bluuebunny/crossref_metadata_2025 huggingface dataset:
Difference in target dose distributions between Acuros XB and collapsed cone convolution/superposition and the impact of the tumor locations in clinical cases of stereotactic ablative body radiotherapy for lung cancer
Authors: Inoue Keiki , Matsukawa Hideaki , Kasai Yuki , Edamitsu Kana , Matsumoto Kazuki , Suetsugu Yoshiki , Hirose Taka-aki , Fukunaga Jun-ichi , Shioyama Yoshiyuki , Sasaki Tomonari
Published: September 2023

Objectives:

The objective of the study is to analyze the difference in target dose distributions between Acuros XB (AXB) and collapsed cone convolution (CCC)/superposition and the impact of the tumor locations in clinical cases of stereotactic ablative body radiotherapy (SABR) for lung cancer.

Materials and Methods:

Ninety-six patients underwent SABR for lung cancers Kyushu University Hospital from 2014 to 2017. We recalculated clinical plans originally calculated by AXB using CCC with the identical monitor units (MUs) and beam arrangements. We calculated the following dosimetric parameters: maximum dose (Dmax), minimum dose (Dmin), homogeneity index (HI), conformity index (CI), and D95 of the planning target volume (PTV). We investigated the difference between the results of two calculations and examined the impact of tumor location. Moreover, we determined the target central dose using a thorax phantom and assessed the calculation accuracy of the two algorithms for each fraction.

Results:

CCC significantly overestimated the dose to PTV, compared to AXB (P < 0.05). The mean differences of Dmax, Dmin, and D95 were 1.17, 1.95, and 1.85 Gy, respectively. The mean differences of HI and CI were 0.02 and − 0.06. Dmin, HI, and D95 had significant correlations with the tumor location, and the difference was greater when the PTV was included the chest wall (P < 0.05). The discrepancy between the calculated and irradiated dose was 2.48% for CCC, whereas it was 0.14% for AXB.

Conclusions:

We demonstrated that CCC significantly overestimated the dose to PTV relative to AXB in clinical cases of lung SABR.
Simple and easily accessible prognostic markers in ewing sarcoma; neutrophil-lymphocyte ratio, neutrophil-platelet score and systemic-inflammation index
Authors: Bal Oznur , Acikgoz Yusuf , Yildiz Birol , Kos Fahriye T. , Algin Efnan , Dogan Mutlu
Published: September 2023

Background:

Inflammation markers are the new point of view in cancer due to increasing data on the interaction of immune system with tumor cells and their prognostic and predictive importance were found in many different types of solid tumors. Therefore, we aimed to evaluate the prognostic value of neutrophil-lymphocyte ratio (NLR), neutrophil-platelet score (NPS), and systemic inflammation index (SII) in Ewing sarcoma patients in which risk groups are still not clearly defined.

Methods and Results:

A total of 64 patients were evaluated retrospectively. Receiver operating characteristic analysis was performed to find cut-off values for NLR and SII. Survival analysis was calculated by using Kaplan–Meier method. Cox regression analysis was performed to determine prognostic factors such as age, stage, and neoadjuvant chemotherapy were statistically significant prognostic factors for OS in multivariate analysis. While patients with low NLR and SII had longer OS (P = 0.003 and P = 0.018), patients with high NPS score had shorter OS (67.7 vs 21.7 months, P = 0.001).

Conclusion:

Patients with lower NLR, NPS, and SII score have a better prognosis compared with those with higher NLR, NPS, and SII score and these simple parameters may be monitoring tools of the tumor microenvironment.
Expression of ER, PR, and HER-2 Neu and correlation with tumor markers in gall bladder carcinoma
Authors: Mani Rishit , Gupta Amit , Gupta Sweety , Goyal Bela , Mishra Rahul , Tandon Amoli , Sharma Oshin , Rohilla Kusum K , Kishore Sanjeev , Dhar Puneet
Published: September 2023

Background:

Females having a large proportion of gallbladder carcinoma (GBC) and a higher incidence of gallstones pointed toward the role of sex hormones in GBC development. In this study, we evaluated the expression of Estrogen receptor (ER), Progesterone receptor (PR), and Her2/neu and their correlation with tumor markers and clinicopathological parameters in the GBC.

Methods:

A total of 50 patients of GBC and 42 patients in control group undergoing surgery for other conditions were taken. The patient’s biopsy sample’s paraffin block was tested for ER, PR, and Her2/neu expression by immunohistochemistry.

Results:

ER and PR had no significant expression in GBC and control group, but Her2/neu had 16% expression in GBC, significantly associated with the degree of differentiation with 62.5% (n-5) being well-differentiated; 75% of Her2/neu positive were in stages III and IV. Her2/neu did not correlate with tumor markers despite expression.

Conclusions:

Her2/neu amplification is a small step in validating that option so it could be included in the treatment and prognostication of GBC.
Acylated ghrelin suppresses doxorubicin-induced testicular damage and improves sperm parameters in rats via activation of Nrf2 and mammalian target of rapamycin
Authors: Shati Ali A. , Khalil Mohammad A.
Published: September 2023

Background:

Exogenous administration of acylated ghrelin (AG) afforded reproductive protective effect in several animal models but not in those treated with doxorubicin (DOX). This study evaluated the protective effect of AG against DOX-induced testicular damage and impairment in sperm parameters in rats and examined the potential mechanisms of action.

