bluuebunny/crossref_metadata_2025 huggingface dataset:
Love Is in the AI of the BeholderArtificial Intelligence and Characters of Love
Authors: NTELIA Renata E.
Published: June 2024

This article examines AI in its capacity to become a companion in a love relationship, whether romantic or otherwise. It shows how AI has moved from the sphere of science fiction to become a reality in everyday life, which makes our interactions with it much more personal, and our perception of it as something human-like, if not yet human. This rightly opens discussions regarding AI behaviour and human coexistence with it. The article argues that since it is difficult, if not impossible, to exactly know how an AI thinks and as we can only discern it by its results and effects, a way to anticipate its outcome is to look at the possibilities of attachment its input entails. AI input is based on mediated human experiences found in the web—aspects of love included. As such, seeing what type of love such data can result in is a valid way of foreseeing what characteristics AI will exhibit when perceived as a love agent. The article further argues that a safe and appropriate space to explore that contingency are digital games. Using an example involving Nier: Automata, it contends that archival datasets alone, full of toxic and problematic examples of love and attachment, will give rise to equally disturbing AI-generated love characters. Instead, it proposes that games can offer a different solution by affording opportunities for cohabitation of human agents and AI, in which the AI will learn about love via playful instances of care, attachment, and attuning.
Diversidade religiosa e discriminação indireta em contexto laboral: O que nos diz a prática dos tribunais?
Authors: Jerónimo Patrícia
Published: June 2024

A crescente visibilidade da religião no local de trabalho está na origem de não poucos focos de tensão e litígio na Europa e tem merecido alguma atenção mediática, sobretudo quando os tribunais são chamados a intervir. Na maioria dos casos, não se trata tanto de discriminação direta contra trabalhadores por causa da sua religião, mas de discriminação indireta resultante da aplicação a todos os trabalhadores de regras “neutras”, que tornam particularmente difícil para as pessoas pertencentes a minorias religiosas a conciliação entre deveres profissionais e deveres religiosos. Neste texto, fazemos um apanhado de decisões de tribunais estatais e internacionais sobre a matéria e discutimos as implicações dessas pronúncias.
La syntaxe et la sémantique des démonstratifs prédicatifs en français, en chinois mandarin et en vietnamien : perspective typologique
Authors: Kong Fanguang , Dao Huy Linh
Published: June 2024

Cet article propose une étude comparative et typologique des démonstratifs prédicatifs en français, en chinois mandarin et en vietnamien. Six classes de démonstratifs ont été étudiées l’une après l’autre : démonstratifs présentatifs, démonstratifs identifieurs, démonstratifs locatifs, démonstratifs copulatifs, démonstratifs de manière et démonstratifs implicites. Cette recherche permet de rendre compte notamment des caractéristiques syntaxiques et sémantiques des démonstratifs prédicatifs dans les trois langues, dans la mesure où ceux-ci fonctionnent souvent comme prédicats non verbaux sans sujet, en assurant soit un rôle référentiel, soit un rôle pragmadiscursif. Les démonstratifs prédicatifs en chinois mandarin et en vietnamien ont une autre particularité, puisqu’un morphème démonstratif peut être utilisé dans plusieurs catégories morphosyntaxiques.
Le démantèlement des ouvrages fortifiés en béton armé de la Première Guerre mondiale
Authors: Lecomte Bertrand
Published: June 2024

Dès la fin de la Première Guerre mondiale, le démantèlement des fortifications de campagne aménagées durant la guerre de position est l’une des priorités de la reconstruction. En Flandre française, des milliers d’ouvrages en béton armé, construits par les troupes allemandes, puis par les forces alliées, doivent donc disparaître. Mais leur destruction représente un travail colossal et complexe, notamment dans le Pays de Weppes. Toutefois, les chantiers de démolition, bien qu’émaillés de nombreux accidents, s’enchaînent à un rythme très soutenu durant les années 1920. Ils sont par la suite de moins en moins nombreux. Devenus sporadiques après 1945, ils sont néanmoins beaucoup plus efficaces qu’auparavant. Après plus d’un siècle, plusieurs centaines de blockhaus échappent encore au démantèlement pour de multiples raisons. Longtemps oubliés, ces vestiges de la guerre sont aujourd’hui intégrés à de nouvelles pratiques culturelles, mémorielles et touristiques, notamment autour de Fromelles et de Laventie. Leur pérennité pousse aussi certains acteurs locaux à se questionner sur leur patrimonialisation et leur mise en tourisme.
Les fortifications tardives de Château-Thierry (XVIe siècle) : une phase majeure disparue
Authors: Guérin Thomas
Published: June 2024

Les fortifications médiévales de Château-Thierry ont fait l’objet d’études approfondies et très documentées. Malgré cela, une ultime phase d’adaptation aux techniques de la guerre moderne est restée complètement inaperçue, jusqu’à ce que l’examen croisé des sources et des données archéologiques révèle son existence. Longtemps considérée comme une phase négligeable, succession d’opérations ponctuelles sans projet global, les fortifications du XVIe siècle de Château-Thierry ont été délaissées en faveur d’autres problématiques historiographiques. Aujourd’hui, l’occasion nous est donnée d’exposer les motifs qui nous conduisent à considérer qu’il s’agit, en réalité, d’une phase de transformation majeure conçue à l’échelle de l’agglomération. Sa disparition, tant physique qu’archivistique, a contribué à la rendre longtemps imperceptible.
Cartographier les pressions qui s’exercent sur la biodiversité : éléments de réflexion autour des pratiques utilisées
Authors: Rouveyrol Paul
Published: June 2024

