Contralateral Nodal Relapse in Well-lateralised Oral Cavity Cancers Treated Uniformly with Ipsilateral Surgery and Adjuvant Radiotherapy With or Without Concurrent Chemotherapy: a Retrospective Study

AIMS

To evaluate the incidence and pattern of contralateral nodal relapse (CLNR), contralateral nodal relapse-free survival (CLNRFS) and risk factors predicting CLNR in well-lateralised oral cavity cancers (OCC) treated with unilateral surgery and adjuvant ipsilateral radiotherapy with or without concurrent chemotherapy.

MATERIALS AND METHODS

Consecutive patients of well-lateralised OCC treated between 2012 and 2017 were included. The primary endpoint was incidence of CLNR and CLNRFS. Univariable and multivariable analyses were carried out to identify potential factors predicting CLNR.

RESULTS

Of the 208 eligible patients, 21 (10%) developed isolated CLNR at a median follow-up of 45 months. The incidence of CLNR was 21.3% in node-positive patients. CLNR was most common at level IB (61.9%) followed by level II. The 5-year CLNRFS and overall survival were 82.5% and 57.7%, respectively. Any positive ipsilateral lymph node (P = 0.001), two or more positive lymph nodes (P < 0.001), involvement of ipsilateral level IB (P = 0.002) or level II lymph node (P < 0.001), presence of extranodal extension (P < 0.001), lymphatic invasion (P = 0.015) and perineural invasion (P = 0.021) were significant factors for CLNR on univariable analysis. The presence of two or more positive lymph nodes (P < 0.001) was an independent prognostic factor for CLNR on multivariable analysis. CLNR increased significantly with each increasing lymph node number beyond two compared with node-negative patients.

CONCLUSION

The overall incidence of isolated CLNR is low in well-lateralised OCC. Patients with two or more positive lymph nodes have a higher risk of CLNR and may be considered for elective treatment of contralateral neck.

Synthesis, characterization, mechanical and magnetic characteristics of Gd3+ /PO4 3 - substituted zircon for application in hard tissue replacements

The study reports on the use of sol-gel technique to yield zircon type [Zr(1-0.1-x) GdxTi0.1 ] [(SiO4 )1-x (PO4 )x ] solid solution. Titanium has been used as a mineralizer to trigger zircon formation while equimolar concentrations of Gd3+ and PO4 3- were added to determine their accommodation limits in the zircon structure. The crystallization of t-ZrO2 as a dominant phase alongside the crystallization of m-ZrO2 and zircon were detected at 1200°C while their further annealing revealed the formation of zircon as a major phase at 1300°C. Heat treatment at 1400°C revealed the formation of zircon-type solid solution [Zr(1-0.1-x) Gdx Ti0.1 ][(SiO4 )1-x (PO4 )x ] comprising the accommodation of 10 mol.% of Gd3+ /PO4 3- at the zircon lattice. Beyond 10 mol.% of Gd3+ /PO4 3- , the crystallization of GdPO4 as a secondary phase is noticed. Structural analysis revealed the expansion of zircon lattice due to the simultaneous occupancy of Gd3+ /PO4 3- for the corresponding Zr4+ /SiO4 4- sites. The mechanical strength of single-phase zircon solid solution was higher in comparison to that of multiphase materials, namely in the presence of GdPO4 formed as a secondary phase in samples with added equimolar Gd3+ /PO4 3- contents beyond 10 mol.%. Nevertheless, the paramagnetic behavior of the samples demonstrated a steady surge as a function of enhanced Gd3+ content.

Enhancing the zircon yield through the addition of calcium phosphates into ZrO2-SiO2 binary systems: synthesis and structural, morphological, mechanical and in vitro analysis

The crystallization of ZrSiO4 is generally accomplished by the addition of mineralizers into ZrO2-SiO2 binary oxides. The current investigation aimed to investigate the effect of adding calcium phosphates into ZrO2-SiO2 binary oxides on the yield of ZrSiO4. The concentration of calcium phosphate additions were varied to obtain ZrSiO4 that fetches improved mechanical and biological properties for application in hard tissue replacements. The findings highlight the significant role of Ca2+ and P5+ in triggering the ZrSiO4 formation via their accommodation at the Zr4+ and Si4+ sites. Especially, calcium phosphate additions trigger the t- → m-ZrO2 transition beyond 1000 °C, which consequently reacts with SiO2 to promote ZrSiO4 formation. Calcium phosphates are accommodated at the lattice sites of ZrSiO4 with a maximum limit of 20 mol%, beyond which the crystallization of β-Ca3(PO4)2 is noticed. The optimum amount of 20 mol% of calcium phosphates displayed a better strength than that of all the investigated specimens. More than 80% of cell viability in MG-63 cells was invariably determined in all the calcium phosphate-added ZrSiO4 systems.

Identification of salivary metabolic biomarker signatures for oral tongue squamous cell carcinoma

OBJECTIVE

To identify the salivary metabolites associated with squamous cell carcinoma of the tongue to develop easy and non-invasive potential biomarkers for disease diagnosis.