Materials and Methods:

Adult male rats were divided into five groups (n = 8/each) as control, control + AG (40 nmol/kg/day; subcutaneous), DOX (10 mg/kg/day 1; intraperitoneal [i.p.]), DOX + AG, and DOX + AG + brusatol (an Nrf2 inhibitor) (2 mg/kg/every 3 days; i.p.). The treatment regimen continued for 65 days.

Results:

AG prevented testicular damage and apoptosis; increased sperm count, motility, and viability; and reduced the number of abnormal sperms. It also increased their circulatory levels of AG, des-acylated ghrelin (DAG), and AG/DAG ratio and the testicular mRNA levels of ghrelin and growth hormone secretagogue receptor 1a Concomitantly, AG increased serum and testicular testosterone levels, reduced serum levels of the follicle-stimulating hormone and luteinizing hormone, and upregulated the testicular protein levels of the steroidogenic acute regulatory protein and 3β-hydroxysteroid dehydrogenase in DOX-treated rats. In the testes of the control and DOX-treated rats, AG increased the phosphorylation of mammalian target of rapamycin and stimulated the levels of glutathione and superoxide dismutase, as well as the nuclear activation of Nrf2. All these effects were completely prevented by co-treatment with brusatol.

Conclusion:

AG replacement therapy could be a novel strategy to prevent reproductive toxicity in cancer patients.
Human osteosarcoma cells in response to ELF-MF: Morphological remodeling compared to cell proliferation
Authors: Shoorche Amin Barati , Mohammadkarim Alireza , Jadidi Majid , Bahraminasab Marjan , Bagheri Hamed , Gholami Somayeh
Published: September 2023

Purpose:

The present study aimed to assess the effects of extremely low-frequency electromagnetic fields (ELF-MF) on structural changes of human osteosarcoma cells by analyzing the stained cytoskeleton for assessing the relationship between the fractal dimension parameter and proliferation rate of radiation-induced cells.

Materials and Methods:

In this study, 2-mT magnetic fields with various waveforms, including sinusoidal, triangular, and pulsed shapes, were employed to determine the biological effects of ELF-EMF on the human osteosarcoma MG-63 cell line. All experiments were performed in two modes: continuous exposure at 3 h and fractionated irradiations at 3 consecutive days. Afterward, the proliferation assay was implemented for assessing the cell proliferation in each group. Moreover, immunofluorescence staining and confocal imaging were performed to determine the cell shape index. Furthermore, fractal dimension analysis was carried out by processing morphological images.

Results:

The proliferation and shape index parameters of radiation-induced osteosarcomas significantly decreased compared with non-irradiated cells. In addition, fractal dimensions significantly increased following fractionated exposure at 3 consecutive days.

Conclusions:

Assessing the fractal dimensions can be considered as a new morphological index for the prognosis of the structural remodeling of human osteosarcoma cells in response to fractionated irradiation of ELF-MF. In addition, various waveforms induce a similar effect on morphological remodeling and cell proliferation.
Retrospective comparison between definitive stereotactic body radiotherapy and radical surgery for 538 patients with early-stage non-small cell lung cancer in a single institution
Authors: Miki Yosuke , Yamashita Hideomi , Nakajima Jun , Karasaki Takahiro , Kitano Kentaro , Katano Atsuto , Takenaka Ryousuke , Ogita Mami , Sawayanagi Subaru , Minamitani Masanari , Jinnouchi Haruka , Noyama Tomoyuki , Takeuchi Kenta , Ishida Aki , Abe Osamu
Published: September 2023

Introduction:

Survival information for stereotactic body radiotherapy (SBRT) and surgery for stage I non–small cell lung cancer (NSCLC) was examined.

Methods:

Stage I NSCLC patients who underwent surgery or SBRT between 2012 and 2016 were retrospectively enrolled in this single-institution study. Using the Kaplan-–Meier method and Cox regression model, overall survival (OS) was estimated and compared.

Results:

Among 538 enrolled patients, compared to the surgery group (443), the SBRT group (95) had more complications (P = 0.01), worse performance status (P = 0.001), and were older (P < 0.001). Three-year OS was 70.5% post SBRT and 90.1% postsurgery. The 3-year cancer-specific survival (CSS) and disease-free survival (DFS) post SBRT and postsurgery were 92.7% vs. 92.3% and 61.1% vs 79.3%, respectively. Three-year locoregional and distant control rates post SBRT and postsurgery were 85.6% vs. 90.1% and 82.5% vs. 86.4%, respectively. Multivariate analysis using the Cox model, including age, T-stage, CCI, and C/T ratio and treatment, showed the surgery group’s OS to be significantly superior to that of the SBRT group (HR of SBRT per surgery: 1.90, 95%CI: 1.12–3.21, P = 0.017). No significant differences were observed in rates of adverse events.

Conclusion:

Although OS was better in the surgery group, no differences in CSS existed. This analysis suggests the need for future studies that compare specific radical surgeries and SBRT in a prospective and randomized setting.
Carcinoma cervix: A single institute experience from Kashmir, Northern India
Authors: Nasreen Shahida , Lone Aabid R. , Manzoor Arshad , Dar Showket A. , Banday Saquib Z. , Nuzhatu Nazia , Rasool Malik T. , Andleeb Asifa , Wani Shaqul Q. , Fatima Kaneez , Sofi Mushtaq A. , Hussain Shaiba , Dar Nazir Ahmad
Published: September 2023

Background:

Carcinoma cervix is the fourth most commonly diagnosed cancer worldwide, with an estimated 604,000 new cases and 342,000 deaths worldwide in 2020. Carcinoma cervix is an uncommon malignancy in Kashmir. In this retrospective study, we have tried to find clinicopathological characteristics of carcinoma cervix along with the survival rates at our tertiary care hospital.

