Role of four-dimensional computer tomography (4D-CT) in non-localising and discordant first-line imaging in primary hyperparathyroidism.

BACKGROUND: Accurate preoperative localisation of parathyroid adenoma is imperative for the success of minimally invasive parathyroidectomy (MIP). OBJECTIVE: Our study aimed to evaluate the role of four-dimensional computer tomography (4D-CT) scan as an imaging modality in patients with failed and discordant localisation reported in the first-line imaging modalities (ultrasonography and 99mTc-MIBI-SPECT/CT). METHODS: This is a prospective cohort study performed at a university teaching centre from March 2013 to July 2021. All patients with primary hyperparathyroidism who had failed localisation by ultrasonography and 99mTc-MIBI-SPECT/CT (SpCT), or discordance between them, had 4D-CT performed in this study. RESULTS: One hundred and two sporadic cases of pHPT with failed/discordant first-line imaging had 4D-CT imaging prior to parathyroidectomy. In 102 patients, 105 parathyroid adenomas were reported on histopathology. 4D-CT was able to localise 78% of them to the correct side and 64% to the correct quadrant in 102 patients, as compared with US (correct side 21%, correct quadrant 16%) and 99mTc-MIBI-SPECT/CT (correct side 36%, correct quadrant 31%). 4D-CT had a sensitivity, precision, accuracy and F1 score for correct quadrant localisation as 79%, 81%, 66% and 80%; and for correct side localisation as 82%, 98%, 80% and 89%, respectively. 4D-CT was able to identify three ectopic adenomas (two in superior mediastinum and one in the oesophageal wall) which were not detected on US or SpCT. CONCLUSION: 4D-CT was found to be sensitive and accurate in preoperative localising of the diseased parathyroid glands after failed/discordant US and SpCT. This led to more patients being offered MIP as the primary surgery and improved operative outcomes.

Regional Variation across Canadian Centers in Radioiodine Administration for Thyroid Remnant Ablation in Well-Differentiated Thyroid Cancer Diagnosed in 2000-2010.

Background. Use of radioactive iodine (RAI) ablation has been reported to vary significantly between studies. We explored variation in RAI ablation care patterns between seven thyroid cancer treatment centers in Canada. Methods. The Canadian Collaborative Network for Cancer of the Thyroid (CANNECT) is a collaborative registry to describe and analyze patterns of care for thyroid cancer. We analyzed data from seven participating centers on RAI ablation in patients diagnosed with well-differentiated (papillary and follicular) thyroid cancer between 2000 and 2010. We compared RAI ablation protocols including indications (based on TNM staging), preparation protocols, and administered dose. We excluded patients with known distant metastases at time of RAI ablation. Results. We included 3072 patients. There were no significant differences in TNM stage over time. RAI use increased in earlier years and then declined. The fraction of patients receiving RAI varied significantly between centers, ranging between 20-85% for T1, 44-100% for T2, 58-100% for T3, and 59-100% for T4. There were significant differences in the RAI doses between centers. Finally, there was major variation in the use of thyroid hormone withdrawal or rhTSH for preparation of RAI ablation. Conclusion. Our study identified significant variation in use of RAI for ablation in patients with well-differentiated thyroid cancer both between Canadian centers and over time.

Comparing a thyroid prognostic nomogram to the existing staging systems for prediction risk of death from thyroid cancers.