DESIGN

Initially, the study utilized untargeted metabolomics to analyze 20 samples of tongue squamous cell carcinoma and 10 control samples. The objective was to determine the salivary metabolites that exhibited differential expression in tongue squamous cell carcinoma. Then the selected metabolites were validated using targeted metabolomics in saliva samples of 100 patients diagnosed with squamous cell carcinoma of the tongue, as well as 30 healthy control individuals.

RESULTS

From the analysis of untargeted metabolomics, 10 metabolites were selected as potential biomarkers. In the subsequent targeted metabolomics study on these selected metabolites, it was observed that N-Acetyl-D-glucosamine, L-Pipecolic acid, L-Carnitine, Phosphorylcholine, and Deoxyguanosine exhibited significant differences. The receiver operating characteristic curve analysis indicates a combination of three important metabolites such as N-Acetyl-D-glucosamine, L-Pipecolic acid and L-Carnitine provided the best prediction with an area under the curve of 0.901.

CONCLUSIONS

The present result reveals that the N-Acetyl-D-glucosamine, L-Pipecolic acid and L-Carnitine are the signature diagnostic biomarkers for oral tongue squamous cell carcinoma. These findings can be used to develop a rapid and non-invasive method for disease monitoring and prognosis in oral tongue cancer.

Development, Physiochemical characterization, Mechanical and Finite element analysis of 3D printed Polylactide-β-TCP/α-Al2O3 composite

Herein, material extrusion (MEX) technique is utilized to develop 3D printed models based on reinforcing β-Ca3(PO4)2/α-Al2O3 composite in polylactide (PLA) matrix. β-Ca3(PO4)2/α-Al2O3 composite has been synthesized through co-precipitation method and the phase content of β-Ca3(PO4)2 and α-Al2O3 components are respectively determined as 64 and 36 wt%. The resultant β-Ca3(PO4)2/α-Al2O3 composite mixed with PLA at various weight ratios were extruded as filaments and subsequently 3D printed into definite shapes for the physiochemical, morphological and mechanical evaluation. 3D printed bodies that comprise 5 wt % β-Ca3(PO4)2/α-Al2O3 composite yielded an increasing tensile, compressive and flexural strength in the corresponding order of ∼15, ∼15 and 22% than 3D printed pure PLA. Further, the Representative volume element (RVE) unit cells developed based on the various investigated compositions of PLA-β-Ca3(PO4)2/α-Al2O3 were subjected to mechanical evaluation through Finite element analysis (FEA) under both static and dynamic loading conditions on ASTM standard specimens. The results from experimental and FEA analysis demonstrated good uniformity that confirmed the reinforcement of 5 wt % β-Ca3(PO4)2/α-Al2O3 in PLA matrix as an optimum combination to yield better mechanical strength.

Gastric lipoma in the pyloric antrum: a rare case report

Introduction and importance

Gastric lipoma (GI) is a rare benign tumor of the stomach that arises from adipose tissue. It is often asymptomatic and is incidentally diagnosed on endoscopy or imaging studies.

Case presentation

A 66-year-old male presented with epigastric pain and acid reflux. Upper gastrointestinal endoscopy revealed a 3-cm submucosal lesion in the pyloric antrum. The patient underwent a subtotal gastrectomy. The specimen was sent to the pathology department. Based on the microscopic findings, the diagnosis was a submucosal GI.

Discussion

The diagnosis of GIs is usually made incidentally during imaging studies. Treatment options include endoscopic or surgical resection; however, conservative management can be considered in asymptomatic patients. Periodic radiological surveillance is recommended to monitor growth and assess for any malignant transformation.

Conclusion

GI is a rare tumor that is usually asymptomatic but can present with nonspecific gastrointestinal symptoms. The diagnosis is confirmed through histological examination, and imaging techniques such as computed tomography or MRI can be useful in preoperative evaluation. Surgical resection remains the primary treatment, while endoscopic resection may be considered in certain cases.

Design and fabrication of dysprosium impregnated polyvinyl alcohol hydrogels. Physiochemical, mechanical, bioimaging and in vitro evaluation

Tissue engineering has gained prominence during the past decade since it offers a key solution to defects associated with the tissue regeneration. The limited healing potential of the cartilage tissue damage has significant clinical implications. Herein, dysprosium (Dy3+) impregnated polyvinyl alcohol (PVA) hydrogels have been developed to enhance the therapeutic efficacy, enabling simultaneous diagnostic imaging and antibacterial drug delivery for potential applications in articular cartilage. Based on the favorable imaging features, Dy3+ impregnated PVA hydrogels with enhanced stability were formed through successive steps of repeated cycles of freezing at - 30 °C for 21 h, thawing at 25 °C for 4 h and lyophilization. The tensile and compression tests of the hydrogels respectively determined a maximum of 3.88 and 1.58 MPa, which reflected better compatibility towards cartilage. The hydrogels fetched a sustained drug release for a period of 12 h with an associated swelling ratio of 80%. The potential of the resultant hydrogels in image diagnosis has been deliberated through their blue and yellow emissions in the visible region. Further, the computed tomography (CT) and magnetic resonance imaging characteristics of the hydrogels respectively accomplished a maximum of 343 Hounsfiled units (HU) and relaxivity of 7.25 mM-1s-1. The cytocompatibility of the hydrogels is also determined through in vitro tests performed in Murine pro B cell line (BA/F3) and human Megakaryocyte cell line (Mo7e) cell lines.

