bluuebunny/crossref_metadata_2025 huggingface dataset:
The composition of INFL
Authors: Ritter Elizabeth , Wiltschko Martina
Published: July 2014

The central goal of this article is to argue that functional categories are universally associated with a core function but that their substantive content is subject to variation. We review evidence from Ritter and Wiltschko (2009) based on language variation: INFL may be associated with temporal, spatial, or participant marking. This paper explores the properties of the universal category INFL in clauses where it remains without substantive content. We show that languages pattern in similar ways in these contexts. That is, in the absence of variable substantive content, the universal formal properties of INFL emerge.
Outpatient Surgery as a Means of Cost Reduction in Total Hip Arthroplasty: A Case-Control Study
Authors: Aynardi Michael , Post Zachary , Ong Alvin , Orozco Fabio , Sukin Dean C.
Published: July 2014

Background

The current healthcare market coupled with expedited recovery and improvements in analgesia have led to the development of total hip arthroplasty being performed as an outpatient procedure in selected patients.

Questions/Purposes

The purpose of this study is to compare outcomes and cost-effectiveness of traditional inpatient THA with outpatient hip replacement at the same facility.

Patients and Methods

This observational, case-control study was conducted from 2008 to 2011. One hundred nineteen patients underwent outpatient THA through a direct anterior approach. These cases were all performed by a single surgeon. Outpatient cases were then compared to inpatient hospital controls performed by the same surgeon at the inpatient hospital facility.

Results

Complications, length of stay, demographic data, and overall costs were compared between groups. There was no difference in complications or estimated blood loss between groups. Most notably, the average overall cost in the outpatient setting was significantly lower than inpatient, $24,529 versus $31,327 ( p = 0.0001).

Conclusions

This study demonstrates that appropriately selected patients can undergo THA in an outpatient setting with no increase in complications and at a substantial savings to the healthcare system.
Selective hypertrophy of the lobus caudatus as a novel approach enabling extended right hepatectomy in the presence of a non-perfused left lateral liver lobe
Authors: Atanasov Georgi , Schmelzle Moritz , Thelen Armin , Wiltberger Georg , Hau Hans-Michael , Krenzien Felix , Petersen Tim-Ole , Moche Michael , Jonas Sven
Published: July 2014

Introduction

Portal vein embolization (PVE) is a well-established technique to enhance functional hepatic reserves of segments II and III before curative extended right hepatectomy for tumors of the right liver lobe. However, an adequate hepatopetal flow of the left lateral portal vein branches is required for a sufficient PVE-associated hypertrophy.

Case report

Here, we report a 65-year old patient suffering from a locally advanced intrahepatic cholangiocarcinoma in the right liver lobe and segment IV. A curative extended right hepatectomy after preoperative PVE of liver segments IV–VIII was initially impossible because of partial thrombosis of the left lateral portal vein branches resulting in an ischemic-type atrophy of segments II and III. However, due to a massive hypertrophy of the caudate lobe following PVE of liver segments IV–VIII, subsequent extended right hepatectomy with intraoperative thrombectomy of segments II and III was made possible.

Conclusions

To our knowledge this is the first case in which an extended right hepatectomy for a liver malignancy, in the presence of atrophic left lateral section, was made possible by a massive PVE-associated hypertrophy of the caudate lobe.
Coeval Felsic and Mafic Magmas in Neoarchean Calc-alkaline Magmatic Arcs, Dharwar Craton, Southern India: Field and Petrographic Evidence from Mafic to Hybrid Magmatic Enclaves and Synplutonic Mafic Dykes
Authors: Jayananda M. , Gireesh R. V. , Sekhamo Kowete-U , Miyazaki T.
Published: July 2014