OBJECTIVE: Thyroid prognostic nomogram can be applied across different histological types for predicting the individualized risk of death from thyroid cancer. The objective of this study was to compare the strength of our recently published thyroid prognostic nomogram with 12 existing staging systems to predict the risk of death from thyroid cancer. METHOD: This study included 1900 thyroid cancer patients, from a population based cohort of 2296 patients, on whom adequate staging information was available. Competing risk sub-hazard models were used to compare 12 pre-existing prognostic models with the nomogram model. Their relative strengths for prediction of patients' individualized risks of death from thyroid cancer were compared using Akaike information criterion (AIC), delta AIC, and concordance index. R version 3.2.2 was used to analyze the data. RESULTS: Our cohort of 450 males and 1450 females included 1796 (93.4%) differentiated thyroid cancers. Amongst the compared models, thyroid prognostic nomogram model appeared to be better than other models for predicting the risk of death from all non-anaplastic thyroid cancer (concordance index = 94.4), differentiated thyroid cancer (concordance index = 94.1) and papillary thyroid cancer (concordance index = 94.7). The difference from next best staging systems was most pronounced in non-anaplastic thyroid cancer (delta AIC = 114.8), followed by differentiated thyroid cancer (delta AIC = 35.6) and papillary thyroid cancer (delta AIC = 8.4). CONCLUSIONS: Thyroid prognostic nomogram model was found to be better than the other models compared for predicting risk of death from thyroid cancer.

Change in CD3ζ-chain expression is an independent predictor of disease status in head and neck cancer patients.

CD3ζ has emerged as a clinically important immunological marker in head and neck squamous cell carcinoma (HNSCC) with reduced level of expression reported in both tumor infiltrating lymphocytes and peripheral blood lymphocytes. In this prospective study (power = 0.99, α = 0.05), CD3ζ expression was compared in 47 HNSCC patients and 53 controls using standardized flow cytometric method. There was no statistical difference in the percentages of the CD3 ε+ T-cell subset present in the peripheral blood mononuclear cells of the HNSCC patients and the healthy controls; however, T cells from the HNSCC patients produced a significantly weaker IFN-γ response in comparison to the healthy controls, when they were stimulated by the recall viral CEF peptide antigen. All patients were followed up for at least 3 years with a median follow-up of 45 months. Levels of CD3ζ-chain expression were measured at 117 follow-up visits at six-month intervals. Receiver operating characteristic curve identified the optimal cut off as a 12% increase in post treatment CD3ζ-chain expression from the baseline levels to confirm absence of HNSCC with the area under curve of 0.81 (95% CI = 0.68-0.94) for predicting absence of HNSCC. The specificity, sensitivity and positive predictive value were 81.25% 79.21% and 97.56%, respectively. Three-year disease specific survival (DSS) was significantly lower (p = 0.007) at 63.2% for patients who showed <12% increase in CD3ζ-chain level as compared to 96.2% for patients who had ≥12% increase. Our results indicate that the change in CD3ζ-chain expression from the baseline is an independent predictor of residual and recurrent HNSCC.

Identifying the most appropriate age threshold for TNM stage grouping of well-differentiated thyroid cancer.

OBJECTIVE: Age is integrated in most risk stratification systems for well-differentiated thyroid cancer (WDTC). The most appropriate age threshold for stage grouping of WDTC is debatable. The objective of this study was to evaluate the best age threshold for stage grouping by comparing multivariable models designed to evaluate the independent impact of various prognostic factors, including age based stage grouping, on the disease specific survival (DSS) of our population-based cohort. METHODS: Data from population-based thyroid cancer cohort of 2125 consecutive WDTC, diagnosed during 1970-2010, with a median follow-up of 11.5 years, was used to calculate DSS using the Kaplan Meier method. Multivariable analysis with Cox proportional hazard model was used to assess independent impact of different prognostic factors on DSS. The Akaike information criterion (AIC), a measure of statistical model fit, was used to identify the most appropriate age threshold model. Delta AIC, Akaike weight, and evidence ratios were calculated to compare the relative strength of different models. RESULTS: The mean age of the patients was 47.3 years. DSS of the cohort was 95.6% and 92.8% at 10 and 20 years respectively. A threshold of 55 years, with the lowest AIC, was identified as the best model. Akaike weight indicated an 85% chance that this age threshold is the best among the compared models, and is 16.8 times more likely to be the best model as compared to a threshold of 45 years. CONCLUSION: The age threshold of 55 years was found to be the best for TNM stage grouping.

Current concepts of surveillance and its significance in head and neck cancer.

