Prognostic evaluation of tumour budding in oral squamous cell carcinoma: Evidenced by CD44 expression as a cancer stem cell marker

OBJECTIVES

Tumor budding is a sign of invasion and early step for metastasis of many cancers including oral squamous cell carcinoma (OSCC). Evidences suggest the presence of cancer stem cells in tumor buds. CD44 has been reported in tumor growth and metastasis as a cancer stem cell marker in OSCC. The study aims to highlight the prognostic significance of tumor budding in association with CD44 expression as a cancer stem cell marker in OSCC.

METHODS

A total of 60 radical neck dissection specimens of OSCC with and without lymph node metastasis were included in the study. The sections were evaluated for TB [Tumor Budding] in H&E and CD44 expression immunohistochemically. OSCC cases were then correlated with clinicopathologic and histomorphologic parameters such as age, gender, habit, site, staging, grading, recurrence, depth of invasion, pattern of invasion, and survival outcomes. Comparison of prognosis and CD44 expression were carried out by statistical methods.

RESULTS

A high TB score was significantly correlated with grading (p = 0.037), POI [Pattern of invasion] (0.029), overall survival (p = 0.047). CD44 over expression showed strong correlations with POI (1HPF:p = 0.037;10HPF:p = 0.027), grading (p = 0.037), and overall survival (p = 0.047). Kaplan-Meier analysis revealed overall survival advantage for LTB [Low TB] (85 %) with OSCC compare to HTB [High TB] (75 %) for > 36 months.

CONCLUSION

Assessment of TB is effective in predicting prognosis of OSCC. Although CD44 expression has demonstrated strong prognostic influence, there were significant differences in its expression with the parameters.

Dealing with Dual Challenges Posed by an Uncorrected Atrial Septal Defect with Poliomyelitis- Anaesthetic Considerations for a Non Cardiac Surgery

Atrial Septal Defect (ASD) is one of the most common congenital heart diseases. This is one such disease where patients largely remain asymptomatic throughout childhood and begin showing symptoms during adulthood. Here the authors present a case of a 44-year-old patient, with an uncorrected ASD and poliomyelitis, who presented with fracture femur. He was posted for Open Reduction Internal Fixation (ORIF) with plating of femur. The anaesthetic management was successfully done with general anaesthesia through endotracheal intubation along with fascia iliaca block. After the procedure and extubation, the patient was conscious, oriented, responded to commands, and had normal vital parameters. He was shifted to the Intensive Care Unit(ICU) for further observation and monitoring in view of his pre-existing co-morbid conditions. Postoperatively, cardiovascular surgeon advised a correction surgery for his ASD at a later date. The patient was discharged on Postoperative Day(POD) 12. Dealing with these two vastly different disease entities in the same patient certainly posed a unique aspect to this case considering the fact that there was no prior literature regarding the same.

Outcome Analysis of Dual Plating in Management of Unstable Bicondylar Tibial Plateau Fracture - A Prospective Study

Introduction:

Bicondylar tibial plateau fractures account for 10-30% of tibial plateau fractures. Despite recent advancements in the management of unstable bicondylar tibial plateau fractures, the outcomes are often poor. The present study aimed to evaluate the functional outcomes and complications of internal fixation of bicondylar tibial plateau fractures with the dual plating using two incisions.

Materials and methods:

The present study included 30 patients (26 males; 4 females, mean age 35.6 years; range, 19 to 65 years) with bicondylar tibial plateau fractures who were treated with dual plating between January 2017 to August 2019. Out of 30 patients, 5 patients had Schatzker type (V) and 25 patients had Schatzker type (VI) bicondylar tibial plateau fracture. All patients were treated with dual plating using two incisions. In all patient’s similar standard physical rehabilitation therapy was followed. All complications including intra and post-operative were assessed and recorded. The patients were followed-up for over 24 months. Functional outcomes were assessed with Rasmussen’s functional grading system, Oxford knee score, and range of motion of knee joint. Radiological outcomes were evaluated using Rasmussen’s radiological scoring system.