Materials and Methods:

Case records of cervical cancer patients registered from January 1, 2015, to January 1, 2019, were retrieved. A total of 138 patients was registered. 22 had undergone surgery, and out of these 17 had received postoperative radiotherapy. 109 patients were treated with definitive chemoradiation and 13 with palliative radiotherapy. Descriptive statistics were used to summarize patient and treatment-related variables, and Kaplan–Meier analysis was performed for survival analysis.

Results:

A total of 138 cases that were registered from 2015 to 2019 were included in this study. The median age at the presentation was 56 years. Most of the patients had a performance status of 1 (98 patients (71.01)). Most of the patients 110 (79.71%) were married before 20 years of age, only 1 patient was unmarried, and 85 (61.59) patients were multiparous in our study group. Only 14 (10.14%) patients in our study group had a history of oral contraceptive use and most of them were non-smokers [124 (89.80%)]. Multiple marriages were present in 8 (5.79%) patients only. The most common presenting symptom was bleeding per vagina (78.26%), and the maximum number of patients fall in the post-menopausal group (67.39%). 116 patients had squamous cell carcinoma histology while 10 patients had adenocarcinoma histology. Most of the patients had stage II and stage III disease (85 patients). At last, follow up out of 138 patients 75 (54.35) were alive. 3 year disease-free survival was 54.34% and 3-year overall survival was 72.46%.

Conclusion:

Carcinoma cervix is an uncommon malignancy in Kashmir because of different socio-cultural and religious practices but the response to treatment, toxicity profile, and survival are similar to the rest of the world.
Copy number variations in male breast cancer
Authors: Kour Akeen , Sharma Sarika , Sambyal Vasudha , Guleria Kamlesh , Singh Neeti R. , Uppal Manjit S. , Manjari Mridu , Sudan Meena
Published: September 2023

Common copy number variations often contain cancer-related genes and are likely to play a role in carcinogenesis. Different mechanisms of tumorigenesis are suggested in female and male breast cancer because of different molecular profiles. The cytogenetic analysis of GTG-banded chromosomes was performed in six male patients with infiltrating ductal carcinoma and six healthy male controls matched for age. Single-nucleotide polymorphism (SNP) array analysis was performed in male breast cancer (MBC) patients. Cytogenetic analysis found aberrations previously implicated in cancer. SNP array analysis in patients revealed a gain of Xp11.23, 8p23.2, Yq11.221, Yq11.3 (AZF region), 12p11.21, 18q12.1, and 17q21.3; a loss of Yq11.222 and 7q11.21; and a loss of heterozygosity of 4p16.3, 6p12.3, 6p22.2-p21.31, 7p14.2-14.1, 18q11.2-q12.1, 20p11.23-11.1, 20q11.21-11.23, 1q25.2-q25.3, 2q11.1-q11.2, 5q23.1-23.2, 11p15.4-15.3, and 22q13.1-13.31. Some of these variations, especially those of the Y-chromosome, have not been reported earlier. Chromosomal loci identified by SNP array harbor genes were reported to be associated with cancer progression and metastasis, indicating their involvement in MBC also.
Role of squamous cell carcinoma antigen in prognostication, monitoring of treatment response, and surveillance of locally advanced cervical carcinoma
Authors: Tony Vinitha , Sathyamurthy Arvind , Ramireddy Jeba Karunya , Iswarya S. Janani , Gowri S Mahasampath , Thomas Anitha , Peedicayil Abraham , Ram Thomas Samuel
Published: September 2023

Introduction:

Squamous cell carcinoma antigen (SCC Ag) is a sub-fraction of the tumor antigen TA-4, first isolated by Kato and Torigoe, the most commonly used tumor marker in cervical cancer. It can be used as a serum marker to detect residual disease, early local recurrence, or distant metastasis in locally advanced cervical cancer even before the clinical symptoms of recurrence or metastasis.

Methods and Materials:

Between January 2018 and August 2018, 30 patients with squamous cell carcinoma cervix (FIGO) stages IB2-IVA, who received concurrent chemoradiation, followed by brachytherapy, were included in the study. Serum SCC Ag levels were collected at four time points during the course of the treatment, and their correlation with tumor and treatment factors were analyzed.

Results:

As the FIGO stage increases, mean pre-treatment SCC Ag also increases. Node-positive patients had higher pre-treatment SCC Ag as compared to those who were negative (P = 0.05). There was a statistically significant decreasing trend in the mean SCC Ag at the end of EBRT (P = 0.015). After completion of treatment, 78% had a complete response, 8% had a partial response, and 14% had progressive disease with statistically significant elevation of SCC Ag at 6 weeks of follow-up (P = 0.01). Patients who progressed or had the residual disease at follow-up were found to have high pre-treatment SCC Ag values.