Pour mieux orienter les politiques de conservation, il est crucial de comprendre les mécanismes responsables de la perte de biodiversité. Les cartes illustrant les pressions anthropiques sur la biodiversité représentent une solution technique en plein développement face à cet enjeu. Cet article, fondé sur une revue bibliographique, éclaire les diverses étapes de leur élaboration et interroge la pertinence des choix méthodologiques envisageables. La définition des notions mobilisées pour élaborer ces cartes, en particulier celle de la pression, représente un premier défi. La pression se trouve précisément à la jonction entre les facteurs de détérioration et leurs répercussions. Cependant, les indicateurs à notre disposition pour la localiser géographiquement sont généralement axés soit sur les causes, soit sur les conséquences de la dégradation. Cet écueil peut être surmonté si la nature des indicateurs utilisés est bien définie. À cet effet, nous proposons une catégorisation des indicateurs de pressions, permettant de faire le lien avec les finalités de la carte. Les transformations cartographiques et sémiologiques, incluant notamment les questions d’échelle et de cumul de pressions, sont ensuite décomposées pour souligner les implications des différents choix méthodologiques possibles et en tirer des recommandations. Nos résultats confirment le besoin d’adapter les méthodes à l’utilisation qui est faite de la carte et plaident pour un meilleur partage de ces méthodes et de leurs limites.
Trouver le chemin de la grâce : les villes rebelles et leurs stratégies pour rétablir le dialogue avec le souverain (royaume de France, seconde moitié du XVe siècle)
Authors: Carbonnet Adrien
Published: June 2024

La répression des soulèvements urbains dans la seconde moitié du xve siècle a donné lieu à des négociations entre le roi et la ville. La recherche de l’accord est toutefois rarement mentionnée dans la documentation. En effet, dans les sources, domine un discours selon lequel la révolte est une offense faite au roi, et donc à Dieu. Dès lors, aucun accord n’est possible entre le souverain et ceux qui sont présentés comme des rebelles. La ville, pénitente, doit alors chercher alors la grâce du souverain. Toutefois, l’analyse des sources de la pratique laisse apparaître une part de négociations dans cette recherche du pardon royal. Les villes élaborent de complexes stratégies pour obtenir une sortie de crise, ce qui conduit à nuancer un récit officiel du pardon qui masque les marchandages, les intermédiaires et les pots-de-vin.
Faire la paix devant notaire (Saint-Germain-des-Prés, première moitié du xviie siècle)
Authors: Roussel Diane
Published: June 2024

Professionnel du droit, le notaire apparaît comme un acteur discret, mais central, de la résolution des conflits à l’ombre de l’institution judiciaire à partir de laquelle les historiennes et historiens ont l’habitude de mener leurs recherches. Cet article propose d’inverser le point de vue et de partir des sources notariales afin de mettre en lumière le rôle du notaire, longtemps chaînon manquant dans les études sur les mécanismes de la régulation sociale. L’étude se fonde sur un corpus d’accords réglant des conflits d’ordre criminel réalisés par le notaire Jacques Legay à Saint-Germain-des-Prés dans la première moitié du xviie siècle. Actes mineurs, à part et inclassables, ces accords ne se laissent pas facilement débusquer par l’historien·ne mais constituent pourtant une pratique banale du notaire. Bien qu’enserrés dans un formulaire rigide et uniforme, les accords révèlent les différentes conditions, les gestes et les paroles par lesquels les parties en conflit parviennent à soigner leurs blessures d’honneur et de sang. Conçus comme le meilleur remède au procès, les accords entretiennent toutefois avec la justice seigneuriale locale des liens étroits. La sociologie des contractants et des justiciables germanopratins éclaire ainsi une partie des motivations et des exigences des populations dans leurs choix de naviguer plus ou moins volontiers entre l’un et l’autre recours.
The Impact of Product Diversification and Insurance Activity to Insurance Industry Performance: Moderating Effect of Insurance Penetration: Evidence from India, Pakistan, and Sri Lanka
Authors: Rathnasiri S. M. H. G. , Buddhika H. J. R.
Published: June 2024

Purpose: The research focused on the insurance industry performance of India, Pakistan & Sri Lanka were supposed to find the impact of product diversification and Insurance activity towards industry performance measured by ROE. Further insurance penetration is considered a moderating variable and objectives same as mentioned above. Product diversification and Insurance activity are key indicators of the insurance industry and insurance penetration is a key indicator of country performance measurement.Methodology: This quantitative study considered countries of Sri Lanka, India, and Pakistan in the South Asian Region and considered the period data from 2012 -2022. The highest developed first three countries were considered for evaluation purposes and diversified (companies operating in both Life & General) insurance companies from each country.Findings: Both product diversification and insurance activity exhibit negative correlations with insurance industry performance, indicating that increasing either factor may result in lower financial performance for insurers in these countries. Furthermore, insurance penetration significantly moderates the relationship between product diversification and insurance industry performance. The three hypotheses formulated and stated that impact is negative for product diversification and insurance activity. Further stated that insurance penetration moderated the insurance industry's performance.Conclusion: The findings underscore the importance of prudent strategic planning and management for diversified insurance companies in India, Pakistan & Sri Lanka. Diversified insurance firms are advised to carefully weigh the trade-offs between diversification and profitability. While diversification can mitigate risk, it may also lead to diminishing the returns in long run.
Impact of dry eye on visual acuity and contrast sensitivity
Authors: Khirat Noha , Abo Habib Ahmed M.A.A. , Al Sebaey Abd-Alrahman , Zaky Marwa A.
Published: June 2024

Background

Although normal visual acuity (VA) has been documented in dry eye disease (DED), it has a deleterious effect on multiple aspects of visual functions.