Result:

All fractures united with a mean time of 18 weeks. The average knee range of motion was 1.5° - 130° (range: 0° - 10° for extension lag, range: 100° -135° for flexion). Mean Rasmussen's functional grading score at the final follow-up was 26.75. All patients showed excellent or good radiographic results according to Rasmussen’s radiological scoring with a mean score of 8.5 (range 6-10). The post-operative radiographs showed mean MPTA was 84.3° and the mean PPTA was 6.2°. In the present study, complications were encountered in five patients. However, there were no cases of secondary loss of reduction, failure of the implant, malunion, or non-union.

Conclusion:

The surgical treatment of bicondylar tibial plateau fractures with dual locking represents a significant treatment option and provides rigid fixation in these fractures with good functional and radiological outcomes.

Intrathecal 0.5% Isobaric Bupiv Acaine Versus 0.5% Isobaric Ropiv Acaine for HIP Surgeries

The sensory motor block for ropivacaine starts at 6.4 minutes and similarly for bupivacaine is 3.32 minutes. The sensory block for ropivacaine is from ranges from T8-T12 and for bupivacaine its T4 - T8 level. The time taken for motor block is 203.8 and for group R its 142.9min. In group B, the mean value of time taken for two segment regression is 97.9 minutes. The time taken for group R to regress is 63.7. In Group its 4. 70 minutes. In Group R the    mean onset of motor block is 9.40 minutes.

Histological assessment of budding and depth of invasion (BD) model in biopsies of oral squamous cell carcinoma

Objectives:

Recognizing precise prognosticators from preoperative biopsies that aids in treatment is of immense clinical importance. Thus, the aim of this study was to assess and compare the tumor budding (B), depth of invasion (D) and combined scores (BD) model in the preoperative biopsies and subsequent postoperative specimens of oral squamous cell carcinoma (OSCC).

Material and Methods:

B and D were assessed in the pre- and postoperative specimens of 65 OSCC cases treated in the institution. Relationship between pre- and postoperative assessments was subjected to McNemar's, Chi-square, Fisher's exact, sensitivity and specificity statistics.

Results:

There was an agreement between the pre- and postoperative B scores in 54 cases with accuracy of 83% (95% confidence interval 71.73%–91.24%). The preoperative scores showed a good sensitivity of 67.86% and a high specificity of 94.59% in predicting the postoperative score of the same. The difference in assessing intensity B as low and high between preoperative and postoperative biopsies was not statistically different. There was an agreement between the pre- and postoperative scores of the BD model in 72%. The difference in BD scoring as low intermediate and high between preoperative and postoperative biopsies were significantly different statistically. Postoperative BD scoring showed a significant association with stage and lymph node metastasis.

Conclusions:

The findings validate the prognostic value of BD model in the postoperative specimens. Its value in preoperative biopsies is questionable. A judicious representative biopsy may increase the accuracy and reliability in the assessment of preoperative B and precision in BD model evaluation.

Urgent request on avian influenza

Highly pathogenic avian influenza (HPAI) H5N8 is currently causing an epizootic in Europe, infecting many poultry holdings as well as captive and wild bird species in more than 10 countries. Given the clear clinical manifestation, passive surveillance is considered the most effective means of detecting infected wild and domestic birds. Testing samples from new species and non‐previously reported areas is key to determine the geographic spread of HPAIV H5N8 2016 in wild birds. Testing limited numbers of dead wild birds in previously reported areas is useful when it is relevant to know whether the virus is still present in the area or not, e.g. before restrictive measures in poultry are to be lifted. To prevent introduction of HPAIV from wild birds into poultry, strict biosecurity implemented and maintained by the poultry farmers is the most important measure. Providing holding‐specific biosecurity guidance is strongly recommended as it is expected to have a high impact on the achieved biosecurity level of the holding. This is preferably done during peace time to increase preparedness for future outbreaks. The location and size of control and in particular monitoring areas for poultry associated with positive wild bird findings are best based on knowledge of the wider habitat and flight distance of the affected wild bird species. It is recommended to increase awareness among poultry farmers in these established areas in order to enhance passive surveillance and to implement enhanced biosecurity measures including poultry confinement. There is no scientific evidence suggesting a different effectiveness of the protection measures on the introduction into poultry holdings and subsequent spread of HPAIV when applied to H5N8, H5N1 or other notifiable HPAI viruses.