Conclusion:

SCC Ag can be potentially used as a reference indicator of biological behavior of cervical cancer, to monitor the treatment response, and as a prognostic marker, especially in those with node-positive disease.
Primary cutaneous large B cell lymphoma masquerading as lupus vulgaris
Authors: Gupta Pooja , Shruti Sharma , Siraj Fouzia , Bhargava Aradhana , Khullar Geeti
Published: September 2023

Primary cutaneous large B cell lymphoma, leg type is a rare and aggressive variant of cutaneous B cell lymphoma. It predominantly affects elderly women, with the lower limb being the most common site of presentation. The overall prognosis is poor, compared to other cutaneous B cell lymphomas. A 47-year-old man presented with a progressively enlarging nodule over the medial aspect of the left foot since 2 months. Clinical examination revealed a nodular plaque-like lesion with central ulceration that measured 7 × 7 cm, firm in consistency, and with ill-defined margins. The initial clinical diagnosis was lupus vulgaris. An incision biopsy was done, which on histopathology and immunohistochemistry revealed a rare diagnosis of primary cutaneous B cell lymphoma, leg type. The patient was started on chemotherapy; however, he succumbed to his illness about 1 year after the initial presentation. It is a rare type of cutaneous lymphoma, which may masquerade infectious disorders such as lupus vulgaris. A detailed histopathological and immunohistochemical analysis is essential for its correct diagnosis and management. Only a handful of cases of this rare condition are reported to date. This case has been reported in view of its rarity and unusual clinical presentation.
A systematic review of Pilomatrix carcinoma arising from the previous scar site of Pilomatrixoma
Authors: Panda Sangram K. , Sahoo Pradyumna K. , Agarwala Sunil K. , Houghton T Tim , Sankar K Vikas , Mohanty Pranita
Published: September 2023

Pilomatrix carcinoma is a rare tumor arising from the hair follicle matrix cells most commonly seen in the head and neck region. Also known as “calcified epithelial carcinoma of Melherbe,” it was first reported in 1980 by Lopansri and Mihm. Since then till date to the best of our knowledge only around 125 cases were reported in literature, of which only 11 cases were reported to arise from histologically proven areas of previous pilomatrixoma which is the benign variant. One such case is being reported here along with the review of literature. A 50-year-old man presented with a swelling in the nape of his neck since 6 months, which was gradually increasing in size. He had a history of similar swelling at the same site 18 months back for which he underwent a surgery at a center outside. Final histopathology report was suggestive of pilomatrixoma with negative margin. Wide local excision of the tumor with 3 cm margin, placement of surgical clips followed by a primary closure was done. The final histopathology report is suggestive of pilomatrix carcinoma. The patient has no recurrence in 6 months follow-up. The differential diagnosis of pilomatrix carcinoma should be considered in cases of recurrent skin tumors. Wide local excision is the preferred treatment. Re-excision should be done in margin positive cases and cases where simple excision was done due to improper preoperative diagnosis. Due to the rarity of the disease, adjuvant treatment is not properly defined.
Spindle cell carcinoma in the trail of radiotherapy for oral squamous cell carcinoma: A quest for rationale
Authors: Rajalekshmi M. P. , Thankappan Prasanth , Joseph T. Isaac , Girish K. L.
Published: September 2023

Spindle cell carcinoma (SpCC) is a rare variant of oral squamous cell carcinoma (SCC) with unique clinicopathological characteristics, a high recurrence rate, and metastatic potential. It will be truly devastating when it occurs as a second wave in a cancer survivor. Despite the multidisciplinary approach in the management of oral SCC, the incidence of second malignancies or multiple carcinomas has been constantly reporting in the literature. Although radiotherapy has saved the lives of countless cancer patients, its several serious late effects are well-documented in the literature, making it a double-edged sword. Radiation epidemiology studies revealed an increased risk of developing radiogenic second cancers after 5 or more years. The purpose of this article is to document a case of SpCC arising in a patient after a span of 5 years who was previously diagnosed and treated with radiotherapy for well-differentiated SCC.
Neoadjuvant chemotherapy for locally advanced head and neck squamous cell carcinoma – Is it still relevant? A practice pattern survey among oncologists of India
Authors: Bandyopadhyay Anis , Goswami Uddiptya , Ghosh Poulomi , Das Priyanka , Mandal Srikrishna
Published: September 2023

Objectives:

Concurrent chemotherapy is the recommended treatment for locally advanced head and neck (H&N) squamous cell carcinoma, and neoadjuvant chemotherapy (NACT) is debated with a few special indications. NACT for advanced head and neck cancer has been studied in clinical trials for more than 2 decades without clear demonstration of the benefit for loco regional tumor control or overall patient survival. Its benefit remains controversial in the absence of clear evidence to define its role. However, there is widespread use of NACT among oncologists. We conducted an online survey to find out the frequency, pattern, prevalence, and aims for use of NACT in locally advanced head and neck cancers among radiation, medical, and surgical oncologists.

Materials and Methods:

Oncologists across India who expressed interest to participate in our survey were asked to complete a short online questionnaire designed to identify the current practice pattern of NACT in head and neck cancer. A mobile app-based questionnaire was sent to 200 oncologists across the country to assess the pattern of NACT use and to solicit their most frequent therapy approach for patients with locoregionally advanced head and neck cancer.

Results:

One hundred and fifty (150) oncologists completed and returned the survey (75%), and 130 were finalized (94 radiation oncologists, 19 medical oncologists, and 17 surgical oncologists). The single most common treatment approach reported for patients with locoregionally advanced H&N cancer was that of sequential chemoradiation (61%), specifically NACT with the TPF regimen (78.5%), followed by radiation therapy. The primary objectives cited by respondents for the use of NACT included the desire to buy time for definitive treatment (20%) and to achieve R0 resection (19.2%). Use of NACT in most patients was more preferred by medical oncologists (21.1%) and radiation oncologists (19.1%) than surgical oncologists (11.8%). Thus, there is not much difference in perception in practice of NACT in radiation, medical, and surgical oncologists. A minimum of two cycles of NACT was preferred by more than half of the doctors (55.4%) with 59.6% radiation oncologists using it before further assessment.