We present field and petrographic data on Mafic Magmatic Enclaves (MME), hybrid enclaves and synplutonic mafic dykes in the calc-alkaline granitoid plutons from the Dharwar craton to characterize coeval felsic and mafic magmas including interaction of mafic and felsic magmas. The composite host granitoids comprise of voluminous juvenile intrusive facies and minor anatectic facies. MME, hybrid enclaves and synplutonic mafic dykes are common but more abundant along the marginal zone of individual plutons. Circular to ellipsoidal MME are fine to medium grained with occasional chilled margins and frequently contain small alkali feldspar xenocrysts incorporated from host. Hybrid magmatic enclaves are intermediate in composition showing sharp to diffused contacts with adjoining host. Spectacular synplutonic mafic dykes commonly occur as fragmented dykes with necking and back veining. Similar magmatic textures of mafic rocks and their felsic host together with cuspate contacts, magmatic flow structures, mixing, mingling and hybridization suggest their coeval nature. Petrographic evidences such as disequilibrium assemblages, resorption, quartz ocelli, rapakivi-like texture and poikilitically enclosed alkali feldspar in amphibole and plagioclase suggest interaction, mixing/mingling of mafic and felsic magmas. Combined field and petrographic evidences reveal convection and divergent flow in the host magma chamber following the introduction of mafic magmas. Mixing occurs when mafic magma is introduced into host felsic magma before initiation of crystallization leading to formation of hybrid magma under the influence of convection. On the other hand when mafic magmas inject into host magma containing 30-40% crystals, the viscosities of the two magmas are sufficiently different to permit mixing but permit only mingling. Finally, if the mafic magmas are injected when felsic host was largely crystallized (∼70% or more crystals), they fill early fractures and interact with the last residual liquids locally resulting in fragmented dykes. The latent heat associated with these mafic injections probably cause reversal of crystallization of adjoining host in magma chamber resulting in back veining in synplutonic mafic dykes. Our field data suggest that substantial volume of mafic magmas were injected into host magma chamber during different stages of crystallization. The origin of mafic magmas may be attributed to decompression melting of mantle associated with development of mantle scale fractures as a consequence of crystallization of voluminous felsic magmas in magma chambers at deep crustal levels.
Low Cost Quantitative Arsenic Determination Kit: A Method by Using Silver Nitrate
Authors: Kar S. , Majumdar R. K. , Chaudhuri M. K.
Published: July 2014

Arsenic sometimes found in ground water which has adverse effect on human health at levels as low as 10µg/ L. Arsenic is known to be one of the most toxic element that cannot be destroyed once it has entered to the environment. It is a dangerous poison at high doses but can cure diseases such as syphilis and leukaemia at low doses. The present study comprises a low cost technique for determination of arsenic concentration in groundwater up to 1000µg/L. The method is based on the reaction of arsenic (V) with potassium iodide and stannous chloride in concentrated hydrochloric acid medium to convert to arsenic (III) and needs 15 to 20 minutes time for complete conversion. After reaction with the granulated zinc (arsenic free), the evolved arsine gas is passed through wet cotton wool of lead acetate for absorbing any sulphide impurities and is finally absorbed by wet filter paper of silver nitrate which gives brown colour. The intensity of the colour varies with respect to the arsenic concentration present in ground water. A master colour chart is prepared by the known arsenic standard solution from 0 to 1000 µg/L for measuring the concentration range of arsenic in contaminated ground water. The quantitative arsenic determination is done with the help of colorimetric study. The absorbed colour of filter paper is thoroughly scanned and Red, Green and Blue (R-G-B) values are obtained by colour picking technique with the help of the software ‘Microsoft Paint’ under the operating system ‘Microsoft Windows 7’. The known arsenic concentrations are plotted against the R-G-B values of the corresponding absorbed colour and three master curves are drawn by the software ‘Mat lab’ for measuring the exact concentration of arsenic in groundwater. For validation, arsenic contamination test is conducted for the ground water samples collected from different areas of 24 Parganas district using our very low cost kit and other costly instruments like Digital Arsenator and Atomic Absorption Spectrometer.
Palynological Investigation of Neogene (Early Miocene) Sediments of Mangalore Basin, India: Palaeoenvironmental and Palaeoclimatic Implications
Authors: Rao M. R. , Verma Poonam
Published: July 2014