Ectopic liver tissue adherent to the gallbladder serosa: two cases report from Syria

Ectopic liver tissue is an exceedingly rare anomaly in which the hepatic tissue is present extrahepatic site and has no connection to the true liver. Most cases of ectopic liver tissue were asymptomatic and discovered by an accident during abdominal surgery or autopsy.

Case presentation

Case 1 involved a 52-year-old man who was admitted to the hospital due to an abdominal grip in the right hypochondrium and epigastrium for 1 month. The patient underwent laparoscopic cholecystectomy. During the gross examination, a well-circumscribed brownish nodule with a smooth outer surface, located at the fundus region was found. Case 2 involved a 40-year-old man with 2 months history of epigastric pain radiating to the right shoulder. Calculus chronic cholecystitis was diagnosed by ultrasound. The patient undergoes elective laparoscopic cholecystectomy. A gross inspection showed a small nodule attached to the serosa of the gallbladder. Microscopically, both cases revealed ectopic liver tissue.

Clinical discussion

Ectopic liver tissue is an uncommon entity that occurs during the embryological development of the liver and can be found below and above the diaphragm, especially the gallbladder. Histologically, it usually has the normal architecture of the liver. Although ectopic liver tissue is an exceptional finding, pathologists should be aware of it because it has a high risk of transformation into malignancy.

Conclusion

Hepatic choristoma is a rare failure of embryological liver development. It should be removed when recognized and examined histologically to rule out malignancy.

Metastatic squamous cell carcinoma of the lung to the thyroid gland presented as nodular goiter: a rare case report

Metastasis of squamous cell lung carcinoma to the thyroid gland is an extremely rare event. It frequently metastasizes to lymph nodes, liver, adrenal glands, bone, brain, and pleura. Among the lung carcinomas metastasizing to the thyroid, adenocarcinomas are the most common followed by squamous cell carcinomas (SCCs).

Case presentation

A 58-year-old male patient presented with bilateral neck swelling. Fine needle aspiration is performed and was undetermined. Ultrasonography of the neck demonstrated multiple hypoechoic nodules with thyroid enlargement. The patient was diagnosed with nodular goitre and he underwent a total thyroidectomy. Microscopically, the Hematoxylin and eosin-stained sections revealed thyroid follicles with sheets composed of polygonal cells with pleomorphic nuclei, prominent nucleoli, and a moderate amount of eosinophilic cytoplasm. Keratin pearls were present. Based on histopathological and clinical findings, the final diagnosis was metastatic SCC to the thyroid gland.

Clinical discussion

Clinically, patients with thyroid metastasis presented with nonspecific symptoms such as thyroid nodule or goitre, cervical discomfort, dyspnoea, dysphagia, or dysphonia. Chemotherapy is used in the case of a poly metastatic tumour and radiotherapy as a palliative treatment whereas radioiodine treatment is not indicated for thyroid metastases.

Conclusion

Diagnosis of SCC in the thyroid gland as a primary or metastatic neoplasm is a significant challenge. In the absence of specific clinical or radiological signs, pathological studies remain the gold standard for diagnosis.

The global syndemic of metabolic diseases in the young adult population: a consortium from the Global Burden of Disease 2000-2019

Funding Acknowledgements

Type of funding sources: None.

Background

A large proportion of premature deaths are related to metabolic diseases in the young adult population. We examined the global trends and mortality of metabolic diseases using estimates from the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2019 in individuals aged below 40 years.

Methods

From 2000-2019, global estimates of prevalence, deaths, and disability-adjusted life years (DALYs) were described for metabolic diseases (type 2 diabetes mellitus [T2DM], hypertension, non-alcoholic fatty liver disease [NAFLD]). Global estimates were limited to mortality and DALYs for risk factors (hyperlipidemia and obesity). Subgroup analyses were performed based on sex, geographical regions and Socio-Demographic Index (SDI). Age-standardized prevalence, death, and DALYs were presented per 100,000 population with 95% uncertainty intervals (UI).

Findings

The prevalence for all metabolic diseases increased from 2000-2019, with the most pronounced increase in males and high SDI countries. In 2019, the highest age-standardised death rates were observed in hypertension (133·88 [121·25-155·73]; males, 160·13 [138·91-180·79]; females, 119·66 [102·33-136·86]), followed by obesity (62·59 [39·92-89·13]; males, 66·55 [39·76-97·21]; females, 58·14 [38·53-81·39]), hyperlipidemia (56·51 [41·83-73·62]; males, 67·33 [50·78-86·43]; females, 46·50 [32·70-62·38]), T2DM (18·49 [17·18-19·66]; males, 19·94 [18·50-21·32]; females, 17·30 [15·62-18·70]) and NAFLD (2·09 [1·61-2·60]; males, 2·38 [1·82-3·02]; females, 1·82 [1·41-2·27]). Similarly, obesity (1932·54 [1276·61-2639·74]) had the highest age-standardised DALYs, followed by hypertension (2885·57 [2580·75-3201·05]), hyperlipidemia (1207·15 [975·07-1461·11]), T2DM (801·55 [670·58-954·43]) and NAFLD (53·33 [40·73-68·29]). Mortality rates decreased over time in hyperlipidemia (-60%), hypertension (-47%), NAFLD (-31%) and T2DM (-20%), but not in obesity (107% increase). The highest metabolic-related mortality was observed in the Eastern Mediterranean and low SDI countries.