Objective

The aim of this study was to evaluate the VA and contrast sensitivity in patients with DED.

Patients and methods

The study included 60 eyes of 30 patients with bilateral DED. The patients were evaluated on presentation and one month and 3 months after treatment. The evaluation included measurement of VA, contrast sensitivity, tear break-up time (TBUT), and Schirmer’s test. The treatment was prescribed for 3 months and included hot fomentations, topical steroids 4 times daily, tear substitutes with sodium hyaluronate 0.1% and tear substitutes with polyethylene glycol 0.3%, propylene glycol, and hydroxypropyl guar 4 times daily, and cyclosporine 0.05% eye drops twice daily.

Results

There was a statistically significant improvement in the functional outcome from baseline to 3 months after treatment. The uncorrected VA improved from LogMAR 0.585±0.27 at baseline to 0.52±0.26, 3 months after treatment (P=0.017). Similarly, the best corrected VA improved from 0.332±0.235 at baseline to 0.217±0.138 (P=0.012), and the contrast sensitivity improved from 1.188±0.255 to 1.59±0.118 (P=0.009) after 3 months. The TBUT significantly improved from 4.08±2.895 s to 8.35±1.665 s (P=0.001) and the Schirmer’s test from 5.45±3.72 mm to 9.53±2.38 mm (P=0.001) 3 months after treatment. There was a significant negative correlation between the TBUT and VA 3 months after treatment (r=−0.4094, P <0.021).

Conclusion

There was a significant improvement in VA, contrast sensitivity, TBUT, and Schirmer’s test within a few months of treatment of DED.
Optical coherence tomography angiography value for detection of early retinal microvascular changes in systemic hypertension
Authors: Sadek Sherin H. , Taher Sameh G. , Hatata Ragai M.
Published: June 2024

Purpose

The aim of this study was to assess the macula and optic disc vessel density (VD) and perfusion and the anatomical alterations at the fovea and optic nerve in chronic treated hypertension (HTN) patients who exhibited no signs of hypertensive retinopathy using optical coherence tomography angiography (OCTA).

Patients and methods

This is a prospective case–control study that included 37 participants. They were subdivided into two groups: the hypertensive group that included 22 patients (mean age=51.9±5.9 years), with no clinically evident signs of hypertensive retinopathy, and the control group that included 15 individuals (mean age=48.8±3.7 years) with no known history of HTN or other chronic systemic diseases. OCTA scans covering a 6.0×6.0 mm area for the macula and a 4.5×4.5 mm region for the optic nerve head were performed to evaluate the VD, the foveal avascular zone area, macular thickness, and retinal nerve fiber layer (RNFL) thickness. The correlation of the VD measurements with the RNFL thickness was evaluated.

Results

The hypertensive patients exhibited a significantly lower overall mean macular VD (45.8±6.0) compared to the control group (48.5±2.9, P=0.017). In addition, they exhibited a significantly lower superficial VD in the superior hemifield (46.4±5.3 and 48.6±2.9, respectively, P=0.030). On the other hand, the deep vascular density in the superior hemifield showed no significant difference between the two groups. In addition, the hypertensive patients were found to have a significantly lower average RNFL thickness (103.2±17.8 μm) compared to the control group (117.1±14.1 μm, P=0.001), with specific statistically significant reductions in the superior (P=0.002) and inferior (P=0.004) sectors. Although the central ganglion cell-inner plexiform layer thickness did not reach statistically significant difference between the two groups (HTN: 50.7±12.0 μm vs. control: 55.7±8.8 μm, P=0.055), the hypertensive group exhibited statistically significant reductions in the ganglion cell-inner plexiform layer thickness in the superior (P<0.001), inferior (P=0.002), nasal (P=0.003), and temporal (P=0.001) sectors compared to the controls. There was no statistically significant difference in the size of the foveal avascular zone between the two groups.

Conclusion

OCTA revealed subclinical alterations in the retinal microvasculature parameters among the hypertensive patients without clinical signs of hypertensive retinopathy, in comparison to normotensive individuals.
Willingness and motivation of Egyptian patients with diabetic retinopathy to participate in clinical trials
Authors: Khalil Ahmed S. , Salama Moustafa A. , Kotb Ahmed N. , Fawzy Hebatallah M. , Hegab Mohammed A.
Published: June 2024

Purpose

The aim of this study was to identify the motivational factors and the barriers of Egyptian diabetic retinopathy (DR) patients to recruitment in clinical trials.

Patients and methods

This is a cross-sectional study of the patients with diabetes mellitus attending the Outpatient Clinic of Zagazig University Hospital from September 2022 to December 2022. Patients with any degree of DR were included. A questionnaire was distributed to all participants. It included the sociodemographic and clinical characteristics and questions to identify the motivational factors or the barriers to participate in a clinical trial. The patients were categorized into two groups according to their tendency for recruitment: the first group that accepted participation, who were asked about the most motivational factors and the second group that refused participation, who were asked about their potential barriers.

Results

The study recruited 206 DR patients of whom 145 (70.4%) accepted to participate in clinical trials, while the remaining 61 (29.6%) patients refused to participate. Fear from blindness was the commonest motivational factor (93.1%) and the risk of side effects was the commonest barrier (100%). Acceptance to participate was higher among those with positive family history of diabetes mellitus (P=0.01). Refusal to participate was higher in mild nonproliferative DR patients (P<0.001), while patients with proliferative DR and macular edema significantly accepted to participate (P<0.001). High education was significantly associated with acceptance compared to those who refused to participate (81.1 vs. 18.9%, respectively, P=0.004). Ocular history of previous intervention was significantly associated with acceptance to participate (P=0.001).