This publication is linked to the following EFSA Supporting Publications article: http://onlinelibrary.wiley.com/doi/10.2903/sp.efsa.2016.EN-1142/full

A qualitative exploration of the informed consent process in hematopoietic cell transplantation clinical research and opportunities for improvement

Informed consent (IC) struggles to meet the ethical principles it strives to embody in the context of hematopoietic cell transplantation (HCT). Patients often participate in multiple clinical trials making it difficult to effectively inform the participants and fulfill complex regulations. The recent Notice of Proposed Rule Making would make major changes to federal requirements, providing a timely opportunity to evaluate existing practice. Twenty health care professionals within a Midwest Academic Medical Center involved in obtaining IC in the HCT clinic or involved in patient care during or after the IC process were interviewed to understand: (1) how they approached the IC process; (2) how they described a 'successful' IC process; and (3) opportunities for innovation. Narrative and discourse analyses of interviews indicate that providers understand IC to be a collaborative process requiring engagement and participation of providers, patients and caregivers. 'Markers of success' were identified including cognitive, affective and procedural markers focusing on patient understanding and comfort with the decision to participate. Opportunities for innovating the process included use of decision aids and tablet-based technology, and better use of patient portals. Our findings suggest specific interventions for the IC process that could support the process of consent for providers, patients and caregivers.

Alkyl succinate poisoning

A case of alkyl succinate poisoning is being reported. Oral ingestion of this compound led to gastrointestinal tract involvement and central nervous system manifestatations suggestive of parkinsonism. The patient recovered completely following conservative management without any sequelae.

Detail reproduction, contact angles, and die hardness of elastomeric impression and gypsum die material combinations

PURPOSE

This study compared surface detail parameters, interfacial contact angles, and die hardness for some combinations of elastomeric impression and die materials.

MATERIALS AND METHODS

Representative polyvinyl siloxanes, polyether, polysulfide, and reversible hydrocolloid impression materials and Type IV, Type V, and resin reinforced-Type IV die materials were evaluated using a factorial design. For the evaluation of surface detail reproduction, the width of the thinnest continuous line observed and the visually observed shape of the thick line were determined from samples formed using a master die conforming to American Dental Association specification 19. The contact angle of freshly mixed die material on the set impression was measured using a contact angle goniometer. Finally, hardness of the die material was determined. After conversion of the data to ranks if necessary, 2-way analysis of variance with Ryan-Einot-Gabriel-Welsch (REGWQ) multiple comparison tests where appropriate were used to determine statistical significance.

RESULTS

The thinnest continuous line demonstrated statistically significant impression material effects, and the observed shape of the thick line showed both statistically significant impression material and die material effects. For both contact angle and die hardness, a statistically significant interaction between the impression and die materials was found.

CONCLUSION

Although statistically significant differences in each property were found, no specific combination of impression and die materials was identified as superior to another for all surface properties studied.

Welfare during stunning and slaughter of poultry

This paper describes research on the electrical stunning of poultry and the problems of achieving an effective humane stun with water bath stunners. The welfare and meat quality advantages of using gas mixtures to stun and kill birds are then described. The evidence strongly suggests that chickens and turkeys can be killed very humanely using either 90% argon in air or a mixture of 30% carbon dioxide and 60% argon in air.

Determination of the aversion of farmed mink (Mustela vison) to carbon dioxide

High concentrations of carbon dioxide are commonly used to kill mink before their pelts are removed. The aversiveness of this procedure was investigated by using a passive avoidance technique. Eight mink were trained to obtain a reward (a novel object) by entering a chamber which could be filled with carbon dioxide, as under commercial conditions (over 80 per cent by volume). In the absence of carbon dioxide, mink entered the chamber within a mean (sd) of 16 (2.1) seconds and spent 45 (12) per cent of the next 10 minutes interacting with the novel object. When there was carbon dioxide in the test chamber, the mink would not enter it and coughed and recoiled from the chamber's entrance instead. It was concluded that the mink detected and avoided high concentrations of carbon dioxide, and that if mink are to be killed humanely, less aversive techniques should be used.