Follow-up in head and neck cancer (hNC) is essential to detect and manage locoregional recurrence or metastases, or second primary tumours at the earliest opportunity. A variety of guidelines and investigations have been published in the literature. This has led to oncologists using different guidelines across the globe. The follow-up protocols may have unnecessary investigations that may cause morbidity or discomfort to the patient and may have significant cost implications. In this evidence-based review we have tried to evaluate and address important issues like the frequency of follow-up visits, clinical and imaging strategies adopted, and biochemical methods used for the purpose. This review summarises strategies for follow-up, imaging modalities and key investigations in the literature published between 1980 and 2009. A set of recommendations is also presented for cost-effective, simple yet efficient surveillance in patients with head and neck cancer.

Implications of understanding cancer stem cell (CSC) biology in head and neck squamous cell cancer.

Head and neck squamous cell cancer (HNSCC) is the sixth most common cancer in the world. Effective therapeutic modalities such as surgery, radiation, chemotherapy and combinations of each are used in the management of this disease. Efforts are ongoing throughout the world to improve early detection and prevention of HNSCCs. Often, treatment fails to obtain total cancer cure and this is more likely with advanced stage disease. In recent years it appears that one of the key determinants of treatment failure may be the presence of cancer stem cells (CSC) that 'escape' currently available therapies. CSCs form a minute portion of the total tumour burden but may play a disproportionately important role in determining outcomes. Molecular mechanisms which underlie the genesis of CSCs are yet not fully understood and their detection within the total tumour bulk remains a challenge. Specific markers like Aldehyde dehydrogenase 1 (ALDH1), CD44 and Bmi-1 have shown early promising results both in CSC detection and in guiding treatment protocols. CSCs have been shown to be relatively resistant to standard treatment modalities. It is hoped that developing robust in vitro and in vivo experimental models of CSCs might provide a means of devising more effective therapeutic strategies.

Effect of storage temperature on physico-chemical and sensory attributes of purple passion fruit (Passiflora edulis Sims).

Physico-chemical and sensory quality of juice from purple passion fruit under different storage temperature and time were assessed. The maximum loss in fruit weight was recorded under room temperature (25 ± 1°C) followed by at 11 ± 1°C. There was an increase in juice percentage up to 9 and 13 days under room temperature and storage at 11 ± 1°C respectively. The optimum flavour in juice was up to 5 days at 25 ± 1°C and up to 21 days at 8 ± 1°C. A significant reduction in sourness was recorded on 5th day under all treatments and the scores for sourness became almost constant after 17 days. The maximum increase in the mean scores of sweetness on 5th day was observed at 25 ± 1°C followed by at 11 ± 1°C. The optimum level of juice sweetness was maintained up to 21 days at 8 ± 1°C. Total soluble solids content increased in initial stage followed by reduction. There was a reduction in the titrable acidity up to 21 days at 8 ± 1°C. A decreasing trend in the reducing and non-reducing sugar of passion fruit was observed under all the treatments. Fruits stored at 25 ± 1°C, developed off-flavour in juice after 5 days, while storage at 8 ± 1°C produced no off-flavor even up to 21 days. Fruits can be stored for 5 days only at 25 ± 1°C as the overall sensory quality of juice reduced significantly afterwards, while juice maintained the optimum overall quality up to 21 days at 8 ± 1°C.

Head and neck soft tissue sarcoma.

Sarcomas are malignant neoplasms originating from mesodermal tissues and constitute less than 1% of body's tumors, including those of the head and neck region. 5-15% of adult sarcomas are in the head and neck region (20% from bones and cartilages and 80% in soft tissues). Commonly encountered sarcomas in the head and neck region are - osteosarcoma, rhabdomyosarcoma, malignant fibrous histiocytoma, fibrosarcoma and angiosarcoma. This article reviews the available literature on head and neck sarcomas.

Head and neck squamous cell cancers: need for an organised time-bound surveillance plan.

