Hypofractionated stereotactic radiotherapy in Spetzler Martin grades 4 and 5 arteriovenous malformations in the pediatric population: Is it a viable alternative?

OBJECTIVE: To analyze the outcomes of hypofractionated stereotactic radiotherapy (HFSRT) for Spetzler Martin grades 4 and 5 arteriovenous malformations (AVMs) in a pediatric population. METHODS: Fourteen patients with Spetzler Martin (SM) grades IV and V large AVMs who underwent HFSRT between January 2013 and July 2019 were retrospectively reviewed. All patients received HFSRT at a dose of 30-36 Gy in 5 to 6 fractions. They were followed up annually with clinical and imaging assessments to evaluate obliteration rates. RESULTS: The median age at presentation was 15 years (range 8-21 years). Ten (71%) were SM grade 4 AVMs and the rest were SM grade 5 AVMs. The majority presented with headache (8 [57%]), and 3 (21%) presented with bleeding. The median nidus volume was 39.4 cc (IQR, 31.4-52.4). Two (14%) patients had infratentorial AVMs. All of them had deep venous drainage. The median clinical follow-up duration was 75 months (range 31-107 months). There was complete obliteration of the nidus in 3 (21%) patients with a median time to obliteration of 39 months. HFSRT resulted in a reduction of the AVM volume to 12 cc or less in nearly 70% of patients. None of the patients experienced re-bleeding. 79% reported an improvement in their symptoms. CONCLUSION: HFSRT is a highly effective treatment for high-grade AVMs in children, which can result in either complete elimination or significant reduction of the nidus volume or make it suitable for additional treatment, such as single-session stereotactic radiosurgery (SRS).

Antioxidant and Cytotoxic Effects of the Methanolic Extract of Eichhornia crassipes Petioles Upon Mg-63 Cell Lines: An In Vitro Study.

INTRODUCTION: Eichhornia crassipes (E. crassipes) are a longstanding hydrophyte belonging to the Pontederiaceae family and subfamily Trollioideae. It is classified as an invasive plant owing to its phenomenal growth and propagation and is often described as the worst aquatic plant. Natural antioxidants, such as phenolic compounds and flavonoids, have an increased protective effect against free radicals. A single laboratory test is insufficient to comprehend all of the mechanisms entailed in investigating the antioxidant effects of the phytoconstituents. The antioxidant propensity of methanolic extracts from E. crassipes petioles was investigated in this study utilizing 2,2'-Azinobis-(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) and 1,1-diphenyl-2-pycryl-hydrazyl (DPPH). Additionally, the cytotoxic effect of E. crassipes methanolic petiole extract upon MG-63 cell lines for the inhibition of osteosarcoma cells was investigated. MATERIALS AND METHODS:  The antioxidant propensity was appraised by employing DPPH and ABTS assays. The cytotoxic effects of the methanolic petiole extract of E. crassipes at varying concentrations on MG-63 cell lines were evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide assay. The absorbance scores were computed using the mean and standard deviation. The half-maximal inhibitory concentration (IC50) was calculated by applying probit analysis. The data were analyzed using SPSS Statistics for the descriptive statistics of the percentage of cell viability and regression analysis. RESULTS: The antioxidant potential was assessed by employing DPPH and ABTS assays at various concentration levels of 50 µg/ml, 100 µg/ml, 200 µg/ml, and 400 µg/ml of methanolic petiole extracts. The antioxidant potential of DPPH (57.95%) and ABTS (60.47%) was more at the elevated doses of 400 µg/mL. The percentage of cell viability upon MG-63 cell line was measured at varying doses of 12.5 µg/ml, 25 µg/ml, 50 µg/ml, 100 µg/ml, and 200 µg/ml of methanolic petiole extracts and was found to be 99.36%, 93.92%, 86.77%, 69.14%, and 45.08%, respectively. The IC50 value for the extract of E. crassipes against the MG-63 cell line was 177.65 µg/mL. The regression equation computed from the findings of the probit analysis was y = -0.2881x + 101.18 with a coefficient of determination of R² = 0.992. CONCLUSION: The methanolic extracts of the various parts of the plant, such as leaves, flower, rhizome, and petioles, have been established in similar prior studies to contain the highest phenolic constituents and were found to have a high rate of DPPH radical scavenging activity and reducing power. It is inferred from the findings of the present study that E. crassipes petiole extracts have a significant protective role against oxidative stress, potentially attributed to the antioxidant potential. Further, the findings of the study reveal that the methanolic petiole extract of E. crassipes induced cytotoxicity upon MG-63 cell lines with an IC50 value of 177.65 µg/mL.

