survival (in months) was 3.9, 6.4, and 1.2 with LDAC, HMA, and BSC, respectively. One-year survival was 17.2% and 6% with HMA and LDAC, respectively (P = 0.02). Overall response rate (ORR) did not differ between HMA and LDAC group (p = 0.12). HMA cohort had higher complete responses (20.6% vs 7.4%, p = 0.02), stable disease (32.7% vs 13.5%, p = 0.02), and transfusion independence (TI) (46.5% vs 22.2%, p = 0.01). Survival did not differ between the groups if the patients achieved ORR (12.3 vs 9.8 p = 0.2) or TI (11.6 vs 6.4 p = 0.2). Stable disease with HMA led to longer survival (8.1 vs 5.3 p = 0.01). HMAs were more effective than LDAC irrespective of cytogenetic risk category and blasts, of note HMAs improved survival of poor risk patients (5.6 vs 2.9 p = 0.004). HMA treatment (HR = 0.48; 95% 0.29-0.79, p = 0.004) and transfusion independence (HR = 0.2; 95% 0.1-0.3, p = 0.0001) predicted survival in multivariate analysis. Neutropenia and febrile neutropenia were frequent in HMA. Thrombocytopenia was the common adverse event with LDAC. Novel and cost-effective drugs are essential to improve the prognosis of these patients.

Role of prephase treatment prior to definitive chemotherapy in patients with diffuse large B-cell lymphoma.

BACKGROUND: During the treatment of diffuse large B-cell lymphoma (DLBCL) patients, treatment-related toxicities are higher in the initial phase of treatment (First cycle effect). Toxicities can be tumor lysis syndrome, deterioration in performance status, febrile neutropenia, and rarely mortality. Prephase treatment before definitive chemotherapy is used in European countries to alleviate these toxicities. METHODS: This was a non-randomized study carried out with the aim to evaluate the role of prephase treatment given prior to definitive chemotherapy in newly diagnosed DLBCL patients. Patients were divided into 2 cohorts "prephase cohort" and "non-prephase cohort." Prephase cohort received prephase treatment consisting of vincristine (1 mg) on -6th day and prednisolone 100 mg daily for 7 days (-6th day to day 0). Prephase treatment was followed by CHOP/R-CHOP chemotherapy on day 1. Non-prephase cohort received chemotherapy without prephase. Both groups were followed up for 30 days post-first cycle chemotherapy. RESULTS: A total of 100 patients with DLBCL (50 in each cohort) were enrolled. There was a significant improvement in performance status of the patients who received prephase. A majority of 92% patients attained ECOG performance status of either 0 or 1 before starting chemotherapy in the prephase cohort. Febrile neutropenia was lower (16%) in the prephase cohort as compared with the non-prephase cohort (34%; P = .037). CONCLUSION: Prephase treatment prior to definitive chemotherapy (CHOP ± Rituximab) improves the performance status and decreases first cycle effect in DLBCL patients.

Juvenile ossifying fibroma with aneurysamal bone cyst: a case report.

The fibro osseous lesions of the jaws represent a diverse group of entities that are characterized by replacement of normal bone by a fibrous connective tissue matrix, with in which varying amounts of osteoid, immature and mature bone and in some instances, cementum like material are deposited. Fibro osseous lesions of the jaws include developmental (hamartomatous) lesions, reactive or dysplastic processes and neoplasms. Juvenile ossifying fibroma (JOF) is a unique fibro osseous neoplasm. It has 2 histopathological variants (1) Trabecular juvenile ossifying fibroma (TrJOF) and (2) Psammomatoid juvenile ossifying fibroma (PsJOF) with TrJOF affecting the jaws of children. Only 20% of the patients are over 15 years of age. JOF is more common in maxilla than mandible. Origin in extragnathic locations is extremely rare. It presents as an asymptomatic progressive, rapid expansion of jaws. Radiographically, tumour is well circumscribed, along with lack of continuity with adjacent bone, cortical expansion & perforation. Histopathologically it consists of a cell rich fibrous stroma with bundles of cellular osteoid and bone trabeculae without osteoblastic rimming, and aggregates of giant cells. It has a recurrence rate of 30-58%. Long standing lesions shows cystic changes. Aneurysmal bone cyst is the most common complication. Here we present a case report of 16 yr old female patient with clinical, radiographic & histopathological features of Trabecular JOF with Aneurysmal bone cyst.

Acrylic finger prosthesis: a case report.

Hands basic function is to grasp, hold and manipulate items. Hand gesture is perhaps the most blatant example of non-verbal communication. Finger and partial finger amputations are most frequently encountered forms of partial hand loss. Common causes are traumatic injuries, congenital absence or malformations present great clinical challenges. In addition to immediate loss of grasp strength, finger absence may cause marked psychological trauma. Individuals who desire finger replacement usually have high expectation for the appearance of prosthesis. This clinical report portrays simple method to retain acrylic finger prosthesis.

Synthesis of chemically pure, luminescent Eu3+ doped HAp nanoparticles: a promising fluorescent probe for in vivo imaging applications.

The poor solubility, poor biocompatibility and disposal issues make fluorescent quantum dots such as CdSe, CdS, ZnS, InP, InAs, etc. impractical for imaging tissues or intercellular structures. As calcium phosphate is the main inorganic component of human bone and teeth, hydroxyapatite (Ca10(PO4)6(OH)2, HAp) is highly biocompatible and bioactive. Since HAp nanoparticles are not luminescent, a novel inorganic biocompatible fluorescent probe was suggested by doping HAp with lanthanides. Here we report the growth of chemically pure fluorescent HAp nanoparticles synthesized by a new methodology, liquid phase pulsed laser ablation using third harmonics (355 nm) of Nd-YAG laser. Europium doped HAp nanoparticles show emission with prominent peaks at 531 nm, 572 nm, 601 nm and 627 nm upon excitation at a wavelength of 325 nm. The red luminescence could also be observed under visible excitation at 459 nm and is suitable for living cell applications.

Elastomeric impression materials: a comparison of accuracy of multiple pours.

AIM: The aim of the present study is to compare the various elastomeric impression materials in terms of accuracy and dimensional stability, with respect to obtaining multiple casts from a single elastomeric impression at various times of pours. MATERIALS AND METHODS: Three master dies were prepared for the impression making, two of these were made of brass containing a central hole with undercuts. The third die simulated a conventionally prepared typodont maxillary central incisor. Three elastomeric impression materials were chosen for the study. Each impression was poured at various time periods. Casts thus obtained were evaluated under a traveling microscope to evaluate various dimensional changes. RESULTS: Addition silicones provided dies which were shorter in height and bigger in diameter. Polyethers provided dies which were shorter in both height and diameter. Condensation silicones showed insignificant changes from the master die at the immediate pour but deteriorated rapidly after that in subsequent pours. CONCLUSION: None of the impression material showed a consistent behavior up to the fourth pour. They occasionally showed deviation from the pattern, but all these values were statistically insignificant. Polyethers showed lesser ability than both the addition silicones as well as the condensation silicones to recover from induced deformation. CLINICAL SIGNIFICANCE: Addition silicones as well as the condensation silicones have better ability to recover from induced deformation when compared to polyether.