A rich palynological assemblage consisting of algal remains (5 genera and 7 species, including dinoflagellate cysts), fungal spores (2 genera and 3 species), pteridophytic spores (5 genera and 8 species), gymnospermous pollen grains (3 genera and 3 species) and angiospermous pollen grains (17 genera and 22 species) has been recorded for the first time from the Miocene sediments exposed along Kullur-Kavur road, near Mangalore along the west coast of Karnataka. Among the important genera are: Achomosphaera, Leptodinium, Staphlosporonites, Hammenisporis, Polypodiaceaesporites, Quilonipollenites, Myricipites, Graminidites, Malvacearumpollis, Palaeomalvaceaepollis and Chenopodipollis. Qualitative and quantitative analyses reveal that the angiosperm pollen grains are dominant over pteridophytic spores and an overall, a warm and humid tropical-sub-tropical coastal climate with heavy precipitation is suggested for the site of deposition. The sediments were deposited in fluctuating conditions ranging from lacustrine to marine environments with fresh water swamps and ponds nearby. The occurrence of Hammenisporis, Polypodiaceaesporites, Quilonipollenites, Myricipites, Graminidites, Malvacearumpollis, Palaeomalvaceaepollis and Chenopodipollis in the present assemblage suggests an early Miocene age. A comparison of the present palynofloral assemblage with those known from the Indian Tertiary sediments shows its close resemblances with the Miocene palynoflora recovered from Quilon and Warkalli beds of Kerala basin.
A Grain Size Model for Role of Tectonics and Climate on Sedimentation in Siwaliks in Mohand Area
Authors: Mishra Manas , Chakrapani G. J.
Published: July 2014

The physical characteristics of sedimentary record are governed largely by grain size distribution in Mohand area where Middle and Upper Siwalik successions are investigated to characterize the sediments deposited in response to the prevailing tectonic activities and climatic conditions. Here we show with the help of cluster analysis that precipitation and tectonic perturbations generate characteristic patterns of grain sizes and stratigraphic succession. Previous studies suggested an increase in precipitation represented by the abrupt accumulation of sediments to foreland Siwalik basin around 11 to 10 Ma. First appearance of diagnostic minerals of the Great Himalayan complex in Siwalik sediments at 9.2 Ma implies the accelerated erosion of Himalaya during Middle to Late Miocene. The response of sedimentation to tectonic activity is resulted by the presence of coarse grained gravel units in Siwalik succession of Mohand area. Apatite fission-track dates and muscovite cooling ages confirm the strong activity on boundary thrusts during 8-6 Ma. Although the responses are non-linear and transient, we clusterize these non-linear responses to tectonics and climate and quantify them to find out the role of tectonics and climate in architecture of sedimentary succession.
Early menarche, depressive symptoms, and coping strategies
Authors: Alcalá‐Herrera Verónica , Marván Ma. Luisa
Published: July 2014

During the time around menarche, young women must make many emotional and social adjustments to adapt to a new life stage. We compared depressive symptomatology and coping strategies between early and average maturer Mexican adolescents girls. The relationships between elapsed time since menarche and both depressive symptomatology and coping strategies were also studied. Three hundred eighty post‐menarcheal students from 11 to 15 years completed the Children's Depression Scale and the Children's Situational Coping Scale. Early maturers showed more depressive symptoms than their peers, but they reported having used fewer non‐productive coping strategies. Early maturers who experienced menarche one to three years previously reported more non‐productive coping strategies than those who had experienced menarche four to six years ago. However, no differences were found in the results of the average maturers depending on the time elapsed since menarche. These findings are discussed in light of the psychosocial context of early maturers.
No Strings Attached: When Giving it Away versus Making Them Pay Reduces Consumer Information Disclosure
Authors: White Tiffany Barnett , Novak Thomas P. , Hoffman Donna L.
Published: July 2014

We examine egocentric biases in mental accounting that occur when consumers face the prospect of disclosing personal information in exchange for online marketing incentives. We find that consumers keep balanced “mental accounts” of the costs and benefits of such exchanges when they are contingent or temporally integrated. However, when non-contingent exchanges are temporally separated so that benefits precede costs, or when bias correction is impeded in the same non-contingent transaction, consumers keep separate mental accounts in which they egocentrically devalue the marketers’ incentives, making them less likely to reciprocate by disclosing. We explore consequences of these findings for online relationships between consumers and marketers.
For New Customers Only: A Study on the Effect of Acquisition Campaigns on a Service Company's Existing Customers’ CLV
Authors: Lhoest-Snoeck Sietske , van Nierop Erjen , Verhoef Peter C.
Published: July 2014