Optimal care of patients with head and neck squamous cell cancer (HNSCC) involves a pre-determined period of post-treatment follow-up for the detection of recurrent or persistent disease, metastases and second primaries at the earliest opportunity. There is little evidence in literature as to whether the surveillance schemes should be based on patient survival, quality of life or cost-adjusted parameters. This article aims at highlighting some of the issues pertinent to the optimization of surveillance strategies in HNSCC.

Robotic surgery in head and neck cancer: a review.

The invasion of robotic technology in surgical fields cannot be ignored. Its success in various surgical disciplines especially in urology, cardiology, and gynaecology has set its own benchmarks. Extrapolation of similar results in head and neck is still in experimental stages and long term results are still eagerly awaited to truly establish its efficacy beyond awe and reality. Nonetheless, its future role in this area is inevitable given the encouraging results obtained so far. This article covers the inception to current application to speculation of robotic technology in complex area of head and neck surgery.

Soil-plant-animal continuum in relation to macro and micro mineral status of dairy cattle in subtropical hill agro ecosystem.

The purpose of the present study was to study the soil-plant-animal continuum in subtropical hilly areas. Soil (n = 96), fodder (n = 96), and blood serum samples from dairy cattle (n = 120) were collected from eight districts of Mizoram, a hilly state in India. The samples were digested using diacid mixture (HNO(3):HClO(4); 10:4) and analyzed for macro (Ca, P, Mg, Na, and K) and micro (Cu, Co, Mn, Fe, and Zn) mineral concentrations. The macro and micro mineral concentrations varied among the different districts. The correlation values between fodder and cattle were significant for all the minerals studied except for P and K. The correlation value between fodder and cattle was highly significant (P < 0.01) for Ca (0.878), Mg (0.88), Cu (0.885), and Zn (0.928). However, such correlations were not observed between the mineral levels in cattle and mineral levels in soil except for Ca (0.782). Equations developed in the present study for prediction of Ca (R(2) = 0.797), Mg (R(2) = 0.777), Zn (R(2) = 0.937), Fe (R(2) = 0.861), and Cu (R(2) = 0.794) had significant R(2) values. Further, it is inferred that dairy cattle reared under smallholder production system were deficient in most of the minerals and supplementation of required minerals is essential for optimum production.

Mineral profiling of local pig-feeds and pigs reared under resource driven production system to reduce porcine mineral deficiency in subtropical hill ecosystem of Northeastern India.

The present study assessed the mineral status of pigs fed with local feed resources. The commonly used plants for feeding pigs and blood serum samples from Hampshire, Large White Yorkshire and indigenous pigs were analyzed for total protein, albumin and cholesterol levels. Processed plant and serum samples were also analyzed for calcium, phosphorus, magnesium, sodium, potassium, copper, cobalt, manganese, iron and zinc. The incidence and extent of mineral deficiency in pigs was quantified. No significant difference was observed in total protein and albumin levels between any two breed/types of pigs, however the Indigenous pigs showed significantly (P < 0.05) higher cholesterol level compared to other two breeds. Among different plants, Spilanthus sp had majority of macro and micro nutrients in high levels. Regarding incidence of mineral deficiency in pigs, it was observed that 90, 67.1, 61.4, 48.6, 95.7% of the pigs were deficient in calcium, phosphorus, sodium, magnesium and potassium. An interesting finding was that all the pigs (100%) utilized in the study were deficient in zinc. From this study, it was inferred that there are good numbers of potential source of mineral that might be used more economically to improve the mineral availability to pigs.

Human oral cancers have altered expression of Bcl-2 family members and increased expression of the anti-apoptotic splice variant of Mcl-1.