A 'Well Woman Clinic' in Bangalore: one strategy to attempt to decrease the transmission of HIV infection

Samraksha, a non-governmental organization (NGO) in Bangalore, South India, was established in 1993 to take steps to control the spread of HIV infection. As a result of their interactions the Samraksha team recognized the urgent need for management of sexually transmitted diseases (STDs) as a crucial component of their work. Samraksha approached Action Health, a UK-based charity, for assistance. This paper outlines the needs assessment and the process of setting up a Well Woman Clinic for commercial sex workers (CSWs) and other vulnerable groups in Bangalore. The pilot project has been running for over a year and has gained credibility both with vulnerable women and with professionals. Furthermore it has officially become a government resource centre for the training of doctors and health-care staff in the management of STDs, and provides formal training sessions for the staff at each of the primary health-care centres in Bangalore. Thus STD management is being integrated with the current primary health-care provision for women throughout Bangalore. Factors influencing the successful development of such a service are considered.

Effect of the method of stunning and the interval between stunning and neck cutting on blood loss in turkeys

Turkey hens were stunned by inducing anoxia with either argon (with approximately 2 per cent residual oxygen) or 30 per cent carbon dioxide in argon with 2 per cent residual oxygen, and the carcases were bled either immediately or five or 10 minutes after they had been stunned. A control group of turkeys was stunned electrically (250 mA for about four seconds) and had their necks cut immediately after stunning. The amount of blood lost was measured and expressed as a percentage of liveweight. The results showed that the necks of gas-stunned turkeys can be cut up to 10 minutes after they have been stunned without reducing the total blood loss significantly.

An evaluation of humane gas stunning methods for turkeys

Spontaneous electroencephalograms (EEG) and somatosensory evoked potentials (SEPS) were recorded in turkeys while they were kept in an atmosphere of either 49 or 86 per cent carbon dioxide in air. The time to the loss of SEPS was not related to the concentration of carbon dioxide, but the time to the onset of an isoelectric EEG was shorter at the higher concentration of carbon dioxide. In comparison with other gas stunning methods it was considered that stunning with these high concentrations of carbon dioxide would not have any welfare advantages over stunning in argon with 2 per cent residual oxygen or in a mixture of 30 per cent carbon dioxide and 60 per cent argon in air.

Time to loss of somatosensory evoked potentials and onset of changes in the spontaneous electroencephalogram of turkeys during gas stunning

The times to the loss of somatosensory evoked potentials (SEPs) and the onset of suppressed and isoelectric electroencephalogram (EEG) were investigated in turkeys as they were stunned with gas mixtures consisting of one of three mixtures: (A) 30 per cent carbon dioxide and 60 per cent argon in air (2 per cent residual oxygen and 8 per cent residual nitrogen); (B) 90 per cent argon in air (2 per cent residual oxygen and 8 per cent residual nitrogen); (C) 65 per cent carbon dioxide in air (7 per cent residual oxygen and 28 per cent residual nitrogen). The time to the loss of SEPs, EEG suppression and the onset of an isoelectric EEG, respectively, were 22, 16 and 35 seconds in mixture A, 44, 41 and 101 seconds in mixture B, and 15, 15 and 67 seconds in mixture C. Stunning turkeys with mixture A or B would be suitable under commercial conditions. Mixture C, containing 65 per cent carbon dioxide in air, is considered on humanitarian grounds to be unacceptable for stunning turkeys owing to the pungency of the carbon dioxide at this concentration.

SAFA test as an aid to the diagnosis of ocular tuberculosis

A prospective double blind study was carried out to evaluate the role of soluble antigen fluorescent antibody (SAFA) test to detect ocular Tuberculosis. The study material comprised 39 patients with suspected ocular tuberculosis suffering from interstitial keratitis, sclero keratitis, granulomatous uveitis, phlyctenular keratoconjunctivitis, Eales disease and central serous retinopathy. The cases of proven ocular tuberculosis showed up as 70 percent strong reactors and 30 percent weak reactors to SAFA while none had a negative response to SAFA. Of these cases skin hypersensitivity reaction was positive only in 40 percent of the cases. The control group revealed a strong SAFA reaction in only 4 percent of cases with a weak reaction in 44 percent of cases. It thus appears that SAFA test can provide a useful addition to the routine tests in diagnosing tuberculosis.

