Patterns of recurrence in patients undergoing curative treatment for maxillary alveolus squamous cell carcinoma.

The aim of this paper was to examine patterns of recurrence in patients undergoing curative treatment for maxillary alveolus squamous cell carcinoma (MASCC). Clinicopathological data on 41 patients undergoing curative resection for MASCC between February 2006 and May 2020 were retrospectively gathered. Outcomes included local, regional, or distant failure as first site of treatment recurrence. Univariate analysis identified significant clinicopathological variables for type of recurrence. Multivariate regression analysis generated predictive models. Ten of 41 patients developed regional recurrence, and nine manifested contralateral recurrence following ipsilateral neck dissection. In three patients the ipsilateral neck was pN0. Nodal metastasis was predictive of regional recurrence, particularly with extranodal tumour extension (ENE). Multivariate analysis with regional recurrence confirmed that ENE was independently predictive. Nodal disease and ENE in patients with MASCC was found to be predictive of contralateral regional recurrence. Management of the neck in MASCC that extends to the palatal aspect should therefore be considered as midline disease.

Glaucoma Detection and Classification Using Improved U-Net Deep Learning Model.

Glaucoma is prominent in a variety of nations, with the United States and Europe being two of the most famous. Glaucoma now affects around 78 million people throughout the world (2020). By the year 2040, it is expected that there will be 111.8 million cases of glaucoma worldwide. In countries that are still building enough healthcare infrastructure to cope with glaucoma, the ailment is misdiagnosed nine times out of ten. To aid in the early diagnosis of glaucoma, the creation of a detection system is necessary. In this work, the researchers propose using a technology known as deep learning to identify and predict glaucoma before symptoms appear. The glaucoma dataset is used in this deep learning algorithm that has been proposed for analyzing glaucoma images. To get the required results when using deep learning principles for the job of segmenting the optic cup, pretrained transfer learning models are integrated with the U-Net architecture. For feature extraction, the DenseNet-201 deep convolution neural network (DCNN) is used. The DCNN approach is used to determine whether a person has glaucoma. The fundamental goal of this line of research is to recognize glaucoma in retinal fundus images, which will aid in assessing whether a patient has the condition. Because glaucoma can affect the model in both positive and negative ways, the model's outcome might be either positive or negative. Accuracy, precision, recall, specificity, the F-measure, and the F-score are some of the metrics used in the model evaluation process. An extra comparison study is performed as part of the process of establishing whether the suggested model is accurate. The findings are compared to convolution neural network classification methods based on deep learning. When used for training, the suggested model has an accuracy of 98.82 percent and an accuracy of 96.90 percent when used for testing. All assessments show that the new paradigm that has been proposed is more successful than the one that is currently in use.

Prognostic significance of dysplasia associated with oral squamous cell carcinoma in patients undergoing surgery with curative intent.

The aim of this study was to evaluate the prognostic significance of dysplasia in patients undergoing primary surgery with curative intent in the treatment of oral squamous cell carcinoma (OSCC). This study specifically aimed to demonstrate the effect of dysplasia on local recurrence, disease specific survival (DSS) and overall survival (OS). Data collection for 833 patients with OSCC undergoing treatment for curative intent was undertaken retrospectively for the period of February 2006 to May 2020. Analysis of any association between known clinicopathological prognostic categorical variables with respect to dysplasia was undertaken using the chi squared test. A Kaplan-Meier analysis was performed to demonstrate the impact of dysplasia on DSS and OS, and Cox's proportional-hazards model deployed to obtain hazard ratios associated with dysplasia and the outcomes of interest. Dysplasia was statistically significant in predicting disease specific and overall survival in patients undergoing primary surgery for OSCC (DSS p<0.001, HR 0.577; 95%CI 0.428 to 0.777), OS p<0.001 HR 0.691; 95%CI 0.562 to 0.850) with the absence of dysplasia predicting poorer outcomes. The absence of dysplasia correlated with pathological higher T and N stage, increased categorised depth of tumour invasion, non-cohesive invasive front, lymphovascular invasion, perineural invasion, extranodal extension and increased modified Glasgow Prognostic Score. No significant prognostic relationship was attributable to the presence of dysplasia at a surgical margin. The absence of dysplasia appeared to be a significant independent prognostic indicator for patients with OSCC. The presence or absence of dysplasia may provide a heuristic means of stratifying OSCC primary lesions in terms of disease hostility.

Patterns of recurrence amongst patients undergoing resection of oral squamous cell carcinoma with curative intent.