Expression of Bcl-2 family proteins in tumours can modulate apoptosis, influencing tumour behaviour and treatment. To investigate their role in oral tumourigenesis, nine Bcl-2 family transcripts were examined in three oral cell lines and 25 oral tumours, using ribonuclease protection assay. Since Mcl-1 mRNA was elevated in these samples, Mcl-1 splice variants were assessed by RT-PCR and Mcl-1 protein was studied in normal, premalignant and malignant oral tissues and cell lines, by immunohistochemistry and/or immunoblotting. The cell lines exhibited significantly higher levels of 7/9 Bcl-2 family transcripts as compared to those in normal tongue, and significantly higher (p=0.030, p=0.004) anti-apoptotic versus pro-apoptotic transcripts. Elevated Mcl-1 mRNA was observed in 11/25 (44%) tumours as compared to normal tissues with a five- to ten-fold higher expression of full-length anti-apoptotic Mcl-1 transcript versus the pro-apoptotic short isoform. Strong cytoplasmic Mcl-1 immunoreactivity was detected predominantly in differentiated epithelia in 27/33 (82%) oral tumours, 18/20 (90%) leukoplakia, 25/30 (83%) submucous fibrosis and 3/3 oral cell lines, with weak staining in 8/15 (53%) normal mucosa samples. Mcl-1 positivity in malignant and premalignant tissues was comparable but significantly higher (p<0.01) than that in normal mucosa. The expression of bcl-2 family genes, including Mcl-1 in tumours, did not correlate significantly with clinicopathological parameters. This is the first report delineating the in vivo expression patterns of Mcl-1 protein and Mcl-1 transcripts in oral cancers and premalignant lesions. The observed imbalance between expression of anti-apoptotic and pro-apoptotic Bcl-2 family genes may promote survival in the oral cell lines. Since the majority of oral tumours associated with tobacco-chewing evolve from premalignant lesions, the sustained expression of full-length anti-apoptotic Mcl-1 protein in these tissues suggests an important role for Mcl-1, early in oral cancer pathogenesis in protecting cells from apoptosis via neutralization of pro-apoptotic members and could be a potential therapeutic target for oral cancers.

Integrated resource-driven pig production systems in a mountainous area of Northeast India: production practices and pig performance.

Data on pig production system was derived through structured household interviews from a total number of 320 rural households and performance of pigs was assessed. Results revealed that the pig production system represented mixed farming based mainly on the common property resources. Majority of the pigs were reared in intensive system and fed with home made cooked feed (kitchen waste and locally available plants). The body weight of crossbred, Burmese and local pigs were 67, 65.4 and 45.6 kg, respectively at 12 months of age with average daily body weight of 184, 179 and 125 g, respectively. The overall mortality among the pigs was 17.96%. The major causes of mortality in pigs were Swine fever, Swine erysipelas, digestive disorders, nephritis and respiratory disorders. The body weight gain in pigs subjected to deworming and mineral mixture supplementation (218 g/day) was significantly (p < 0.05) higher than the control group (178 g/day). The input output ratio was 1:1.7 for both crossbred and Burmese pigs, while the corresponding ratio for local pigs was 1:1.2. It is inferred that the smallholder resource driven pig production system is economically viable and sustainable at household level and there is enough scope to improve the smallholder resource driven pig production system.

Analysis of integrated animal-fish production system under subtropical hill agro ecosystem in India: growth performance of animals, total biomass production and monetary benefit.

The present study assessed the benefits of integration of animals with fish production in optimizing the bio mass production from unit land in subtropical hill agro ecosystem. Hampshire pigs and Khaki Campbell ducks were integrated with composite fish culture. The pig and duck excreta were directly allowed into the pond and no supplementary feed was given to fish during the period of study. The average levels of N, P and K in dried pig and duck manure were 0.9, 0.7 and 0.6 per cent and 1.3, 0.6 and 0.5 per cent, respectively. The average body weight of pig and duck at 11 months age was 90 and 1.74 kg with an average daily weight gain of 333.33 and 6.44 g, respectively. The fish production in pig-fish and duck-fish systems were 2209 and 2964 kg/ha, respectively while the fish productivity in control pond was only 820 kg/ha. The total biomass (animal and fish) production was higher (p<0.05) in commercial feeding system compared to the traditional system, however the input/output ratio was 1:1.2 and 1:1.55 for commercial and traditional systems, respectively. It was inferred that the total biomass production per unit land was high (p<0.05) when animal and fish were integrated together.