This study examines the effect of attractively priced acquisition campaigns on retention intention, and subsequently CLV, of existing customers. The main finding is that customers who are aware of the acquisition campaigns both have a significantly higher intention to stay and do actually stay longer than do customers who are unaware of these campaigns. However, since CLV is not only influenced by retention intention but also by revenues and costs, it is found that aware customers do not have a significantly different CLV than do unaware customers. The inclusion of attractiveness of the offer as an additional explanatory variable results in a positive effect of campaign attractiveness on retention intention, i.e. if the customer thinks the acquisition campaign is attractive, the retention intention will be higher. However, the effect that is found for intention cannot be directly translated in actual behavior.
S-phase fraction as a useful marker for prognosis and therapeutic response in patients with aplastic anemia
Authors: Tripathi Anil Kumar , Tripathi Payal , Kumar Ashutosh , Ahmad Rizwan , Singh Raj K. , Balapure Anil K. , Vishwakerma Achchhe L.
Published: July 2014

BACKGROUND:

The functional definition of aplastic anemia (AA) is the failure of hematopoietic stem cells to proliferate. The aim of the present study was to analyze the S-phase fraction (SPF) (proliferative activity) in patients with AA at diagnosis to explore its relationship with disease characteristics and its value in discriminating among patients with different prognoses. We also investigated whether the SPF value influenced the response to immunosuppressive therapy in AA patients.

PATIENTS AND METHODS:

The analysis of SPF at the time of diagnosis was carried out by flow cytometry on peripheral blood samples from 53 consecutive patients with AA and 30 age- and sex-matched controls. All patients were given cyclosporine and followed up periodically to determine response to therapy.

RESULTS:

Based on the median SPF, AA patients were divided into two groups: patients with SPF <0.59% (n=27) and patients with SPF >0.59% (n=26). An SPF <0.59% was associated with advanced age (P=.02) and elevated serum LDH level (P=.01). Patients with an SPF <0.59% also had a higher incidence of paroxysmal nocturnal hemoglobinuria and cytogenetic abnormalities. During a median follow-up of 18 months, 3.7% of patients with SPF >0.59 and 11.5% of patients with SPF <0.59% developed dysplasia and one patient with SPF >0.59% converted into AML. A significantly higher (P=.018) overall response rate of 53.9% was found in patients with SPF >0.59% versus 22.2% of patients with SPF <0.59% at 6 months.

CONCLUSIONS:

Independently of the peripheral blood count, the SPF at diagnosis may provide information on the expected response to immunosuppressive therapy and the propensity for disease to evolve into MDS/AML. Hence, SPF may serve as an early indicator for the evolution of MDS/AML in patients with AA and thus contribute to therapeutic decisions.
Pediatric immunohematopoietic stem cell transplantation at a tertiary care center in Cape Town
Authors: Wood Lucille , Juritz June , Havemann Jonathan , Lund Jo , Waldmann Herman , Hale Geoffrey , Jacobs Peter
Published: July 2014

INTRODUCTION AND STUDY DESIGN:

We conducted a retrospective analysis of consecutive referrals of patients under 18 years of age undergoing immunohematopoietic stem cell transplantation to assess the influence of age, diagnosis, graft type and gender on survival. We also contrasted program activity and outcome to that reported from a state hospital in the same geographical area over a comparable period.

METHODS:

conditioning employed either a sequential combination of fractionated 12Gy whole body and 6Gy total nodal irradiation separated by 120mg/kg of cyclophosphamide in patients over 1 5 years of age. Alternatively, the latter agent was combined initially with oral busulphan and later the intravenous equivalent. Neuroblastoma cases were prepared using a different regimen. In allografts the harvested product underwent ex vivo T-cell depletion with the humanized version of anti-CD 52 monoclonal antibody designated Campath 1H. No additional immunosuppression was given except where matched unrelated volunteer donors were employed.