Electrophysiological responses of the housefly, Musca domestica nebula (Fr), taste receptors to KCl

This paper aims at studying the response of the housefly labellar chemoreceptor to stimulation by KCl. These studies are limited to testing various concentrations of KCl solutions (0.005-1 M), using the electrophysiological "tip recording" method and examining the various spike characteristics such as threshold, phasic and tonic response, spike amplitudes, frequency and adaptation; for the anion, cation and water receptors. The large, medium and small hairs all respond to salt. The frontal large, medium and small hairs show a higher frequency response to equimolar KCl than the distal hairs. There is a bilateral symmetry in response pattern. The results are compared with the reported work on Phormia and Calliphora species. The Biedler's hypothesis is also tested for the salt receptors of Musca.

A combined TDDA-PVC pH and reference electrode for use in the upper small intestine

Incorporation of a ligand into polyvinylchloride allows the production of ion selective electrodes that are soft-bodied and disposable. With features make them especially suitable for clinical, particularly gastroenterological, investigations. We report here on the construction of a combined reference and pH electrode suitable for use at jejunal biopsy. With this type of pH electrode, the pH of the mucosal surface of the jejunum in UK and in Indian subjects, without evidence of upper gastrointestinal disease, was about pH 6.0. This was almost identical to previous values measured using a separate reference electrode. Both the polymer electrode and a suitable data logger can be conveniently produced in the laboratory and compare favourably with commercially available systems, provided the range of pH likely to be encountered is within the operating range of the incorporated ligand.

Effect of extracellular pH and DNFB treatment on the mechanical performance of frog skeletal muscle

isometric tension and maximum velocity of shortening of frog sartorious and biceps muscles were measured at varying pH and compared with the values obtained for muscles treated with DNFB. Both To and Vmax exhibited increase with increase in pH above neutral pH upto pH 9, and decreased as the pH was decreased up to 5. Muscle treated with DNFB at pH 7 showed about 30% decrement but these too improved at pH 9 to almost 105% and 130% respectively compared to untreated muscle at pH 7. Using the number of short duration tetanic contractions, which reduce To and Vmax by half, as an index for the onset of fatigue, high pH was found to have a positive effect in both normal and DNFB-treated muscle. Thus, the crucial factor for onset of fatigue is not a fall in ATP level but acidification and treatment with high pH Ringer's solution partially annuls the effect of acidosis, arising either naturally or from DNFB treatment. One additional role of creatine kinase activity to that of ATP regeneration is suggested to be the maintenance of neutral pH in the sarcoplasm.

Soluble antigen fluorescent antibody test in the serodiagnosis of tuberculous meningitis

Diagnosis of tuberculous meningitis (TBM) is difficult and frustrating. Modified soluble antigen fluorescent antibody (SAFA) test was applied to 40 CSF and 32 serum samples from 48 patients to assess the efficacy of this test in the rapid diagnosis of TBM. Using this test, false negative results were obtained in 41.6% and 40% of CSF and serum samples. False positive results were obtained in 22.2% and 26.7% of CSF and serum samples respectively. SAFA test was not found to be helpful in the sero-diagnosis of TBM. It is suggested that the best immunodiagnostic test for TBM will be to demonstrate the presence of antigen, antibody and antigen-antibody complex in the CSF for M. tuberculosis.

Coupling of the enzymic activities of myosin ATPase and creatine kinase and its role in muscular contraction

During muscular contraction the regeneration of ATP, catalysed by creatine kinase (CK), keeps pace with the hydrolysis of ATP by myosin ATPase posing the question of its regulatory mechanism. In the background of F-actin activation of heavy meromyosin (HMM) ATPase activity we have investigated in vitro the role of F-actin in regulating CK's activity in the absence and presence of HMM. For the coupled enzyme system we have also looked into the roles played by the individual reactants. F-actin has been found to appreciably increase CK's activity in the absence of HMM. While HMM alone inhibited CK's activity, there was a several fold increase when F-actin was also present. By a process of elimination we conclude that none of the reactants apart from H+ could be involved in regulating CK's activity in the coupled enzyme system. As no change in the pH of reaction mixture was observed during the reaction, we further conclude that the two enzymic reactions are coupled by proton transfer along F-actin. Implications of the findings for PCr-Cr shuttle and movements of ATP and ADP in sarcomere are discussed.

A comparison of the antidepressant action of citalopram and amitriptyline

The response of patients with major depressive illness to citalopram of amitriptyline was compared in a double-blind multi-centre trial. No differences in efficacy were observed, but citalopram had less hypnotic effect, and a remarkably lower profile of side-effects.