This study was aimed to identify key clinicopathological variables that predict recurrence in those undergoing curative resection of oral squamous cell carcinoma (OSCC) with emphasis on initial treatment failure patterns. Between February 2006 to May 2020, clinicopathological data on 833 patients who underwent curative resection of OSCC were gathered. Outcomes of interest included local, regional, distant, and overall recurrence. Univariate analysis was performed to identify significant clinicopathological variables for each recurrence type, and a multivariate regression analysis was utilised to generate predictive models. A total of 187 patients (22.4%) developed recurrent disease; 79 local, 63 regional, and 46 distant. For local recurrence: tumour depth of invasion (DOI) >5--10 mm, tumour DOI >10 mm and modified Glasgow Prognostic Score (mGPS) 2 were independently predictive (c-index 0.708). For regional recurrence: primary OSCC of hard palate/maxilla, pN1, pN3b, and non-cohesive invasive front were independently predictive (c-index 0.738). For distant recurrence: pN1 pN2a, pN2b, pN2c, pN3b, and tumour DOI >10 mm were independently predictive (c-index 0.809). For recurrence at any site; pN1, pN2a, pN2b, pN2c, pN3b, tumour DOI >5-10 mm, tumour DOI >10 mm, mGPS 2, and involved surgical margins were independently predictive (c-index 0.750). Recurrence events after curative treatment for OSCC are relatively predictable on the basis of available clinicopathological characteristics. It seems likely that trials of adjuvant systemic therapy in high-risk OSCC will continue to be designed with emerging therapeutic agents. Trials should focus on those of highest risk of relapse and this study adds clarity to the selection of the correct target population.

Various Spectrum Of Ocular Tuberculosis.

Mycobacterium Tuberculosis may infect any organ in the body, when it affects ocular tissue symptoms are vague and hence diagnosis is challenging, through a number of cases reported in our clinic it is emphasized to make quantiferon test as part of routine investigation for cases of presenting with uveitis thus leading to timely diagnosis and accurate treatment.

The Influence of Epigenetic Factors in Four Pairs of Twins With Non-Syndromic Craniosynostosis.

The aims of this retrospective case series were to investigate whether twins born with craniosynostosis mirrored each other regarding operative surgery performed, age of undertaking surgery; outcomes in speech, language, and developmental milestones and what environmental factors were present for each set of twins.Case selection was based on clinical and radiographical evidence of craniosynostosis amongst twin sets. The twin sets included were those with craniosynostosis who had different sutures affected or those with the same suture affected but with a varying degree of severity.The presence of the following factors may have played an influential role in the clinical presentation of the twins; these were as follows: a maternal history of smoking, breech presentation, and genetic mutations. It was notable that the overall outcomes for the twins in this study were similar.These cases highlight the multifactorial nature in the development of craniosynostosis and how this influenced the phenotypic presentation of the twins.

Transoral tongue base mucosectomy for the identification of the primary site in the work-up of cancers of unknown origin: Systematic review and meta-analysis.

BACKGROUND: The use of transoral robotic surgery (TORS) and laser microsurgery (TLM) in the diagnosis and identification of the site of the unknown primary has become increasingly common. This systematic review and meta-analysis aims to assess the use and efficacy of TORS and TLM for this indication. METHOD: Systematic review and meta-analysis of studies employing TORS or TLM in diagnosis of the unknown primary tumor site in patients with cervical nodal metastases of squamous cell origin. MEDLINE, EMBASE and CINHAL were searched from inception to July 2018 for all studies that used TORS and or TLM in identifying the unknown primary. RESULTS: 251 studies were identified, of which 21 were eligible for inclusion. The primary tumour was identified by TORS/TLM in 78% of patients (433 out of 556). Tongue base mucosectomy (TBM) identified the primary in 222 of 427 cases (53%). In patients with negative physical examination, diagnostic imaging and PETCT, TBM identified the primary in 64% (95% CI 50, 79) cases. In patients who had negative CT/MRI imaging, negative PETCT and negative EUA and tonsillectomy, TBM identified a tongue base primary in 78% (95% CI 41, 92) cases. Haemorrhage, the commonest complication, was reported in 4.9% cases. Mean length of stay varied between 1.4 and 6.3 days. CONCLUSION: Tongue base mucosectomy, performed by TORS or TLM, is highly efficacious in identifying the unknown primary in the head and neck region.

Recurrent mutations at estrogen receptor binding sites alter chromatin topology and distal gene expression in breast cancer.