Antiproliferative Effects of Methanolic Root Extracts of Eichhornia crassipes Against a Skin Melanoma Cell Line: An In Vitro Study.

Background Melanoma is the most aggressive form of skin cancer, accounting for 3% of all malignant cancers. Phytochemicals and their related compounds are found in various parts of the plant Eichhornia crassipes and have a variety of pharmacological actions. The current research was intended to compare and evaluate the anti-proliferative action of methanolic extracts of E. crassipes roots and petioles against the Sloan Kettering Melanoma (SK-Mel-5) cell line. Materials and methods The waters around Ezhikkara, Ernakulum, Kerala, were discovered to contain E. crassipes. We used a Soxhlet extractor to get this concentrated liquid. For this test, we employed a methanolic extract of roots and petioles to determine the extent to which different concentrations of the extract inhibited cell proliferation. Data on absorbance were reported as a mean standard deviation. Using Probit analysis, the IC50 was calculated by evaluating the gradient of the regression line to get a value. Results Concentrations of methanolic root and petiole extracts of 12.5 µg/ml, 25 µg/ml, 50 µg/ml, 100 µg/ml, and 200 µg/ml were analyzed. The methanol petiole extract reduced the viability of SK-Mel-5 cells more than the root extract, with IC50 values of 323.59 µg/ml and 174.70 µg/ml of the test sample concentration, respectively. The regression equation for the root extract was y = -0.1264x + 90.902 and R2 = 0.845, and for the petiole extract, it was y = -0.2187x + 88.206 and R2 = 0.917. Conclusion The current study found that increasing the concentration of methanolic extracts of roots and petioles of E. crassipes exhibited an increased cell growth inhibition rate. However, methanolic petiole extracts were more cytotoxic than the roots. Thus, the current study demonstrated the therapeutic use of E. crassipes as an anticancer agent, thereby providing a valuable alternative for enabling the early management of melanoma.

Extrinsic parameter's adjustment and potential implications in Plasmodium falciparum malaria diagnosis.

Malaria is a major public health concern, affecting over 3.2 billion people in 91 countries. The advent of digital microscopy and Machine learning with the aim of automating Plasmodium falciparum diagnosis extensively depends on the extracted image features. The color of the cells, plasma, and stained artifacts influence the topological, geometrical, and statistical parameters being used to extract image features. During microscopic image acquisition, custom adjustments to the condenser and color temperature controls often have an influence on the extracted statistical features. But, our human visual system sub-consciously adjusts the color and retains the originality in a different lighting environment. Despite the use of appropriate image preprocessing, findings from the literature indicate that statistical feature variations exist, allowing the risk of P. falciparum misinterpretation. In order to eliminate this pervasive variation, the current work focuses on preprocessing the extracted statistical features rather than the prepossessing of the source image. It begins with the augmentation of series images for a microscopic field by inducing illumination variations during the microscopic image acquisition stage. A set of such image series is analyzed using a Nonlinear Regression Model to generalize the relationship between microscopic images acquired with variable ambient brightness and a specific feature. The projection point of the centroid feature onto the brightness parameter is identified in the model and it is denoted as the optimum brightness factor (OBF). Using the model, the feature correction factor (CF) is calculated from the rate of change of feature values over the interval OBF, and the brightness of the test image is processed. The present work has investigated OBF for selected image textural features, namely Contrast, Homogeneity, Entropy, Energy, and Correlation individually from its co-occurrence matrices. For performance analysis, the best state-of-the-art method uses selected texture as a subset feature to evaluate the effectiveness of P. falciparum malaria classification. Then, the impact of proposed feature processing is evaluated on 274 blood smear images with and without Feature Correction (FC). As a result, the "p" value is less than .05, which leads to the result that it is highly significant and the classification accuracy and F-score of P. falciparum malaria are increased.