Conclusion

The growing prevalence of metabolic diseases, increasing obesity-related mortality trends, and the sex-regional-socioeconomic disparities evident in young adulthood, present the concerning global burden of metabolic diseases now and in the years ahead.

Retraction: Smart rose flower like bioceramic/metal oxide dual layer coating with enhanced anti-bacterial, anti-cancer, anti-corrosive and biocompatible properties for improved orthopedic applications

Retraction of ‘Smart rose flower like bioceramic/metal oxide dual layer coating with enhanced anti-bacterial, anti-cancer, anti-corrosive and biocompatible properties for improved orthopedic applications’ by N. Murugan et al., RSC Adv., 2015, 5, 85831–85844, https://doi.org/10.1039/C5RA17747B.

Retraction: Fabrication of divalent ion substituted hydroxyapatite/gelatin nanocomposite coating on electron beam treated titanium: mechanical, anticorrosive, antibacterial and bioactive evaluations

Retraction of ‘Fabrication of divalent ion substituted hydroxyapatite/gelatin nanocomposite coating on electron beam treated titanium: mechanical, anticorrosive, antibacterial and bioactive evaluations’ by A. Karthika et al., RSC Adv., 2015, 5, 47341–47352, https://doi.org/10.1039/C5RA05624A.

Maintenance therapy with a poly(ADP-ribose) polymerase inhibitor in patients with newly diagnosed advanced epithelial ovarian cancer: individual patient data and trial-level meta-analysis

Background

We synthesize the efficacy and toxicity of poly(ADP-ribose) polymerase inhibitors (PARPis) in patients with newly diagnosed advanced ovarian cancer.

Patients and methods

We manually extracted individual patient data (IPD) for progression-free survival (PFS) from published survival curves of randomized controlled trials (RCTs) that compared PARPi versus placebo as maintenance therapy in first-line treatment, for whole study populations and subgroups, based on BRCA1/BRCA2 mutation (germline and/or somatic) and homologous recombination deficiency (HRD) status, using WebPlotDigitizer software. The respective PFS curves for each study and combined population were reconstructed from extracted IPD. The primary outcome was PFS in combined whole population and subgroups.

Results

In IPD analysis of combined population from three RCTs, with 2296 patients and 1287 events, PFS was significantly longer in PARPi versus placebo [median 20.4 (95% confidence interval (CI) 18.6-21.9) versus 14.9 (95% CI 13.9-16.5) months, respectively; hazard ratio (HR) 0.67, 95% CI 0.60-0.75; P < 0.001]. In IPD subgroup analyses from four eligible RCTs (2687 patients and 1485 events), median PFS was significantly longer in PARPi versus placebo arm, in the BRCA-mutated (45.7 versus 17.7 months, respectively; HR 0.38, 95% CI 0.32-0.46; P < 0.001), HRD-positive including BRCA-mutated (34.7 versus 17.9 months, respectively; HR 0.45, 95% CI 0.38-0.54; P < 0.001), and HRD positive excluding BRCA-mutated (22.3 versus 13.1 months, respectively; HR 0.47, 95% CI 0.34-0.65; P < 0.001) subgroups, but not in the HRD-negative (15.0 versus 11.3 months, respectively; HR 0.90, 95% CI 0.76-1.05; P = 0.75) subgroup. Results of trial-level meta-analysis were concordant with IPD analysis in whole population and subgroups.

Conclusions

Among newly diagnosed ovarian cancer patients, PARPi maintenance therapy significantly improves PFS in those with germline and/or somatic BRCA mutation and/or HRD-positive tumor but not in those with HRD-negative tumor.

•

Maintenance PARPi resulted in significant PFS improvement in total population, but benefit varied in subgroups.

•

PARPi showed PFS gain in BRCA-mutated (45.7 versus 17.7 m) and HRD-positive subgroups.

•

No significant PFS benefit was seen in the HRD-negative subgroup (15.0 versus 11.3 months; P = 0.75).

•

PARPi should be a standard treatment in newly diagnosed ovarian cancer patients except those with HRD-negative tumors.

Splenic cystic lymphangioma in adults: A rare case report from Syria

Introduction and importance

Splenic lymphangiomas are an extremely rare entity that is mainly diagnosed in children. They are often found in the neck and axilla region. Cystic lymphangioma in the abdomen is unusual and the spleen is an exceptional location for lymphangiomas.