Conclusion:

Although level I evidence for inferior outcomes with NACT as compared to concurrent chemoradiation therapy is there, the use of NACT is quite common among various oncologists in the country because of reasons such as buying time for definitive treatment, achieving R0 resection, better outcome and survival, partial response, better tolerability, better distant control, LN size regression, down-staging of primary tumor, selection of chemosensitive patients, reducing the volume of the radiation field, and better tolerability of subsequent Chemoradiation (CTRT) intensity of subsequent chemoradiation therapy.
Smoking cessation through nicotine replacement therapy for patients visiting the Dental College, Pune – A quasi-experimental study
Authors: Mukadam Ajinkya , Shetiya Sahana H.
Published: September 2023

Background and Aim:

Smoking leads to a very unhealthy lifestyle and has many deleterious effects on the body and surroundings. Studies have indicated that aiding contemplating smokers using behavior counseling and nicotine replacement therapy has shown positive results for abstaining from the habit. We aimed to assess and carry out smoking cessation for smokers using behavioral counseling, motivational interviewing, and nicotine replacement therapy (NRT) and assess their carbon monoxide (CO) cutoff level, Fagerstrom nicotine dependence test (FTND) scoring, and transtheoretical model (TTM) of change at baseline and 6 months, along with abstinence from the habit.

Materials and Methods:

CO cutoff, FTND scoring, and TTM of change were assessed at baseline and 6 months for smokers. Behavioral counseling with motivational interviewing was provided to the participants on the day of recruitment, and baseline data were recorded. All smokers included in the study were in the precontemplation and contemplation stages to quit smoking. Based on the frequency of smoking, NRT was prescribed to them in the form of a patch (21, 14, or 7 mg), only gums (2 mg), or a combination of both. Counseling was provided telephonically every month for 6 months. Urine cotinine assessment was carried out to verify the self-reported smoking status of the participants at the sixth month.

Results:

The CO cutoff, FTND scoring, and TTM of change showed statistically significant difference from baseline to the sixth month. Also, 20% (confidence interval [CI] 0.10–0.33) of participants who abstained from the habit were in the action and maintenance stages of change. Among 20% of participants, 16% (CI 0.10–0.36) of participants self-reported quitting within 6 months using combination therapy. Two percent (CI 0.00–0.40) each abstained by using nicotine gums and combination therapy of patch and gums, which was validated through urine cotinine.

Conclusion:

The cotinine test provided negative results, confirming the self-reported abstinence of 20% of participants, who were mostly male students and professionals in the age group of 20–40 years and those who used NRT. Nicotine patches provided the highest point prevalence of abstinence compared to gums and combination therapy.
Can combined non-invasive methods improve diagnosis of lung cancer?
Authors: Mohapatra Madhusmita Mohanty , Rajaram Manju , Gochhait Debasis , Kumar Saka Vinod , Chakkalakkoombil Sunitha Vellathussery
Published: September 2023

Background:

Lung cancer is the most common malignancy in both gender. Early diagnosis is needed to reduce morbidity and mortality. There is a debate about the most accurate investigating modality for the diagnosis of lung cancer.

Methods:

It is a retrospective cohort analysis to determine whether an approach of combined contrast-enhanced computed tomography (CECT) thorax with bronchoscopy method has higher sensitivity and specificity than combined CECT thorax with sputum cytology method. Records of patients with lung cancer who had visited the hospital within the last 6 months were retrospectively analyzed for their diagnostic modality. SPSS version 19 software was used for statistical analysis of the data. CECT scan thorax, bronchoscopy, and sputum cytology for lung cancer patients were analyzed. The CECT thorax plus bronchoscopy method was compared with the CECT thorax plus sputum cytology method. Their sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in diagnosing lung cancer were analyzed.

Results:

Sixty-two patients were considered, including 62.9% males with a mean age of 55.5 years. In patients diagnosed with lung cancer, CECT thorax combined with bronchoscopy method was found to have a sensitivity of 96.67% than CECT thorax combined with sputum cytology method with a sensitivity of 90% and the difference in sensitivity between all individual approaches as well as the combined method was statistically significant with a P = 0.00001 and Chi-square value of 86.5909 owing to the low sensitivity of sputum cytology. CECT thorax combined with sputum cytology approach had a better specificity than CECT thorax combined with bronchoscopy.

Conclusion:

Combined CECT thorax with sputum cytology method has a better specificity in diagnosing lung cancer than combined CECT thorax with bronchoscopy method.
Computer-aided Diagnosis of Polyp Classification Using Scale Invariant Features and Extreme Gradient Boosting
Authors: Don S.
Published: September 2023

Aims:

Analysis of colonoscopy images is an important diagnostic procedure in the identification of colorectal cancer. It has been observed that owing to advancements in technology, numerous machine-learning models now excel in the analysis of colorectal polyps classification. This work focused on developing a framework that can classify polyps using images during colonoscopy.

Materials and Methods:

First, the images were corrected by removing their spectral reflection. Second, feature pools were obtained by applying Radon transform (θ=45, 90, 135, and 180). From the Radon transform, fractal dimension was calculated as a feature vector combined with Zernike moment obtained from the Zernike features. Finally, Extreme Gradient Boosting (XGBoost) algorithm was applied for the classification and to compare it with state-of-the-art methods.