BACKGROUND: The mutational processes underlying non-coding cancer mutations and their biological significance in tumor evolution are poorly understood. To get better insights into the biological mechanisms of mutational processes in breast cancer, we integrate whole-genome level somatic mutations from breast cancer patients with chromatin states and transcription factor binding events. RESULTS: We discover that a large fraction of non-coding somatic mutations in estrogen receptor (ER)-positive breast cancers are confined to ER binding sites. Notably, the highly mutated estrogen receptor binding sites are associated with more frequent chromatin loop contacts and the associated distal genes are expressed at higher level. To elucidate the functional significance of these non-coding mutations, we focus on two of the recurrently mutated estrogen receptor binding sites. Our bioinformatics and biochemical analysis suggest loss of DNA-protein interactions due to the recurrent mutations. Through CRISPR interference, we find that the recurrently mutated regulatory element at the LRRC3C-GSDMA locus impacts the expression of multiple distal genes. Using a CRISPR base editor, we show that the recurrent C→T conversion at the ZNF143 locus results in decreased TF binding, increased chromatin loop formation, and increased expression of multiple distal genes. This single point mutation mediates reduced response to estradiol-induced cell proliferation but increased resistance to tamoxifen-induced growth inhibition. CONCLUSIONS: Our data suggest that ER binding is associated with localized accumulation of somatic mutations, some of which affect chromatin architecture, distal gene expression, and cellular phenotypes in ER-positive breast cancer.

Transient Corneal Edema After Phacoemulsification.

OBJECTIVE: To determine the association between pre-operative and intra-operative factors leading to transient corneal edema after phacoemulsification. STUDY DESIGN: Cohort study. PLACE AND DURATION OF STUDY: Department of Ophthalmology, Shifa Foundation Community Health Centre, Islamabad, from October 2011 to September 2012. METHODOLOGY: Patients undergoing phacoemulsification and Intraocular Lens (IOL) implantation were enrolled in the study using consecutive non-probability sampling. Pre-operative risk factors including peripheral corneal degenerations, the type and density of cataract were documented. Surgical risk factors included the incision site, the type of intraocular lens, the phacotechnique and the phacopower time. Postoperatively the patients were assessed for corneal clarity and the degree of striate keratopathy. Statistical analysis was done using SPSS version 17. RESULTS: There were 43% male and 57% female patients (n = 182). Mean age was 58.92 ± 13.00 years (median and mode-60 years). Factors which increased the risk of transient corneal edema after phacoemulsification included hypertension (p = 0.022), dense nuclear cataracts (p=0.006), divide and conquer technique (p = 0.008), duration of phacopower use (p < 0.001) and peripheral corneal degenerations (p < 0.001). CONCLUSION: Patients with peripheral corneal degenerations and dense nuclear cataracts had significantly higher rates of postoperative corneal edema. Use of phaco-chop technique and less phaco-power time helps in decreasing corneal edema.

Spontaneous idiopathic true exfoliation of the anterior lens capsule during capsulorhexis.

We report a unique case of spontaneous per-operative idiopathic development of true exfoliation of the anterior lens capsule during capsulorhexis. A 45 year old female who underwent phacoemulsification for a cataract in the left eye, developed a partial split (the double ring sign) and eventual complete separation of the superficial lamina of the lens capsule during capsulorhexis. Radial tears developed in the remaining lamina making the capsular bag unstable. The surgery was converted to manual nucleus expression. An intra ocular lens was implanted via scleral fixation. The final best corrected visual acuity in the left eye was 6/6. The patient is comfortable with the vision. Though a rare event, the surgeon must always be alert to the development of spontaneous idiopathic per operative true exfoliation of the lens capsule.

Unilateral ptosis: a rare presentation.

We report a case of unilateral gradual drooping of right upper eyelid. It was mild to moderate in intensity and variable during the day. Examination was suggestive of myogenic ptosis (with slightly reduced levator palpebrae superioris function). She was screened for myasthenia gravis with negative tensilon test and oral trial of pyridostigmine for few weeks without any improvement, and was advised surgery at an overseas center. A second opinion was taken before surgery. A detailed history revealed that local administration of Botulinum toxin was done four months ago by a plastic surgeon. This along with mildly compromised levator function without any systemic features and negative tensilon test, led us to believe that ptosis was secondary to injection Botulinum toxin. Patient was reassured and advised to use crutch glasses for a month and then report any spontaneous improvement. She reported improvement in the right eye after six weeks, with reappearance of forehead lines.