Case presentation

We report a case of a 73 - year - old woman who presented with abdominal pain in the left upper quadrant for a month. Abdominal imaging studies show multiple splenic cysts. Splenectomy was performed and the specimen was sent for histopathologic examination. Microscopic inspection revealed splenic lymphangioma.

Clinical discussion

Splenic lymphangiomas are uncommon lesions. Most cases have been reported in children. The head, neck, and axillary regions are the most common sites, whereas lymphangioma in the spleen is exceptional.

Conclusion

Splenic lymphangiomas are uncommon benign tumors that are rarely seen during adulthood. Splenectomy is the preferred treatment.

•

Lymphangiomas are rare benign tumors of the lymphatic vessels, mainly found in children but rarely in adults.

•

We report a case of a 73-years old woman with splenic cystic lymphangioma.

•

Lymphangioma in the spleen is extremely rare. Clinically, it is usually asymptomatic.

Monkeypox: epidemiology, mode of transmission, clinical features, genetic clades and molecular properties

OBJECTIVE

Recently monkeypox cases have been reported from many non-endemic countries. The objective of this article is to bring out the epidemiology, mode of transmission, clinical features, genetic clades, and molecular properties of monkeypox virus.

MATERIALS AND METHODS

A detailed literature review was conducted on monkeypox, using databases PubMed/Medline, EMBASE, PMC and Cochrane Library, for the period between 1985 to 2022.

RESULTS

Genetically monkeypox virus can be classified into Central African clade and Western African clades. The sequence similarity between the two strains was found to be 99.5%. However, some significant differences were found in the virulent and nonvirulent genes of the strains, such as BR-203, BR-209, COP-C3L b and COP-H5R, COP-A9L, COP-A50R, and COP-A36R, respectively. Human to human transmission occurs after exposure to respiratory droplets, oral secretions, contact with lesions, fomites, and direct/sexual contact. Monkeypox can also be transmitted from the infected mother to the fetus through the placenta leading to congenital infection. In May 2022 several cases have been reported from Europe, North America, and Australia, particularly from homosexual men.

CONCLUSIONS

Monkeypox is a zoonotic disease which was prevalent in Central and Western African countries. Recently, human to human spread was noticed in developed countries of Europe, North America and Australia. Despite with a close genetic similarity between the two clades, the Central African strain is comparatively very virulent with high mortality. Monkeypox should be considered a re-emerging, neglected disease and proper measures like hand hygiene, wearing masks and vaccination to the high-risk groups are advised.

A LONG-TERM 10G-HYPERGRAVITY EXPOSURE PROMOTES CELL-CELL CONTACTS AND REDUCES ADHESIVENESS TO A SUBSTRATE, MIGRATION, AND INVASIVENESS OF MCF-7HUMAN BREAST CANCER CELLS

BACKGROUND

G-force is a fundamental force controlling human cells. Cancer is one of the 4 major health challenges in the Space missions. Cancer in Space project evaluates the reaction of human cancer cells to the conditions of the space flights, including an exposure to high g-forces.

AIM

Explore an impact of 10 g force on the oncogenic properties of human breast adenocarcinoma cells MCF-7.

MATERIALS AND METHODS

Cells were exposed to 10 g force for 10 days, as part of a 6-week simulation of conditions of a space flight. Then the cells were cultured for one week under normal culture conditions, before performing tests. Cell proliferation, cell viability, cell-cell contact inhibition, migration, and invasiveness were measured. Immunoblotting was used to evaluate expression of proteins.

RESULTS

Proliferation, cell-cell interaction and formation of 3D structures, migration, and invasiveness of cells exposed to 10 g were compared to parental cells cultured at 1 g condition. 10 g exposed cells showed a higher propensity for cell-cell contact inhibitions and lower for 3-dimensional growth in dense culture. This correlated with the decrease of proliferation in a dense culture as compared to the parental cells. The decrease of migration, adherence to a surface, and invasiveness was observed for cells subjected to the hypergravity, as compared to the parental MCF-7 cells. Enhanced expression of E-cadherin and phosphorylated pY576-FAK were observed in 10 g exposed cells but no impact on the expression of Erk, pErk, FAK and p53 was detected.

CONCLUSION

The prolonged exposure of MCF-7 cells to 10 g force targets cell-cell and cell-substrate interactions.

Short report - Lethal and aggressive pancreatic cancer: molecular pathogenesis, cellular heterogeneity, and biomarkers of pancreatic ductal adenocarcinoma

This short report describes the carcinogenesis of the pancreas leading to pancreatic ductal adenocarcinoma (PDAC) determined by molecular, cellular, and functional heterogeneity. Among the diverse types of pancreatic cancers, PDAC is the most lethal, aggressive, and one of the leading cancers associated with the highest mortality. Pancreatic cellular components like pancreatic stellate cells (PSC), mesenchymal stem cells (MSC), and pancreatic fibroblast cells (PFC) exhibit these properties in PDAC. After the appearance of point mutations in KRAS, the mutations in tumor suppressor genes appear sequentially in the order of CDKN2A, TP53, and SMAD4 that eventually resulting in PDAC development. As of today, there are no effective therapeutic options or treatments available for PDAC. The main difficulty in managing PDAC cases is its defiance to chemotherapy and radiotherapy. There were several attempts to identify a suitable biomarker for the early diagnosis and prognosis of PDAC. Anyway, these recently discovered biomarkers vary in their sensitivity and specificities. Some of the other important and reliable biomarkers for PDAC are carbohydrate antigen 19-9 (CA 19-9), carcinoembryonic antigen (CEA), cell migration-inducing hyaluronan binding protein (CEMIP), serum fatty acid metabolite PC-594, and micro-RNAs (miRNAs).