RESULTS:

Sixty-eight procedures were carried out in 61 patients over a 6-year period. Of 11 with acute myeloid leukemia, 8 are alive and well whereas 8 of the 14 with the lymphoblastic variant have died. Of the remaining 12 with hematologic malignancy, all but 2 are alive. Ten of the 17 with aplasia are alive as are all with thalassemia or sickle cell disease. None of the four variables tested affected survival.

CONCLUSION:

Our analysis indicates that the standardized preparative regimen, coupled with a now well-es-tablished immunosuppressive regimen, is as effective in patients under 1 8 years of age as in adults. Our analysis also indicates that in a resource-scarce or developing country, it is mandatory to limit high-risk and relatively expensive procedures to active teams that enjoy international accreditation, whether these be in the state or private sector.
Cancer Prevention and Control in the Eastern Mediterranean Region
Authors: Khatib Oussama , Aljurf Mahmoud
Published: July 2014

Cancer is increasingly recognized as a major health concern in the Eastern Mediterranean (EM) region. The emergence of cancer and other non-communicable diseases (NCDs) in most EM region countries is related to increases in life expectancy, an increasing proportion of elderly people, and the successful control of most childhood communicable diseases, along with rapid strides in socioeconomic development. in the next 15 years, cancer incidence in the EM is expected to increase by 100% to 180%, according to World Health organization (WHO) projection modelling, the largest increase foreseen among developing countries. Even though 30% of cancers can be prevented and controlled using available knowledge, death rates will increase by 17% by 2015 because of the challenges and barriers to implementing national strategic action plans. other problems facing countries in the region are the lack of national cancer surveillance and little harmonization in monitoring and surveillance methodologies. Data on cancer mortality in the 21 countries is limited or lacking, with only 7 countries having national population-based registries. There is no linking of cancer mortality data to NCD prevention and control. A model of integrated care for NCD prevention programs in general and cancer in particular is lacking, and finally, there is inadequate national capacity-building and a lack of program sustainability. The WHO Regional committee for the EM has adopted a resolution recognizing the considerable magnitude of cancer as a major cause of morbidity, human suffering, and mortality in the region. in the last 15 years, the WHO cancer control programme has fostered the development of national cancer control programs as a primary intervention strategy for a comprehensive and cost-effective approach at the country level.
Stem cells, DNA damage, ageing and cancer
Authors: Pazhanisamy Senthil Kumar
Published: July 2014

A comprehensive knowledge of adult stem cells not only sheds light on their significant roles in many fun-damental biological process, but also on their implications in a variety of deleterious disorders including leukemia, lymphoma, ageing and other relevant degenerative disorders. Elucidating the diverse signaling pathways in stem cells paves the way for development of targeted therapeutic approaches against degen-erative disorders. Despite emerging studies, our understanding of the key molecular machineries that pro-foundly influence key stem cell properties is poor. This review discusses the seminal aspects of stem cell self-renewal mechanisms with an emphasis on various influencing factors, including DNA damage, and intrinsic and extrinsic factors that govern the significant characteristics of tissue stem cells under normal and stress conditions. AISO outlined are intriguing aspects of how molecular interventions in key stem cell pathways could be exploited to develop novel therapies against stem cell disorders.
Accuracy of the Fischer scoring system and the Breast Imaging Reporting and Data System in identification of malignant breast lesions
Authors: Al-Khawari Hanaa , Athyal Reji , Kovacs Agnes , Al-Saleh Mervat , Madda John Patrick
Published: July 2014

BACKGROUND AND OBJECTIVES:

Fischer developed a scoring system in 1999 that made identifying malignant lesions much easier for inexperienced radiologists. Our study was performed to assess whether this scoring system would help beginners to accurately diagnose breast lesions on magnetic resonance (MR) imaging and to assess the correlation between the magnetic resonance mammography Breast Imaging Reporting and Data system (MRM BI-RADS) grade and the final diagnosis.