Results:

The experimental results obtained with the proposed framework have been reported, cross-validated, and discussed. The proposed method gives a classification accuracy of 93% for light XGBoost and 92% for XGBoost.

Conclusion:

This study shows that by applying scale invariant features over a small dataset, XGBoost outperforms state-of-the-art methods when it comes to polyp classification.
Planning System-dependent Recommendations of Intensity-modulated Technique for Breast Radiotherapy: A Literature Review-based Adaptation and Institutional Dosimetric Experience from a Large-volume Tertiary Cancer Care Hospital
Authors: Sarkar Biplab , Pradhan Anirudh
Published: September 2023

This article aims to identify, through a literature review, the best intensity-modulated technique (IMRT)/volumetric-modulated arc therapy (VMAT) for the breast/chest wall (Br/CW) as a function of the treatment planning system (TPS) and present the institutional dosimetric data for the same. A PubMed search was conducted following intensity-modulated irradiation techniques (IMRT) presented in the study: field-in-field (FiF), tangential IMRT (t-IMRT), multi-field IMRT, tangential VMAT (t-VMAT), half-arc VMAT (HA-VMAT), and large arc VMAT (LA-VMAT). The literature with at least one arm VMAT is included in this study. A total of 370 articles were identified between 2010 and 2022, out of which 19 articles were found to be unique. These articles were classified in terms of the TPS used: Eclipse (9), Monaco (6), RayStation (2), Pinnacle (1), and one unidentified TPS. Based on the literature review, dosimetric attributes, and second cancer risk analysis (SCRA), t-IMRT was found to be the most preferable technique in Eclipse, Pinnacle, and RayStation TPS. However, for Monaco TPS, t-VMAT (approximately 30° tangential arc) offers better dose coverage with lower organ-at-risk (OAR) doses. In terms of OAR doses and SCRA, LA-VMAT (≥210°) and HA-VMAT (180°) are avoidable techniques in any TPS, and FiF should be preferred over these two techniques. In our present institution, which uses the Eclipse TPS, data for 300 patients treated with t-IMRT were collected. The data included beam angle, monitor unit [MU], target coverage (D95% and V105% [cc]), and analysis of the maximum (%), and mean dose (%) of the OAR. t-IMRT utilizes two medial and three lateral tangential beams placed at a spread of approximately 10° and 20°, respectively. The results showed a D95% of 96.3 ± 1.2% and a V105% of 4.9 ± 7.0 cc. The mean doses to the heart and ipsilateral lung were 10.1 ± 20.9% and 11.4 ± 10.2%, respectively. The mean MU was 1282.7 ± 453.4. Based on the findings, the most preferred intensity-modulated technique for Eclipse, Pinnacle, and RayStation is t-IMRT, while for Monaco, it is t-VMAT. The data from the Eclipse planning system demonstrate a satisfactory dosimetric outcome for t-IMRT. However, the use of VMAT techniques employing an arc angle between 180° and 210° or higher is strongly discouraged.
Development of Prediction Model for Mean Parotid Dose of HNC Undergoing Radiotherapy - A Single Institutional Study
Authors: Bera Soumen , Choudhury Dipika , Roy Sanjoy , Mukhopadhyay Partha , Sarkar Sandip
Published: September 2023

Aim:

The aim of the study was to develop a simple prediction model based on previous treatment plans for head-and-neck cancer (HNC).

Materials and Methods:

This study was conducted on 95 patients who underwent volumetric-modulated arc therapy (VMAT) with curative intent for HNC at our institute between January 2016 and December 2022 with intact bilateral parotid glands. Two simple prediction models were used: one linear regression model and one exponential model. Both models use fractional overlapping parotid volume with planning target volume (PTV) as a predictor of mean parotid dose. The fractional overlapping volume was calculated as the difference between the volume of the parotid gland minus the volume of the parotid gland outside the PTV plus a 2 mm margin, divided by the volume of the parotid gland. Statistical calculations were done using data analysis tools and Solver in Microsoft Excel (Microsoft Office 2013, Redmond, WA, USA). To enhance the accuracy of the results, outliers were excluded with residuals >2 standard deviations below and above the residuals. R
2 and root-mean-square error were calculated for both models to evaluate the quality of the predictions. The normality of both models’ residuals was validated using the Shapiro–Wilk test.

Results:

Both linear and exponential prediction models exhibited strong correlation statistics, with r
2 = 0.85 and 0.82, respectively. The authors found a fractional overlap of 16.4% and 18.9% in linear and exponential models that predict parotid mean dose 26 Gy. The implementation was carried out on a cohort of 12 prospective patients, demonstrating a remarkable improvement in minimizing the dose to the parotid glands.

Conclusion:

In this single-institutional study, the authors successfully developed a prediction model for mean parotid dose in HNC patients undergoing radiotherapy. The model showed promising accuracy and has the potential to assist planners in optimizing treatment plans and minimizing radiation-related toxicity. It is possible to avoid under sparing the organs at risks in some cases and wasting time or effort on physically impossible goals in others using this prediction model. As a result, planning resources can be used much more efficiently. Future studies should focus on validating the model’s performance using external datasets and exploring its integration into clinical practice.
Effects of pneumoperitoneum and Trendelenburg position on intracranial pressure and cerebral blood flow assessed using transcranial doppler: A prospective observational study
Authors: Joseph Anu , Theerth Kaushic A. , Karipparambath Vinodan , Palliyil Aruna
Published: September 2023

Background and Aims:

Laparoscopic lower abdominal surgeries involve carbon dioxide (CO2) insufflation and Trendelenburg position. The raised intra-abdominal pressure can increase intracranial pressure (ICP) and alter cerebral blood flow. This study was conducted to determine the effect of pneumoperitoneum and Trendelenburg position on ICP and cerebral perfusion pressure (CPP) measured using transcranial Doppler (TCD)

Material and Methods:

A prospective observational study was conducted in 43 patients of either sex, aged between 18 and 60 years with American Society of Anesthesiologists physical status I and II, undergoing elective laparoscopic surgery in Trendelenburg position. After standard anesthesia induction, pneumoperitoneum was created to facilitate surgery, maintaining an intra-abdominal pressure of 10–15 mmHg and Trendelenburg position of 25°–30°. End-tidal carbon dioxide (EtCO2) was maintained between 30 and 35 mmHg. The ICP was assessed non-invasively using TCD-based diastolic flow velocities (FVd) and pulsatility index (PI) of middle cerebral artery. Data was represented as mean ± standard deviation and compared using paired t test. A P value of < 0.05 was considered significant.

Results:

Mean ICPPI at baseline was 14.02 ± 0.89 mmHg which increased to 14.54 ± 1.21 mmHg at pneumoperitoneum and Trendelenburg position (P = 0.005). Mean ICPFVd at baseline was 6.25 ± 2.47 mmHg which increased to 8.64 ± 3.79 mmHg at pneumoperitoneum and Trendelenburg position (P < 0.001). There was no statistically significant change in the CPP or mean arterial pressure values intraoperatively.

Conclusions:

Laparoscopic procedures with CO2 pneumoperitoneum in Trendelenburg position increase ICP as measured using TCD ultrasonography. The CPP was not significantly altered when EtCO2 was maintained in the range of 30–35 mmHg.
Management of Tolosa-Hunt syndrome with Ayurveda therapeutic measures and interventions
Authors: Parameswaran Sreekala N. , Kumar Aravind , Sukumaran Krishnendu , Varma Kavya R.
Published: September 2023

BACKGROUND:

Tolosa-Hunt syndrome (THS) is a rare disorder characterized by episodic periorbital pain associated with paralysis of either one or more of the III, IV, or VI cranial nerves. It is usually self-resolving, but relapse may be seen. In Ayurveda, a clinical condition “Vatahata Vartma” is narrated, resembling THS. Based on the resemblance, a diagnosed case of THS was treated by Ayurveda measures and treatment described for the management of Vatahata Vartma.

MATERIALS AND METHODS:

A 50-year-old man, who was previously diagnosed and underwent treatment for THS, presented with complaints of increased drooping and swelling at his left upper eyelid along with strenuous eyeball movements since February 2021. Drooping of the eyelids was measured by the amount of ptosis, margin-reflex distance, and the function of the levator palpebrae superioris. The patient was treated with Ayurveda oral medicines (herbal decoctions, herbal clarified butter, herbal powders, and herbal tablets), biopurification (therapeutic purgation and retention of medicine in the buccal cavity), and external Ayurveda ocular therapy (ocular irrigation, bolus sudation, eye drops, herbal paste over the eyelids, retention of herbal clarified butter over the eyes, collyrium, paste over the head, and irrigation over the head). The total duration of therapy was 11 months.

RESULTS:

Swelling and ptosis of the left upper eyelid were reduced, and the patient could do the normal movement of the left upper eyelid.

CONCLUSION:

THS can be treated with Ayurveda measures and interventions narrated in Ayurveda under Vatahata Vartma. A clinical study on large sample size is required to validate the result obtained in the present case study.
Efficacy and safety of Ayush AGT gel-based cream in superficial external wounds
Authors: Rai Amit K. , Khanduri Shruti , Goel Sumeet , Thugutla Maheshwar , Panigrahi Hemanta K. , Sai Prasad Avvaru J. , Avhad Anil , Singhal Richa , Rana Rakesh , Chandrasekhararao Bhogavalli , Srikanth Narayanam
Published: September 2023

BACKGROUND:

Traditional medicine has been extensively used to manage skin wounds since ancient times. Central Council for Research in Ayurvedic Sciences has developed a coded herbal formulation, Ayush AGT gel-based cream, through a systematic drug development process for managing superficial skin wounds.

OBJECTIVE:

This clinical study is designed to determine the clinical efficacy and safety of Ayush AGT gel-based cream in healing superficial external wounds.

MATERIALS AND METHODS:

This open-label, multicenter, prospective, interventional single-arm trial is being conducted at three peripheral institutes of the Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Government of India viz. Central Ayurveda Research Institute, New Delhi, and Regional Ayurveda Research Institutes at Ahmedabad and Vijayawada, India. A total of 30 participants will be enrolled in the study from each of the three study sites. Patients of any sex aged 18–60 years with superficial external wounds requiring dressing and solitary wounds not less than 2.5 cm in diameter will be considered for enrollment in the study. The enrolled participants will be managed by the topical application of Ayush AGT gel-based cream on the wound bed once daily, followed by bandaging with the sterile material for four weeks. The outcome measures are time to complete re-epithelialization of the wound, incidence of wound infection, pain during the change of dressing (assessed through visual analog scale), incidence of blistering, and adverse events.