Cancer of the buccal mucosa: a tale of two continents.

Squamous cell carcinoma (SCC) of the buccal mucosa in North America is thought to be different from that in the Indian subcontinent. This study compared the treatment outcomes and prognostic factors in 64 patients with SCC of the buccal mucosa treated at Cancer Care Manitoba (CCMB), Canada, and 64 similar patients treated at the Tata Memorial Hospital (TMH), India. Overall, cause-specific and disease-free survival for the two geographical groups were calculated and the impact of individual prognostic factors on survival was assessed. CCMB patients were significantly older (p<0.001), had less differentiated tumour (p=0.053) and had higher chances of positive or close surgical margins (p=0.012). At 5 years, they had lower 5-year overall survival (57.4% versus 80.1%; p<0.001), cancer-specific survival (76.4% versus 85.0%; p=0.043) and disease-free survival (42.9% versus 66.4%; p=0.004). Age had an independent influence on overall survival and cause-specific survival. After adjusting for age there was no difference in cause-specific survival between the two groups (HR=1.20; 95% CI=0.46,3.17; p=0.710). The apparent survival difference between the CCMB and TMH patients was due to the difference in the age of presentation and not because of different biological behaviour.

Reproductive performance of crossbred dairy cows reared under traditional low input production system in the eastern Himalayas.

Reproductive performance of crossbred cows reared under traditional low input production system was assessed. A total number of 160 farmers were surveyed and traditional fodders were evaluated for proximate composition. Total protein, albumin and cholesterol concentrations in blood serum were analyzed. The age at first service, age at first calving, calving interval, calving to first service and calving to conception interval were calculated from records of 261 crossbred dairy cows. The crude protein, crude fiber, nitrogen free extract, ether extract and total ash content varied from 7.2 to 13.9, 18.2 to 34.4, 39.1 to 59.2, 2.1 to 4.1 and 7.2 to 17.9%, respectively. The total protein and albumin concentrations in blood serum were 7.6 +/- 0.3 and 4.3 +/- 0.3 g/dl, respectively. The cholesterol concentration was 221.1 +/- 8.2mg/dl. The mean age at first service and age at first calving was 28.6 +/- 1.0 and 40.7 +/- 1.1months, respectively. The mean values for calving to first service and calving to conception intervals were 182 +/- 14.5 and 224 +/- 9.0days, respectively. The conception rate was significantly high among the cows that showed typical fern pattern of cervical mucus (56.6%). The conception rate based on 1(st) insemination was 44.4%. The incidence of repeat breeders and anestrus among the crossbred cows were 12.8 and 14.1%, respectively.

Analysis of a village chicken production system and performance of improved dual purpose chickens under a subtropical hill agro-ecosystem in India.

This study was designed to analyze the low input backyard poultry production system practiced by the tribal farmers, and evaluate the performance of an improved dual-purpose breed, the Vanaraja. Results revealed that a significantly (p < 0.05) higher number of farmers used temporary, non-conventional poultry houses made of locally available materials, such as bamboo and wood. Most of the farmers (65.9 %) did not provide balanced feed to their poultry and did not vaccinate their birds against any disease. Under standard management conditions, the average body weight of Vanaraja birds at 6 weeks was 625 +/- 10.9 g. Under backyard conditions, the body weight at 18 months was 3.6 +/- 0.8 kg. The age at first egg was 154 +/- 9 days in the backyard system, whereas under the intensive system it was 196 +/- 4 days. Annual production under the backyard and intensive systems of rearing was 176 +/- 9 and 152 +/- 7 eggs, respectively. Mortality of adult birds was 12 % and predation by foxes and wild cats accounted for 1.67 %. This study revealed that village chickens are an important income source for household expenses, and that traditional free-range poultry production in the smallholder sector of developing countries can possibly be improved through the use of improved dual-purpose birds.