PATIENTS AND METHODS:

The lesion morphology and contrast kinetics of 63 masses in 41 patients were evaluated on MRI and accorded a MRM BI-RADS final assessment category using the Fischer scoring system. The accuracy was evaluated after the final diagnosis was obtained by tissue sampling and follow-up imaging.

RESULTS:

There were 25 malignant and 30 benign lesions. Eight lesions were seen by MRI only and we could not verify their pathology since we did not have MR-guided biopsy facilities at the time of the study. On MR mammography, the proven carcinomatous lesions were characterized as BI-RADS category V in 16 (64%), category IV in 7 (28%), and category III in 2 (8%) lesions. Benign lesions were graded as category V in 3 (10%), category IV in 6 (20%), and category III in 3 (10%), category II in 10 (33%) and category I in 8 (27%) lesions. The MRM BI-RADS category accurately predicted malignancy in 92% and a benign pathology in 70% of the lesions. The overlap between the MRM features of chronic inflammatory lesions and carcinomas resulted in a lower accuracy in diagnosing benign as compared to malignant lesions.

CONCLUSION:

The MRM BI-RADS lexicon using the Fischer scoring system is useful and has a high predictive value, especially for malignant breast lesions, and is easy to apply. Overlapping features between benign inflam-matory and malignant lesions might yield a reduced accuracy in inflammatory pathologies.
Systemic amyloidosis presenting as mucocutaneous bullous lesions
Authors: Ahmad Qazi M. , Sultan Sheikh Javeed , Shah Iffat H. , Sameem Farah
Published: July 2014

A 65-year-old male presented with hemorrhagic bullous skin lesions with purpura and ecchymoses. There was increased skin fragility with a strongly positive Nikolsky sign. Histopathology of the skin revealed large amounts of amyloid deposits in the dermis with a positive congo Red staining around the dermal vessels. Examination and tests in this patient also revealed anemia, hepatomegaly, infiltrative cardiomyopathy, polyneuropathy and immunoglobulin ? deposition, favoring a diagnosis of primary amyloidosis (AL type). The present case is reported in view of the rarity of the bullous variant of primary systemic amyloidosis as well as presence of mucosal lesions and a positive Nikolsky sign.
Immunohematopoietic stem cell transplantation in Cape Town
Authors: Wood Lucille , Haveman Jonathan , Juritz June , Waldmann Herman , Hale Geoffrey , Jacobs Peter
Published: July 2014

BACKGROUND AND OBJECTIVES:

Immunohematopoietic stem cell transplantation has curative potential in selected hematologic disorders. Stem cell transplantation was introduced into South Africa in 1970 as a structured experimental and clinical program. In this report, we summarize the demography and outcome by disease category, gender, and type of procedure in patients older than 18 years of age who were seen from April 1995 to December 2002.

PATIENTS AND METHODS:

This retrospective analysis included 247 individuals over 18 years of age for whom complete data were available. These patients received grafts mostly from peripheral blood with the appropriate stem cell population recovered by apheresis.

RESULTS:

Patient ages ranged from 20 to 65 years with a median age of 42 years. There were 101 females and 146 males. There were no withdrawals and 63% survived to the end of the study. At 96 months of follow-up, a stable plateau was reached for each disease category. Median survival was 3.3 years (n=6, 14.6%) for acute lymphoblastic anemia, 3.1 years (n=44, 18%) for acute myeloid leukemia, 2.8 years (n=47, 19%) for chronic granulocytic leukemia, 2.8 years (n=71, 29%) for lymphoma, 1.5 years (n=23, 9%) for myeloma, 1.43 years (n=10, 4%) for aplasia, and 1.4 years (n=38, 15%) for a miscellaneous group comprising less than 10 examples each. Multivariate analysis showed that only diagnosis and age had a significant impact on survival, but these two variables might be interrelated. There was no significant difference in outcome by source of graft.