Efficacy of emicizumab in von Willebrand disease (VWD) patients with and without alloantibodies to von Willebrand factor (VWF): Report of two cases and review of literature

INTRODUCTION

von Willebrand disease (VWD) is the common bleeding disorder with a clinically relevant bleeding prevalence of 1:10,000. von Willebrand disease patients lack both von Willebrand factor (VWF) and factor VIII (FVIII), which are critical for normal haemostasis. The conventional treatment for VWD includes desmopressin and replacement therapy with plasma derived FVIII with VWF concentrates or recombinant VWF. Development of alloantibodies is a rare occurrence, there is a paucity in the literature of treatment modalities in these patients. Not many reports are available in literature on the efficacy of emicizumab in VWD patients with or without alloantibodies to VWF.

AIM

To do systematic review of literature on emicizumab in VWD and report our experience of emicizumab in two patients of VWD METHODS: We used electronic search engines till May 2021 in 'Google scholar' and 'PubMed', to collect the case reports or case series on use of emicizumab for management of VWD. Two of our severe VWD patients were successfully treated with emicizumab. A systematic review was performed and the results discussed.

RESULTS

The electronic search revealed six case reports using emicizumab for treatment of VWD. Two were in vitro studies and four in patients with VWD type 3 disease. In vitro studies and in VWD patients on emicizumab, showed improvement in thrombin generation and fibrin formation. Among four patients, three had alloantibodies to VWD and one was negative. All these patients were treated with emicizumab for 6-12 m. After starting emicizumab, none of them had spontaneous bleeding requiring treatment. During treatment with emicizumab, one patient had trauma-associated soft tissue hematoma, which was treated with rFVIIa and another patient had bleeding following dental exfoliation treated with Humate P. We treated two of our VWD patients one with and one without inhibitors with emicizumab after failure of other therapies. Both the patients showed marked improvement and continued to remain well and free of bleeding episodes. None of the patients had any thrombosis or thrombotic microangiopathy (TMA) during treatment with emicizumab.

CONCLUSION

In conclusion, this review supports the safety and efficacy of emicizumab in type 3 VWD patients with or without alloantibodies. Further large studies are required to confirm the safety and efficacy of emicizumab in VWD.

Piperazinyl-Based Diamide Ligand for Selective Precipitation of Actinyl (UO22+/PuO22+) Ions with Fast Kinetics

A novel ligand N,N'-bis(N″,N″-diethyl carbamoyl) piperazine (BDECP), L1, is synthesized as a selective precipitant for hexavalent actinyl (UO₂²⁺ and PuO₂²⁺) ions from an aqueous nitric acid medium. The ligand BDECP forms an infinite one-dimensional coordination polymer with uranyl nitrate and behaves as a bridging bidentate neutral donor. There is an alternate repetition of [UO₂(NO₃)₂] and BDECP units as evidenced by single-crystal X-ray diffraction. Uranyl ion (UO₂²⁺) can be precipitated in >99% yield from an aqueous nitric acid medium. L1 shows fast kinetics of precipitation of uranyl ion as compared to those of other reported ligands like N-alkyl pyrolidone and N-(1-adamantyl) acetamide. Avrami's coefficient, obtained from the Avrami-Erofe'ev equation, shows that the precipitation mechanism is controlled by the phase boundary and not governed by diffusion. Theoretical studies of the uranyl complex of L1 show that there is no thermodynamic preference for L1 as compared to other potential amide-based precipitants. The principal factors that govern the fast kinetics of precipitation are the aqueous solubility and higher charge density on the amide oxygen of L1.

Omicron (B.1.1.529) - variant of concern - molecular profile and epidemiology: a mini review

Recently a new variant of SARS-CoV-2 was reported from South Africa. World Health Organization (WHO) named this mutant as a variant of concern - Omicron (B.1.1.529) on 26th November 2021. This variant exhibited more than thirty amino acid mutations in the spike protein. This mutation rate is exceeding the other variants by approximately 5-11 times in the receptor-binding motif of the spike protein. Omicron (B.1.1.529) variant might have enhanced transmissibility and immune evasion. This new variant can reinfect individuals previously infected with other SARS-CoV-2 variants. Scientists expressed their concern about the efficacy of already existing COVID-19 vaccines against Omicron (B.1.1.529) infections. Some of the crucial mutations that are detected in the receptor-binding domain of the Omicron variant have been shared by previously evolved SARS-CoV-2 variants. Based on the Omicron mutation profile in the receptor-binding domain and motif, it might have collectively enhanced or intermediary infectivity relative to its previous variants. Due to extensive mutations in the spike protein, the Omicron variant might evade the immunity in the vaccinated individuals.