Antiproliferative Action of Methanolic Petiole Extract of Eichhornia Crassipes on Human Prostate Adenocarcinoma Cell Line: An In Vitro Study.

BACKGROUND: An increasing number of people are turning to herbal medicines in their search for innovative pharmaceuticals since they are effective treatments for a wide variety of conditions and traditional herbs are rich in bioactive chemicals. In this study, we looked at whether or not a petiole extract of Eichhornia crassipes preserved in methanol inhibited the proliferation of prostate cancer (PC3) cell lines. MATERIALS AND METHODS: Lakes in Ezhikkara, Ernakulum, Kerala, were the source of E. crassipes. Soxhlet extraction was used to create the extract. 3-[4,5-dimethylthiazol-2-yl]2,5-diphenyltetrazolium bromide (MTT) assay was used to determine the cell viability of methanolic petiole extract at various concentrations. Mean and standard deviation was used to determine absorbance scores. Utilizing probit analysis, we determined the IC50 value. The descriptive statistics to measure the percent of viable cells along with the regression equation were calculated using SPSS. RESULTS: It has been shown that the methanol extract significantly impacted PC3 cell lines' capacity to survive. It was also determined that increasing the medication concentration resulted in a decrease in cell viability. The percentage of living cells was measured after being exposed to methanol extracts at concentrations of 12.5 µg/ml, 25 µg/ml, 50 µg/ml, 100 µg/ml, and 200 µg/ml, and found to be 95.13, 85.88, 76.12, 64.33, and 53.62 percent, respectively. With IC50 values of 199.488 g/ml, it was shown that methanolic petiole extracts of E. crassipes are cytotoxic. Using probit analysis, we determined that the regression equation is y = -0.2051x + 90.915, with an R2 value of 0.893. CONCLUSION: As a result of its chemotherapeutic properties, the E. crassipes petiole extract has the potential to be employed in therapeutic applications, with the ultimate goal of bettering prostate cancer management practices and clinical results by drastically lowering cell viability. The study's results may pave the way for fresh chemotherapeutic approaches to be developed for the treatment of androgen-independent prostate cancer.

A comparative study of Sterofundin and Ringer lactate based infusion protocol in scoliosis correction surgery.

BACKGROUND: A major change in anesthesia practice as regards to intraoperative infusion therapy is the present requirement. Switching over to balanced fluids can substantially decrease the incidence of lactic acidosis and hyperchloremic acidosis. The deleterious effects of unbalanced fluids are more recognizable during major surgeries. We prospectively studied the influence of Sterofundin (SF) and Ringer lactate (RL) on acid-base changes, hemodynamics, and readiness for extubation during scoliosis surgery. SUBJECTS AND METHODS: Thirty consecutive children posted for scoliosis surgery were randomized to receive either RL (n = 15) or SF (n = 15) as intraoperative fluid at 10 mg/kg/h. Fluid boluses were added according to the study fluid algorithm. Arterial blood was sampled and analyzed at hourly intervals during surgery. Red blood cell transfusion was guided by hematocrit below 27. Patients were followed for 24 h postoperatively in the Intensive Care Unit. RESULTS: There was no statistically significant difference in the volume of infused fluid (2400 ± 512 ml in Group RL and 2200 ± 640 ml in Group SF. There were no significant changes in pH of patients infused with SF. Statistically, significant higher lactate levels were seen in RL-infused group. The strong ion difference was decreased in both groups, but it normalized earlier with SF. CONCLUSIONS: SF-infused patients had nonremarkable changes in acid-base physiology in scoliosis surgery.

Feasibility and response of concurrent weekly docetaxel with radical radiotherapy in locally advanced head and neck squamous cell carcinoma.