CONCLUSION:

The results confirm that procedures carried out in a properly constituted and dedicated unit, which meets established criteria and strictly observes treatment protocols, generate results comparable to those in a First World referral center. Low rates of transplant-related mortality, rejection and graft-versus-host disease are confirmed, but the benefits cannot be extrapolated outside of academically oriented and supervised facilities.
Multimodality treatments in locally advanced stage thymomas
Authors: Hassan Mohammad , Seoud Diaa Eldin A.
Published: July 2014

BACKGROUND AND OBJECTIVES:

Complete surgical resection is the main goal in the treatment of thymoma, but is not always achievable in stage III and IVA thymoma because of local invasion of the neighboring organs or the presence of diffuse pleural or pericardial implants. We reviewed our experience in multimodality treatment of advanced stage (III and IVA) thymic tumors to evaluate the effectiveness and safety in patients with locally advanced unresectable thymoma.

PATIENTS AND METHODS:

We studied patients with newly diagnosed, histologically proven, unresectable malignant thymoma who underwent a multimodality treatment regimen that consisted of neoadjuvant chemotherapy (three courses of cisplatin and etoposide), followed by surgical resection, postoperative radiation therapy, and consolidation chemotherapy (three courses of cisplatin and etposide).

RESULTS:

Nine patients were consecutively enrolled from December 2001 to June 2007, and all were valuable for assessment. Disease responded to neoadjuvant chemotherapy completely in 1 patient (11%) and partially in 6 patients (66%) with an overall response of 77%. Two patients had a minor response (22%). Eight patients had surgical resection; 1 refused surgery. Tumors were removed completely in 5 patients (62.5%) and incompletely in 3 (37.5%). All patients received radiation therapy and consolidation chemotherapy. seven patients were alive (77% at 4 years), with a median follow-up of 31 months, and 6 patients were disease free (66.6% disease-free survival at 4 years). The major side effect from neoadjuvant and consolidation chemotherapy was myelosup- pression.

CONCLUSION:

The multimodality treatment of stage III and IVA thymic tumors by integration of surgery, radiotherapy, and chemotherapy, contributed to a good long-term outcome. The neoadjuvant chemotherapy improves the resectability rate and the survival of locally advanced stages of the disease.
Thyroid carcinoma in Pakistan
Authors: Bukhari Uzma , Sadiq Saleem , Memon Jawaid , Baig Farooq
Published: July 2014

BACKGROUND AND OBJECTIVES:

To address the need for epidemiologic data on thyroid carcinoma in Pakistan, we evaluated the frequency and types of thyroid carcinoma with respect to age and sex.

METHODS:

In a a retrospective study conducted at the Jinnah postgraduate Medical centre in Karachi, we reviewed thyroid lesions reported over a period of 5 years, from July 2000 to June 2005. pathology slides were studied to determine the types and frequencies of malignant lesions of the thyroid.

RESULTS:

Of 998 thyroid lesions reviewed, 153 cases were malignant. papillary carcinoma was the commonest malignant lesion with a frequency of 90.2%, followed by 4.5% for medullary carcinoma, 2% for follicular carcinoma, 2% for undifferentiated carcinoma and 0.7% each for mixed medullary and papillary carcinoma and poorly differentiated carcinoma. Females were predominant (82.4%) as compared with males (17.6%) for a female-to-male ratio 4.7:1. The maximum number of the patients were in the fourth decade of life followed by the third and second decades.

CONCLUSION:

The commonest malignant thyroid lesion was papillary carcinoma. Thyroid cancer was more common in females. papillary, medullary and follicular carcinomas were found in patients in the third and fourth decades of life, while poorly and undifferentiated carcinomas were diagnosed from the fifth to seventh decades of life.
Nosocomial sepsis-induced late onset thrombocytopenia in a neonatal tertiary care unit
Authors: Charoo Bashir Ahmad , Iqbal Javeed , Iqbal Qazi , Mushtaq Sheikh , Bhat Abdul Wahid , Nawaz Imtiyaz
Published: July 2014

BACKGROUND AND OBJECTIVES:

Late onset sepsis (LOS)(onset of sepsis >72 hours of age or nosocomial sepsis) is an important cause of morbidity and mortality in the neonatal intensive care unit (NICU). Thrombocytopenia is an important complication of sepsis. We investigated the incidence of thrombocytopenia in LOS patients and studied the influence of various parameters on platelet response.