66 Significance of Percutaneous Biopsy in the Clinical Management of Renal Masses

Aim

Percutaneous renal mass biopsy is increasingly used in the management of renal masses. The objective of our study was to determine the significance of percutaneous renal mass biopsy and its impact on clinical management.

Method

Retrospective study of all patients who had image guided percutaneous renal mass biopsy health-board wide from April 2011 to April 2019. Renal mass biopsies were performed for either a localised or metastatic renal mass. Results of the renal biopsies were compared to final diagnosis to determine diagnostic accuracy measured by sensitivity, specificity, negative predictive value and positive predictive value.

Results

Out of 429 patients who had a renal biopsy, 91 patients- 55 males (61%) and 36 females (39%) were included in the final analysis. The mean age of the study population was 66 years (range 46-87). Renal mass biopsies were performed using coaxial 18-gauge core needle technique. We categorised patients into two groups (metastatic renal masses and localised renal mass). Sixty-eight patients had biopsies for metastatic disease and 23 patients had biopsies for a localised renal mass. In the localised disease group, the sensitivity was 100%, positive predictive value was 82% (95% CI, 48.2-97.7%) and the negative predictive value was 100% (95% CI, 66.4-100%) (Clopper Pearson Method). For patients with metastatic renal mass the positive predictive value was 83%.

Conclusions

Percutaneous renal mass biopsy may have a role for metastatic renal cancers that require targeted therapy and localised masses that require curative treatment.

Evolving biothreat of variant SARS-CoV-2 - molecular properties, virulence and epidemiology

SARS-CoV-2 are enveloped RNA viruses that belong to the family Coronaviridae of genus Beta coronavirus, responsible for the COVID-19 pandemic. The mutation rate is high among RNA viruses and in particular, coronavirus replication is error prone with an estimated mutation rate of 4x10-4 nucleotide substitutions per site per year. Variants of SARS-CoV-2 have been reported from various countries like United Kingdom, South Africa, Denmark, Brazil and India. These variants evolved due to mutations in spike gene of SARS-CoV-2. The most concerning variants are Variant of Concern (VOC) 202012/01 from United Kingdom and B.1.617 variant of India. Other variants include B.1.351 lineages, cluster 5/SARS-CoV-2 variant of Denmark, 501.V2 variant/SARS-CoV-2 variant of South Africa, lineage B.1.1.248/lineage P.1 of Brazil. Mutations in S protein may result in changes in the transmissibility and virulence of SARS-CoV-2. To date, alterations in virulence or pathogenicity have been reported among the variants from many parts of the globe. In our opinion, since the S protein is significantly altered, the suitability of existing vaccine specifically targeting the S protein of SARS-CoV-2 variants is a major concern. The mutations in SARS-CoV-2 are a continuous and evolving process that may result in the transformation of naïve SARS-CoV-2 into totally new subsets of antigenically different SARS-CoV-2 viruses over a period of time.

Role of microbial dysbiosis in carcinogenesis & cancer therapies

The human body supports a heterogeneous population of microorganisms. Every microorganism has the ability to contribute to the unique microenvironment around it. The aim of this review is to discuss the changes in the microbial population and their relative abundance across different ecosystems of the human body, the interactions within the microbial communities, metabolites they secrete to their external environment, their immunomodulatory functions, their signal transduction pathways and how these respond to environmental stimuli such as various diets, alcohol and drug consumption, smoking and finally suggest new therapeutic approaches. The microbiota may leads to cancer through inflammation mediated mechanisms which modulate immune responses, or produce carcinogenic metabolites and genotoxins, or deregulate cell proliferative signalling pathways. The identification of these molecular mechanisms in carcinogenesis may lead to better treatment strategies. In this review we have tried to explore the changes in microbial composition between cancer and normal tissues and what molecular mechanisms provide a connecting link between microbial dysbiosis and cancer.

MiRNA expression profiling and emergence of new prognostic signature for oral squamous cell carcinoma

Oral squamous cell carcinoma (OSCC), the most common type of head and neck cancers, is associated with high recurrence, metastasis, low long-term survival rates and poor treatment outcome. As deregulated miRNA expression plays a crucial role in malignant transformation and cancer progression, the present study is aimed at profiling the miRNA expression pattern in OSCC and developing a new miRNA prognostic signature for oral cancer. MiRNA expression profiling was performed using MiRNA microarray in 30 tumor and 18 normal samples. MiRNA signature obtained was validated with quantitative real time PCR (qRT-PCR) in 144 tumor and 36 normal samples. The potential targets, clinical implications and prognostic value of the miRNA signature were elucidated by various bioinformatics and statistical analyses. Microarray profiling identified a set of 105 miRNAs to be differentially expressed in OSCC, out of which a subset of 19 most dysregulated miRNAs were validated by qRT-PCR. In silico analysis revealed the signature miRNAs to be involved in various cancer associated pathways. Up-regulation of miR-196a, miR-21, miR-1237 and downregulation of miR-204, miR-144 was associated with poor prognosis of OSCC patients. The mir-196a/miR-204 expression ratio emerged as best predictor for disease recurrence and patient survival. Altogether, our study identified a miRNA signature for OSCC with prognostic significance.