Conclusion

Acceptance of DR Egyptian patients to participate in clinical trials was unpredictably high. The results of this questionnaire should encourage researchers to conduct more clinical trials.
Ocular graft host disease after allogeneic stem cell transplant: unique risk factors and outcomes
Authors: Abdel Fattah Maaly A.M. , ElGohary Ghada , Hashmi Shahrukh K.
Published: June 2024

Objective

The aim of this study was to formulate a retrospective study investigating the ocular findings and associated risk factors in long-term survivors after allogenic-hematopoietic stem cell transplantation (HSCT) in Saudi Arabia.

Patients and methods

This observational study was conducted on patients who underwent HSCT from 1996 to 2016 at King Faisal Specialist Hospital and Research Center in Riyadh, Saudi Arabia. The study included 72 patients who were human leukocyte antigen-matched donors with identical matched sibling donors. Peripheral blood was the source of stem cells in 61 patients. The ophthalmological examination included visual acuity (VA) testing, refraction, tear break-up time, Schirmer’s test, slit-lamp biomicroscopy, and dilated ophthalmoscopy. Chronic ocular graft-versus-host disease (GVHD) inclusion was based on strict selection criteria. The patients identified with mild to moderate ocular GVHD had less than or equal to three corneal staining, 13–32 points ocular surface disease index (OSDI), and Schirmer’s test of 6–15 mm were classified as group 1, while those with severe ocular GVHD defined as having more than four corneal stainings, more than or equal to 33 points OSDI, and less than or equal to 5 mm Schirmer’s test were classified as group 2. Impairment of VA was classified as mild (20/22–20/50), moderate (20/70–>20/200), or severe (≤20/200) impairment.

Results

Chronic GVHD was diagnosed in 394 patients within the first 5 years after transplantation. Ocular GVHD was detected in 81 (20.56%) patients. They were classified into group 1 (65 patients, 80.25%) with mild to moderate ocular GVHD and group 2 (16 patients, 19.75%) with severe ocular GVHD. All patients had OSDI ranging from more than or equal to 13 to more than or equal to 33. Retinal changes were detected in five patients, optic disc changes in two patients, steroid-induced proliferative diabetic retinopathy in three patients, and old branch retinal vein occlusion in one patient. All patients with identical matched sibling donor showed normal or mild to moderate impaired VA except for two patients. All patients responded to topical eye drops except for nine who required surgical procedures. Normal or mild impaired VA was reported in 59 patients with statistical significance (P=0.0053), while 42 male patients versus 29 females had normal or mild impaired VA with a statistically significant difference (P=0.0179).

Conclusion

Ocular GVHD is a complex disease in our unique population. Every patient before allogenic HSCT be referred to a cornea specialist to evaluate the baseline parameters for the pre-HSCT diagnosis of dry eye disease.
Clinical Characteristics of Macroprolactinomas and Response to Medical Therapy
Authors: Tiwari Pooja , Saikia Uma K. , Baro Abhamoni , Bhuyan Ashok K.
Published: June 2024

Introduction:

The presentation of macroprolactinomas and response to treatment may vary according to age, sex and tumour characteristics. To analyse clinical phenotype, biochemical and radiological characteristics of macroprolactinomas presenting to a tertiary care centre. A retrospective observational study from January 2018 to December 2022.

Methods:

Thirty diagnosed cases (18 females, 12 males) of macroprolactinomas were included and followed up for one year.

Results:

The most common presentation was headache (73%), visual disturbances (50%), galactorrhoea (33.3%) and loss of libido (26.6%) along with menstrual cycle disturbances (94%), and infertility (55%) in females. Duration of symptoms (2.22 ± 2.87 vs 4.61 ± 3.4 years), tumour size (4.8 ± 2.09 vs 2.75 ± 1.24 cm) and prolactin levels (5153.5 ± 4755.3 vs 1803.5 ± 3785.5 ng/ml) were different significantly between males and females. Good response to medical therapy was observed in 84% of the treatment-naive patients.

Conclusion:

Macroprolactinomas in males present with shorter duration of symptoms, larger size, higher prolactin levels and more resistant tumours, emphasizing the need for early diagnosis and aggressive management. Medical therapy remains the treatment of choice irrespective of gender.
Thyroid Function Test in Preterm Neonates: Normative Data
Authors: Mukherjee Debarghya , Mukhopadhyay Pradip , Saha Bijan , Sen Sangita , Ghosh Sujoy
Published: June 2024

Introduction:

Initial surge of thyroid-stimulating hormone (TSH) in neonates increases free and total triiodothyronine (T3) and tetraiodothyronine (T4) in 24–36 hours following birth, and the effect then gradually wanes off. As somatic and intellectual development is dependent on normal thyroid function especially in infancy, normative data in these children may be of immense value to diagnose hypothyroidism in this subset of infants. Comprehensive normative values of thyroid function parameters in preterm neonates are scarcely available. The objective of this study was to determine the normative value of thyroid function parameters in preterm neonates.

Methods:

Preterm neonates (n = 102) born at 34 and 35 weeks of gestation of euthyroid mothers from an iodine-sufficient population were evaluated for T3, T4, free thyroxine (FT4) and TSH during 3–7 days after birth and again after 1 month. The expected date of delivery (EDD) and Ballard score were used to identify the duration of gestation.