DISCUSSION:

Ayurveda interventions have been found effective in wound healing in routine clinical practice as well as in published experimental and clinical studies. Ethno-medicine practices also utilize different medicinal plants to manage skin wounds. Several patents on herbal interventions for wound healing have also been granted. However, clinical research to explore the standard wound management for superficial external wounds is not common. So, it is expected that the outcomes of this study will provide a significant lead in the search for safe and effective management options for skin wounds.
Prophylactic effect of Ayurveda interventions in prevention of COVID 19 in selected containment zones of Delhi
Authors: Rao BCS , Yadav Babita , Sharma MM , Jameela Sophia , Rana Rakesh Kumar , Singhal Richa , Sharma Bhagwan Sahai , Khanduri Shruti , Makhija Deepa , Gupta Bharti , Kumar Adarsh , N Srikanth , Dhiman Kartar Singh
Published: September 2023

BACKGROUND:

The exponential rise of cases and associated morbidity and mortality has managed to make COVID-19 a serious threat. Minimising the transmission of disease by prevention and control strategy forms the core-pillar of response. Ayurveda with its holistic approach can potentially promote disease prophylaxis both at the individual as well as community levels. This clinical study was executed in a community set-up to explore the potential of Ayurvedic interventions in COVID-19 prophylaxis.

MATERIALS AND METHODS:

The study was conducted as an open label community based study in six selected containment zones of Delhi on 9200 individuals with an objective to record the incidence of COVID-19 in these areas. The selected Ayurvedic Interventions (Ashwagandha, Maha Sudarshan Ghan Vati, Samshamani Vati) were distributed in the dose of two tablets of 250 mg each twice daily after food with lukewarm water for a period of one month. Onset of any COVID-19 related clinical symptoms, patient satisfaction in general health parameters and incidence of ADR/AE were taken as outcome measures.

RESULTS:

9010 participants were recruited with mean age of 37.9 years. A total of 12 participants (0.17%) were reported positive during the intervention period, among 279 who underwent testing (because of contact tracing or symptoms). Participants who were devoid of any symptoms throughout the trial period were 98.8%. Statistically significant improvement was observed in parameters of general well-being at the end of study period.

CONCLUSION:

Ayurveda interventions demonstrated potential as a safe prophylactic measure against COVID 19 with comparatively good compliance and minimal adverse effects.
Effect of Ayurveda interventions in the management of venous stasis dermatitis in a patient with type 2 diabetes: A case report
Authors: Chandrasekharan Chandini , Bhat Sulochana , Kannan Amulya , Jenu Anagha
Published: September 2023

BACKGROUND:

Venous insufficiency disorder associated with diabetes is a concerning condition. It can result in venous stasis dermatitis, also known as stasis eczema, characterized by inflammatory changes in the lower extremities. A similar condition is described in Ayurveda as Vatarakta, which can present as Kushtasamalakshanas (early symptoms resembling skin disorders) in the lower limbs due to vitiated Vata (bodily humor) and Rakta Dhatu (blood tissue). Ayurvedic intervention promises successful results through both Shodhana (detoxification) and Shamana (pacifying/palliative) treatment along the line of management in Vatarakta disease. Managing such problems in diabetes patients must be well-planned to prevent rising blood sugar levels. Therefore, venous stasis dermatitis in diabetic individuals can be effectively treated with Shamana (pacifying therapy) combined with Sadyovirechana (therapeutic purgation without prior administration of medicinal oil/ghee).

PATIENT INFORMATION:

A 54-year-old woman with type 2 diabetes mellitus approached for the Ayurvedic management of inflammatory changes on her right lower leg. She complained of hyperpigmentation, swelling, aching pain, dryness, and severe itching of the right lower leg along the medial aspect of the ankle and foot for 6 months.

DIAGNOSIS:

According to CEAP (clinical, etiological, anatomical, and pathophysiological) classification, this clinical condition was identified as venous stasis dermatitis with C4a Ep AP PO (changes in skin and subcutaneous tissues in the form of pigmentation/eczema, primary, perforating veins, obstruction, respectively). Before beginning Ayurvedic treatment, an assessment using the revised venous clinical severity score (RVCSS) revealed a score of 7.

INTERVENTIONS:

Vatashaamaka-Raktadushtihara treatment (therapy that pacifies vitiated bodily humor and purifies vitiated blood tissue) was provided to the patient for 60 days which included Deepana-Pachana (digestive and metabolism-enhancing therapy) followed by Sadyovirechana (therapeutic purgation without prior administration of medicated oil/ghee) using Nimbamritadi Eranda Tailam and Samana Treatment (pacifying therapy) including local application of Nalpamaradi Kera Tailam.

OUTCOME:

After 60 days of treatment, there was a noticeable improvement in all symptoms except varicosity, and the RVCSS dropped from 7 to 3.

CONCLUSION:

Even though treating venous insufficiency issues in diabetic individuals may be challenging, a well-planned Ayurvedic therapy regimen that includes Sadyosodhana (therapeutic purgation without prior administration of medicinal oil/ghee) and Shamanatreatment (pacifying therapy) can have excellent results and offer hope for the treatment of several disorders associated with diabetes.
Scope and implementation strategies to streamline medical pluralism in the contemporary healthcare system
Authors: Pattanshetty Sanjay , Venkatesh Maddur D.
Published: September 2023

Medical pluralism in the healthcare system can play a significant role in achieving desired health outcomes. Harnessing the capacity and competency of diverse human resources, effective utilization of available healthcare infrastructure, international cooperation, leveraging partnerships among public and private healthcare sectors in health services, and research and development are key strategies to develop and explore further. Following the guidelines and recommendations of the World Health Organization, traditional medicine strategy can be helpful to translate and contextualize the implementation strategies to streamline medical pluralism in the current healthcare system.