Neuroprotective effects of a dendrimer-based glutamate carboxypeptidase inhibitor on superoxide dismutase transgenic mice after neonatal hypoxic-ischemic brain injury

The result of a deprivation of oxygen and glucose to the brain, hypoxic-ischemic encephalopathy (HIE), remains the most common cause of death and disability in human neonates globally and is mediated by glutamate toxicity and inflammation. We have previously shown that the enzyme glutamate carboxypeptidase (GCPII) is overexpressed in activated microglia in the presence of inflammation in fetal/newborn rabbit brain. We assessed the therapeutic utility of a GCPII enzyme inhibitor called 2-(3-Mercaptopropyl) pentanedioic acid (2MPPA) attached to a dendrimer (D-2MPPA), in order to target activated microglia in an experimental neonatal hypoxia-ischemia (HI) model using superoxide dismutase transgenic (SOD) mice that are often more injured after hypoxia-ischemia than wildtype animals. SOD overexpressing and wild type (WT) mice underwent permanent ligation of the left common carotid artery followed by 50 min of asphyxiation (10% O₂) to induce HI injury on postnatal day 9 (P9). Cy5-labeled dendrimers were administered to the mice at 6 h, 24 h or 72 h after HI and brains were evaluated by immunofluorescence analysis 24 h after the injection to visualize microglial localization and uptake over time. Expression of GCPII enzyme was analyzed in microglia 24 h after the HI injury. The expression of pro- and anti-inflammatory cytokines were analyzed 24 h and 72 h post-HI. Brain damage was analyzed histologically 7 days post-HI in the three randomly assigned groups: control (C); hypoxic-ischemic (HI); and HI mice who received a single dose of D-2MPPA 6 h post-HI (HI+D-2MPPA). First, we found that GCPII was overexpressed in activated microglia 24 h after HI in the SOD overexpressing mice. Also, there was an increase in microglial activation 24 h after HI in the ipsilateral hippocampus which was most visible in the SOD+HI group. Dendrimers were mostly taken up by microglia by 24 h post-HI; uptake was more prominent in the SOD+HI mice than in the WT+HI. The inflammatory profile showed significant increase in expression of KC/GRO following injury in SOD mice compared to WT at 24 and 72 h. A greater and significant decrease in KC/GRO was seen in the SOD mice following treatment with D-2MPPA. Seven days after HI, D-2MPPA treatment decreased brain injury in the SOD+HI group, but not in WT+HI. This reduced damage was mainly seen in hippocampus and cortex. Our data indicate that the best time point to administer D-2MPPA is 6 h post-HI in order to suppress the expression of GCPII by 24 h after the damage since dendrimer localization in microglia is seen as early as 6 h with the peak of GCPII upregulation in activated microglia seen at 24 h post-HI. Ultimately, treatment with D-2MPPA at 6 h post-HI leads to a decrease in inflammatory profiles by 24 h and reduction in brain injury in the SOD overexpressing mice.

COVID-19 (Novel Coronavirus 2019) - recent trends

The World Health Organization (WHO) has issued a warning that, although the 2019 novel coronavirus (COVID-19) from Wuhan City (China), is not pandemic, it should be contained to prevent the global spread. The COVID-19 virus was known earlier as 2019-nCoV. As of 12 February 2020, WHO reported 45,171 cases and 1115 deaths related to COVID-19. COVID-19 is similar to Severe Acute Respiratory Syndrome coronavirus (SARS-CoV) virus in its pathogenicity, clinical spectrum, and epidemiology. Comparison of the genome sequences of COVID-19, SARS-CoV, and Middle East Respiratory Syndrome coronavirus (MERS-CoV) showed that COVID-19 has a better sequence identity with SARS-CoV compared to MERS CoV. However, the amino acid sequence of COVID-19 differs from other coronaviruses specifically in the regions of 1ab polyprotein and surface glycoprotein or S-protein. Although several animals have been speculated to be a reservoir for COVID-19, no animal reservoir has been already confirmed. COVID-19 causes COVID-19 disease that has similar symptoms as SARS-CoV. Studies suggest that the human receptor for COVID-19 may be angiotensin-converting enzyme 2 (ACE2) receptor similar to that of SARS-CoV. The nucleocapsid (N) protein of COVID-19 has nearly 90% amino acid sequence identity with SARS-CoV. The N protein antibodies of SARS-CoV may cross react with COVID-19 but may not provide cross-immunity. In a similar fashion to SARS-CoV, the N protein of COVID-19 may play an important role in suppressing the RNA interference (RNAi) to overcome the host defense. This mini-review aims at investigating the most recent trend of COVID-19.

Spiritual Care: Define and Redefine Self

Spiritual care is deep rooted in the traditional ancient system of medicine. However, due to lack of high grade evidences, practitioners of modern system of medicine are hesitant to inculcate spirituality in their clinical practice. This paper is an attempt to basic understanding of spiritual care therapy, current evidences for it and the challenges for incorporation in the allopathic system of medicine.