Results:

The mean gestational age was 34.7 ± 0.41 weeks. The mean (± SD) for T3 (ng/dl), T4 (μg/dl), FT4 (ng/ml) and TSH (μIU/ml) on days 3–7 following birth was as follows: 156 ± 44.6, 12.8 ± 3.7, 1.50 ± 0.54 and 7.13 ± 6.04, respectively. Around 4 weeks of age, values changed to 104 ± 38.4, 12.1 ± 4.02, 1.46 ± 0.42 and 3.25 ± 2.85, respectively. All parameters changed significantly around 4 weeks, except FT4. None of the parameters were correlated with gestational age or body weight at birth. Normative values for each parameter in percentiles were generated.

Conclusion:

This study generated the normative values of the thyroid function test during the first week and after around 4 weeks of life for premature neonates (born at 34–35 weeks).
Currarino syndrome with immature teratoma: A case report with review of literature
Authors: Behera Gayatri , Manekar Aaditya , Mahallik Santosh , Sable Mukund , Das Kanishka
Published: June 2024

Currarino syndrome (CS) is a rare congenital syndrome characterized by a triad of anorectal malformation, sacral deformity, and presacral mass. In about 50% of cases, it is caused by HLXB9 gene mutation in chromosome 7q36. A 13-month-male child presented with presacral discharging sinus with a history of surgery for anorectal malformation and perineal fistula at the time of birth. On detailed investigation, the child revealed to have anal atresia, hemisacrum, and presacral mass. Histopathology of presacral mass showed features of immature teratoma. The presacral mass in CS is mostly an anterior myelomeningocele or presacral teratoma. The development of immature teratoma in presacral mass is very rare. The histopathological identification of immature component of teratoma in the presacral mass of CS is important for risk stratification and further management. Suspicion of CS should be raised in any child presenting with partial phenotype of the triad.
Evaluation of response to neoadjuvant chemotherapy in technically unresectable moderately advanced oral cavity cancers
Authors: Kadian Abhishek , Takkar Puneet , Sharma Ankit , Sharma Prateek
Published: June 2024

Background:

Moderately advanced and technically unresectable oral cavity cancers have a poor prognosis. Neoadjuvant chemotherapy might be beneficial in such patients by reducing tumour bulk and allowing definitive surgery.

Aim:

To evaluate the response of neoadjuvant chemotherapy in moderately advanced technically unresectable oral cavity cancers.

Methodology:

Prospective observational study - secondary data analysis of patients with moderately advanced oral cavity cancer, which were treated with neoadjuvant chemotherapy (NACT) during the period November 2014-April 2016. Data was analysed for information on patient characteristics, chemotherapy received, toxicity, clinical response rates, local treatment offered and pathological response rates. The statistical analysis was performed with SPSS version 20.

Results:

30 patients, with a median age of 52 years were analyzed. Buccal mucosa was the most common sub site (50%). Three drug regimen was utilized in all patients. Resectability was achieved in 14 patients (46.67%). Febrile neutropenia was seen in 3 patients (10%). The overall response rate was 31%.

Conclusion:

NACT was effective in converting moderately advanced technically unresectable oral cavity cancers to operable disease in approximately 47% of patients. Post NACT, there is significant association between clinical and pathological findings of response rates. There is no increase in surgical complication rates following NACT.
Peripheral giant cell lesion of the oral cavity in a 12-year-old child: A rare case report
Authors: Patel Chirag , Diwanji Amish , Mathur Jyoti , Purani Jigar
Published: June 2024

Giant cell lesion of the oral cavity in a pediatric population is a very rare entity. Peripheral giant cell granuloma (PGCG) is one such non-neoplastic lesion-causing gingival tumor. Here, a case of successful management of PGCG in a 12-year-old child is presented with a two-year follow-up. Clinical, radiographic, and histological features of PGCG are discussed with the importance of a long-term follow-up of the lesion.
Split X-Jaw techniques of volumetric modulated arc radiotherapy in nasopharyngeal cancer: A dosimetric comparison
Authors: Nath Jyotiman , Sarma Gautam , Goswami Shachindra , Sharma Shashi Bhushan , Goswami Pranjal , Kalita Apurba Kumar
Published: June 2024

Purpose:

The current study aims to compare the split x-jaw planning technique of volumetric modulated arc radiotherapy (VMAT) with the traditional open and limited jaw techniques of VAMT in nasopharyngeal carcinoma treatment. The multi-leaf collimators on the varian linear accelerator move on a carriage with a maximum leaf span of 15 cm. Therefore, treatment of larger planning target volumes, such as in nasopharyngeal cancer with traditional open and limited jaw technique, yields compromised dose distribution.

Method:

Computed tomography data sets of 10 nasopharynx cancer patients were enrolled for the study. For each case, three separate treatment plans were generated viz. open, limited, and split x-jaw planning techniques with similar planning objectives. Only PTVs requiring a field size larger than 18 cm in the x-jaw position were considered.

Results:

Comparable results were obtained regarding organs at risk (OAR) sparing in all the techniques. The target dose coverage with split x-jaw VMAT was superior to both open and limited jaw planning techniques, with a statistically significant difference in the intermediate dose planning target volumes (PTVs) (PTV59.4), P < 0.05. However, the split technique’s dose to the spinal cord and larynx was significantly lower (P < 0.05).