OBJECTIVE: (1) To study the feasibility, adverse effects and response of concurrent weekly Docetaxel with radical radiotherapy in inoperable locally advanced head and neck squamous cell carcinoma. (2) To assess the compliance and tolerance of weekly Docetaxel with radiotherapy. MATERIAL AND METHODS: Twenty one patients with stage III and IV head and neck squamous cell carcinoma satisfying inclusion criteria were selected and treated with conventional external radiotherapy of 70Gy in 35 fractions with weekly concurrent Docetaxel (15mg/sqm), administered one hour before radiotherapy. Assessment of toxicities and evaluationof response was carried out. RESULTS: Majority of patients had stage IV diseaseand 17/21 (81%) received the planned radiotherapydose of 70Gy and ≥4 cycles of weekly chemotherapy. Duration of treatment ranged from 7.1to 11.2 weeks. The toxicities noted were Grade III mucositis in 57% and grade III skin reaction in 23%, grade III dysphagia in 38% and grade II weight loss in 23% of patients. Systemic toxicities associated with chemotherapy were minimal and there was no dose limiting toxicities. The overall locoregional response at first follow up was 85%, with complete response of 70% and partial response of 15%. CONCLUSION: Concurrent Docetaxel is a feasible and suitable alternate to Cisplatin and 5-Fluorouracil chemotherapy with good patient compliance. The late toxicities and survival need to be followed up.

Ocular lesions in 1,000 consecutive HIV-positive patients in India: a long-term study.

BACKGROUND: Ocular lesions in patients on highly active antiretroviral therapy (HAART) have shown changes in disease prevalence and pattern. Although they have been described in the Western population, there are not many such studies in the HAART era from India. This study aims to present the clinical profile, systemic correlation, and visual outcome in HIV-positive patients in relation to HAART in comparison with pre-HAART Indian studies and current Western data. Ocular findings and systemic correlation in 1,000 consecutive patients with HIV seen at a tertiary eye care center were analyzed. This study uses a prospective observational case series design. RESULTS: Age range of the patients was 1.5 to 75 years. Ocular lesions were seen in 68.5% of the patients (cytomegalovirus (CMV) retinitis was the commonest). The commonest systemic disease was pulmonary TB. Mean interval between HIV diagnosis and onset of ocular lesions was 2.43 years. CD4 counts range from 2 to 1,110 cells/mm3. Immune recovery uveitis (IRU) was seen in 17.4%. Interval between HAART initiation and IRU was 4 months to 2.5 years. Recurrence of ocular infection was seen in 2.53% (post-HAART) and > 20% (pre-HAART). Overall visual outcome showed improvement in about 14.3% and was maintained in 71.6% of the patients. CONCLUSIONS: CMV retinitis is the commonest ocular opportunistic infection in India, even in the HAART era. Newer manifestations of known diseases and newer ocular lesions are being seen. In contrast to Western studies, in our patients on HAART, ocular lesions do not always behave as in immunocompetent individuals. Ocular TB needs to be kept in mind in India, as well as other neuro-ophthalmic manifestations related to cryptococci, especially in gravely ill patients. Occurrence and frequency of various ocular opportunistic infections in developing nations such as India have significant variations from those reported in Western literature and need to be managed accordingly.

Thermo-optic characterization of neodymium/nickel doped silica glasses prepared via sol-gel route.

Intrinsic as well as rare earth (Neodymium) doped silica glasses with various molar ratio of dopant and a metallic (Nickel) co-dopant is prepared via sol-gel route. The structural characterization of the sample is carried out using X-ray diffraction and Fourier Transform Infrared Spectroscopy. The influence of dopant and doping concentration on the optical properties of silica matrix is investigated via UV-VIS absorption spectroscopy. Effect of dopant on thermal effusivity value of the host matrix is carried out by laser induced open cell photoacoustic technique. Analysis of the results showed that doping affect the thermal effusivity value and results are interpreted in terms of structural modification of the lattice and phonon assisted heat transport mechanism.