Conclusion:

The split x-jaw planning technique of VMAT can be adapted for larger PTVs requiring an x-jaw of more than 15 cm. The only concern with this technique is the increased MU.
Concurrent chemoradiation with low-dose and long-duration weekly infusion of gemcitabine in unresectable squamous cell carcinoma of head and neck (SCCHN)
Authors: Ahmad Farhan , Akram Mohammad , Khan Mohsin
Published: June 2024

Background:

Concurrent chemoradiotherapy now represents the standard of care in locally advanced unresectable squamous cell carcinoma of the head and neck, and the administration of cisplatin in triweekly or weekly schedules is the most commonly used chemotherapeutic agent. However, the chemotherapeutic agent and its scheduling with radiation is still an area of investigation with safer toxicity profile and better response rates. Gemcitabine is a potent radiosensitizer, and non-cytotoxic concentration results in decreased systemic toxicity while maintaining radiosensitization properties. Furthermore, data are emerging for low-dose and long-duration infusion where this strategy is found to be effective and a safe alternative to standard brief infusion. Based on these two strategies, that is, non-cytotoxic concentration with long duration, we have explored the unique possibility of further lowering the toxicity profile without compromising the efficacy.

Method:

Eligible patients of locally advanced unresectable squamous cell carcinoma of the head and neck underwent radiation treatment with concurrent gemcitabine. A total dose of 70 Gy in 35 fractions over a period of seven weeks with conventional fractionation schedule was delivered with cord off after 44 Gy. Concurrent gemcitabine was administered intravenously for over two hours once a week, 1–2 h before radiation and for seven consecutive weeks at 50 mg/m2.

Result:

Fifty-two patients was enrolled in this study, out of which 41 completed the treatment. Fifty-nine percent completed treatment within seven weeks. Sixty-four percent were found to have received more than five cycles. Mean follow-up of patients was found to be 4.9 months. Sixty-eight percent had complete response. Stage III patients achieved more complete response compared to stage IV. There was no site-wise difference in achieving complete response. Patients who have received less than five chemo cycles or completed the treatment in more than seven weeks had less complete response. Sixty-one percent had severe mucositis while 39% developed mild/moderate mucositis. Considering skin toxicity, 80% were found to have mild/moderate skin toxicity, while only 20% suffered from severe grades of skin toxicity.

Conclusion:

Gemcitabine in low-dose and long-duration infusion is a potent radiosensitizer with safer hematological toxicity and manageable local toxicities.
Epidemiological trends of colorectal cancer cases in young population of Eastern India: A retrospective observational study
Authors: Raj Shraddha , Kishor Kunal , Devi Seema , Sinha Dinesh K. , Madhawi Richa , Singh Rajesh K. , Prakash Pritam , Kumar Saket
Published: June 2024

Background:

Colorectal cancer (CRC) is a disease of the older population in developed countries where the incidence among the young is rising despite the decline in the overall incidence. Contrary to this, in India, which is a low-incidence country for CRCs, the incidence among all age groups including the young is rising. This study aimed at describing the clinico-demographic profile of young CRC cases and the epidemiological trend of the proportion of young cases from 2014 to 2021 in a tertiary cancer center in Eastern India.

Methods:

This retrospective observational study was conducted at Department of Radiation Oncology, State Cancer Institute, IGIMS Patna, India a prominent tertiary cancer care center of Bihar. All histopathologically confirmed CRC cases in the 0–39 years age group were considered young and evaluated for the clinical, demographic profile as well as yearly trends in proportion out of total CRC cases. Microsoft Excel (2021) was used for statistical analysis. A P value of 0.05 was considered significant.

Results:

Young colorectal (less than 40 years) patients constituted a third (n = 344, 33.4%) of total colorectal (n = 1028) cases. The median age among the young CRC cases was 30 years (range: 12 to 39 years). Rectum was the most common subsite noted (n = 255,74.1%) among this group of young patients. The most commonly encountered stage of the disease was III (n = 107, 31.1%) and chemotherapy was the most common treatment offered (n = 153, 44.5%). The proportion of young (0–39 years) CRC cases ranged between 29.4 and 37.4 (mean 33.5 ± 2.77, P value = 0.725) over the calendar years of the study period.

Conclusion:

The proportion of young (<40 years of age) cases out of total CRC cases in our study is higher than that in developed countries. However, the trends of this proportion have been consistent over the study period, i.e., from 2014 to 2021 without any significant change in our hospital-based cancer registry. Rectal cancer affected nearly three out of every four CRC patients in this age group. More advanced disease at presentation emphasizes the need for measures of screening, early diagnosis, and adequate infrastructure for treatment.
Differential methylation of DNA promoter sequences in peripheral blood mononuclear cells as promising diagnostic biomarkers for colorectal cancer
Authors: Mosallaei Meysam , Siri Goli , Alani Behrang , Khomartash Mehdi Shakouri , Naghoosi Hamed , Pourghazi Farzad , Heidari Reza , Sabet Mehrdad N. , Behroozi Javad
Published: June 2024

Objectives:

Previous reports have indicated that the methylation profile in peripheral blood mononuclear cells (PBMCs) in different genes and loci is altered in colorectal cancer (CRC). Regarding the high mortality rate and silent nature of CRC, screening and early detection can meaningfully reduce disease-related deaths. Therefore, for the first time, we aimed to evaluate the early non-invasive diagnosis of CRC via quantitative promoter methylation analysis of RUNX3 and RASSF1A genes in PBMCs.

Materials and Methods:

In the present study, we analyzed the methylation status of two important tumor suppressor genes including RUNX3 and RASSF1A in 70 CRC patients and 70 non-malignant subjects using methylation-quantification of endonuclease-resistant DNA (MethyQESD), and a bisulfite conversion-independent method.

Results:

RUNX3 was significantly hypermethylated in PBMCs of CRC patients compared to healthy controls (P < 0.001). By determining the efficient cutoff value, the sensitivity, and specificity of RUNX3 promoter methylation for CRC diagnosis reached 84.28% and 77.14%, respectively. The receiver operating characteristic (ROC) curve analyses demonstrated that RUNX3 promoter methylation has high accuracy (areas under the curve [AUC] = 0.840, P < 0.001) for discriminating CRC subjects from healthy individuals. Moreover, RUNX3 methylation levels in PBMCs progressively increased with the stage of the disease (P < 0.001). Although the amount of RASSF1A promoter methylation was not significantly different between CRC patients and controls as well as in different stages of the disease (P > 0.05).

Conclusion:

Our findings confirmed that PBMCs are reliable sources of methylation analysis for CRC screening, and RUNX3 promoter methylation can be used as a promising biomarker for early diagnosis of CRC.
Efficacy and safety of sorafenib in adult metastatic osteosarcoma patients
Authors: Dogan Izzet , Paksoy Nail , Basaran Mert
Published: June 2024

Background:

There are limited data on the efficacy of targeted therapy in metastatic osteosarcoma. The goal of this study was to assess the effectiveness of sorafenib in adult patients with heavily pretreated metastatic osteosarcoma.

Method:

Patients with metastatic osteosarcoma aged more than 18 years were assessed retrospectively. The patients’ clinical, pathological, and therapeutic data were collected. For survival analysis, Kaplan-Meier models were used.

Results:

The research involved 15 patients. The ratio of male and female patients was 2/1, with a median age of 25 years (range: 19-64 years). The most common primary tumor localization was the extremities (66.6%). Fourteen (93.3%) patients had previously received palliative chemotherapy and six (40%) patients had palliative radiotherapy. The median progression-free survival was found as 5.5 months (95% confidence interval, 1.3-9.7). A stable response was observed in seven (46.6%) patients and progressive disease in eight (53.4%) patients. Grade 1-2 toxicities were detected in 50% of the patients, while grade 3-4 toxicities were observed in 14.3% of the patients.

Conclusions:

We demonstrated real-life results of sorafenib for disease management in pretreated adult patients with metastatic osteosarcoma in the study. Sorafenib was effective for disease control and well tolerated in the patients. Sorafenib may be a treatment option for disease control after the disease progresses with chemotherapy in patients with metastatic osteosarcoma.
Histomorphologic analysis of ovarian tumors according to the New 2020 WHO classification of female genital tumors
Authors: Patel Nirali , Bavikar Rupali , Ingale Yaminy P.
Published: June 2024

Introduction:

In terms of female genital tract-related cancers, ovarian tumors account for 3% of all tumors. On the basis of gross, radiological, and clinical features alone, ovarian neoplasms cannot be diagnosed. Therefore, a clear histological diagnosis is necessary before beginning a permanent course of therapy.

Settings and Design:

Cross-sectional analytical study.

Material and Methods:

In this ambispective study, a total of 480 patients with ovarian tumors were included from January 2015 to July 2022 at a tertiary care center in western Maharashtra.

Statistical Analysis Used:

Descriptive statistics-percentages, mean, and Chi-square test (to calculate P value) were used to analyze the collected data.

Aim:

To determine clinical presentation, age distribution and incidence of various morphological and histological variants of ovarian tumors.

Results:

Out of 480, 250 cases (52%) in 41–50 years of age, followed by 154 cases (32%) in 21–30 years of age. Our study showed 301 cases of benign, 42 cases of borderline, and 137 cases of malignant neoplasms of ovary out of 480 cases studied. Out of 480 cases, 244 cases (50.83%) were cystic, 138 cases (28.75%) were solid, and 98 cases (20.42%) were mixed (cystic/solid). Out of 480 cases, 326 cases (67.91%) were surface epithelial ovarian neoplasms. In this research, most frequent ovarian neoplasms were serous tumors in 216 cases (45%) followed by mucinous tumors in 78 cases (16.25%). In 96% cases, clinical diagnosis matched with histopathological diagnosis.

Conclusion:

In our research, benign ovarian neoplasms were most frequent. Serous tumors were the most frequent type of surface epithelial neoplasms followed by mucinous tumors. Peak incidence was seen in fifth decade. Higher risk of malignancy was seen in nulliparity or low parity and early menarche not associated with risk of malignancy. Cystic morphology more common in benign neoplasms and complex or solid morphology showed greatest increase in incidence of malignancy. Latest WHO classification has important impact on prognosis and therapy of the patient.
Intrapleural nivolumab in cancer patients with pleural effusion
Authors: Tsimafeyeu Ilya , Goutnik Vadim , Shrainer Igor , Kosyrev Vladislav , Bondarenko Anastasia , Utyashev Igor
Published: June 2024

We assessed the preliminary efficacy and toxicity of intrapleural instillation of nivolumab in patients with large pleural effusion. Patients with metastatic cancers who have a large volume of pleural effusion and required evacuation were eligible. Thoracentesis followed by nivolumab (40 mg, single intrapleural instillation) was performed. The primary endpoint was 3-month recurrence-free survival. A total of 13 patients were enrolled. The study was terminated after stage 1 as no efficacy was observed; 7 patients (54%) had a recurrence of pleural effusion at 3 months. Thirteen (100%) patients had no recurrence, dyspnea, or cough within 1 month, and the median time to recurrence was 1.9 months (95% confidence interval [CI], 1.35–2.5). No adverse events were identified. We concluded that a single intrapleural instillation of the nivolumab at 40 mg was ineffective and well-tolerated in cancer patients with pleural effusion.
Comparison of imaging modalities for the accurate delineation of arteriovenous malformations (AVM) and evaluation of setup accuracy with reference to non-invasive LINAC-based stereotactic radiosurgery (SRS)
Authors: Sukumaran Anju K. , Raghavan Rajeev K. , Mathew Beela S. , Bhasi Saju , Koshi Sumod M. , Krishna KM Jagathnath
Published: June 2024

Aims:

To compare the accuracy of nidus delineation using magnetic resonance angiography (MRA) to digital subtraction angiography (DSA) and to evaluate setup accuracy of non-invasive frame SRS treatments.

Settings and Design:

A prospective observational study of 16 patients who underwent non-invasive frame LINAC-based SRS for brain AVMs.

Materials and Methods:

The nidus was separately delineated using DSA and MRA after co-registration onto CT simulation images and compared with respect to their volume and maximum diameters. During treatment, the setup errors observed in x-, y-, and z-directions were recorded.

Statistical Analysis:

Paired t-test (to compare volume and maximum diameter). Wilcoxon signed-rank test (for setup accuracy).

Results:

The mean volume of nidus contoured in MRA was 4.16 cc compared to 3.11 cc in DSA (P 0.297). The mean maximum diameters using MRA and DSA, respectively, in antro-posterior, cranio- caudal, and transverse diameters were 21.97 cc vs. 19.46 cc (P 0.2380), 6.59 cc vs. 9.63 cc (P 0.161), and 18.87 cc vs. 16.81 cc (P 0.178). But these modalities can potentially misinterpret the nidus volume, warranting caution for use of either modality alone. The mean translational shift observed in the x-, y-, and z-directions were 0.06 mm, 0.13 mm, and 0.13 mm, respectively, when couch was brought to neutral position after clockwise couch rotation and 0.07, 0, and 0, respectively, after counterclockwise couch rotation.

Conclusion:

This study could not demonstrate any statistically significant differences in nidus delineation between MRA and DSA. Setup accuracy achieved with non-invasive thermoplastic mask-based immobilization is within acceptable limits for SRS.
Effect of Dimethyl Sulfoxide Primer Application Before a Two-Step Etch-and-Rinse Adhesive on the Microtensile Bond Strength and Nanoleakage
Authors: Ismail Omar Abdelaziz , Hassanein Olfat Elsayed , Hafez Randa , Mamdouh Mai
Published: June 2024

Aims:

This study investigates the impact of low concentrations of dimethyl sulfoxide (DMSO) on the stability of the dentinal hybrid layer formed using a two-step etch-and-rinse adhesive.

Materials and Methods:

Midcoronal dentine surfaces of 21 extracted molars were etched and randomly recruited into the study groups. This experimental study involved extracting wisdom teeth, preserving them at 4°C in 0.9% sodium chloride with 0.02% sodium azide, sectioning and polishing them, and randomly assigning them to three groups (n = 7/group) for DMSO pretreatment (1% DMSO/water [H2O], 10% DMSO/H2O, or no treatment/controls) in preparation for microtensile bond strength assessment and the sectioned beams (0.9 mm2) where all were subjected to tension until fracture after storage for 24 h after soaking into artificial saliva for 12 months. In addition, nanoleakage assessment was conducted using scanning electron microscopy. The findings were computed statistically using analysis of variance and Tukey’s tests (α=0.05).

Results:

The results revealed that immediate bond strength had no significant difference between the three groups (P > 0.05). After aging, the control group showed diminished bond strengths less than that of intervention for 1 and 10% DMSO solutions (P < 0.05). Regarding nanoleakage, the aged control group showed the highest level of silver infiltration along the hybrid layer. Approximately, 10% of treatment with DMSO in the aged group showed significantly less nanoleakage compared with using a concentration of 1%.

Conclusions:

This study concludes that dentinal pretreatment using DMSO minimizes hybrid layer degradation and improves bond strength in adhesive restorations. It was also inferred that higher concentrations of DMSO may provide a better seal at the tooth–restoration interface within limits.
Hormonal Changes as the Risk Factor That Modified Periodontal Disease in Pregnant Women: A Systematic Review
Authors: Susanto Agus , Bawono Chandra Andi , Putri Sindi Septihani
Published: June 2024

Aims:

Periodontal disease is a condition characterized by a local infection and immune-inflammatory response involving the supporting tissues of the teeth. The main cause of periodontal disease is dysbiosis bacteria in dental plaque, which can be modified by risk factors, including hormonal changes during pregnancy, which cause various physical changes, including periodontium. This study aimed to review the influence of hormonal changes in pregnancy based on clinical findings and biological changes.

Materials and Methods:

This study was conducted in PubMed NCBI, Cochrane, ScienceDirect, EBSCOhost database, and web search engine Google Scholar using a systematic review method with Population, Intervention, Comparison, and Outcomes based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The inclusion criteria were articles in English from 2013 to 2023 that discussed the influence of hormone changes on periodontal tissues in pregnant women.

Results:

Articles that comply with the inclusion criteria of this study were nine articles. The study designs included cross-sectional, randomized control trials, and cohorts. Four articles observed the condition of periodontal tissues based on periodontal pocket depth (PPD) and clinical attachment loss (CAL), one article based on PPD only, and two articles based on plaque index. All of the nine articles observed the periodontal condition based on bleeding on probing. Eight out of nine included articles stated a positive correlation between hormone levels and the condition of periodontal tissues in pregnant women.

Conclusions:

The increase in hormone levels during pregnancy is the risk factor that can modify periodontal tissue conditions based on clinical findings, such as PPD and CAL, and also affects biological changes in the total number of biofilms and proinflammatory cytokines.