PATIENTS AND METHODS:

Infants born in the level 3 neonatal intensive care unit between January 2002 and December 2006 with documented LOS were included in this prospective study. Multiple hemograms with platelet counts, bacterial blood culture and fungal blood culture were obtained in all patients. Demographic and clinical data were compared between patients without thrombocytopenia and with mild, moderate and severe thrombocytopenia. Duration of thrombocytopenia in relation to type of organism and mortality with respect to degree of thrombocytopenia were also studied.

RESULTS:

Of 200 patients with culture-proven nosocomial sepsis, 119 (59.5%) patients developed thrombocytopenia (platelet count >150×109/L). in our series Klebsiella pneumoniae was the most frequently isolated organism (125/200, 62.5%) and the incidence of thrombocytopenia was 60.0% (75/125). However, the incidence of thrombocytopenia was highest among patients who had concurrent bacterial and fungal sepsis (28/31, 90.3%). coagulase- negative staphylococcal (CONS) sepsis was present in 21 (10.5%) patients and the incidence of thrombocytopenia was 33.3%. isolated fungal sepsis was present only in 6 (3%) patients and the incidence of thrombocytopenia was 66.0%. The incidence of thrombocytopenia was highest among preterm babies and low-birth weight (LBW) babies. Twenty-seven percent (54/200) of babies presented with mild thrombocytopenia, 20% (40/200) presented with moderate thrombocytopenia, and 12.5%(25/200) developed severe thrombocytopenia. severity of thrombocytopenia was also directly related to the presence of necrotizing enterocolitis (NEC) and disseminated intravascular coagulation (DIC). The mortality rate was significantly associated with the degree of thrombocytopenia.

CONCLUSION:

LOS sepsis is an important risk factor for thrombocytopenia in the NICU. Fungal and gramnegative sepsis are frequently associated with a decreased platelet count. sepsis-induced thrombocytopenia is more common among LBW babies and preterm babies. The mortality rate is significantly related to degree of thrombocytopenia.
Acinic cell carcinoma of the salivary glands
Authors: Al-Zaher Nabil , Obeid Amani , Al-Salam Suhail , Al-Kayyali Bassam Sulaiman
Published: July 2014

Acinic cell carcinoma (ACC) is a low-grade malignant salivary neoplasm that constitutes approximately 17% of primary salivary gland malignancies. In the head and neck region, the parotid gland is the predominant site of origin and women are usually more frequently diagnosed than men. previous radiation exposure and familial predisposition are some of the risk factors for ACC. A slowly enlarging mass lesion in the tail of the parotid gland is the most frequent presentation. The diagnosis is usually confirmed with a fine needle aspiration biopsy, and surgical excision is the main treatment of this malignant neoplasm. other treatment modalities such as radiotherapy may be indicated in some cases. ACC has a significant tendency to recur, to produce metastases (cervical lymph nodes and lungs), and may have an aggressive evolution. Therefore, long-term follow-up is mandatory after treatment.
A retrospective comparison of allogeneic peripheral blood stem cell versus bone marrow transplantation
Authors: Henrique Bittencourt , Monalisa Lopes , Antonio Vaz de Macedo , Elen Rose Teixeira , Gabriel Gomes Sabido Gomes , Ferreira Galileu Galilei , Leandro Amaral , Priscila Soares , Mônica Vieira , Dusse Luci Maria
Published: July 2014

BACKGROUND AND OBJECTIVES:

Disease evolution depends in part on the source of transplanted cells. Therefore, we compared outcomes after allogeneic bone marrow (BM) and peripheral blood stem cell (PBSC) transplantation in patients who underwent transplant at Hospital das Clinicas of the Federal university of Minas Gerais, Brazil.

PATIENTS AND METHODS:

We studied 364 patients who received allogeneic BM (n=142) or PBSC transplantation (n=222) between July 1995 and May 2005. The median age of the patients was 31 years (range, 3.1-58 years). chronic myeloid leukemia was the predominant diagnosis (41.2%). A conditioning regimen with cy- closphosphamide and busulfan was used in 79.4% (n=289) and graft-versus-host disease (GVHD) prophylaxis was cyclosporine/methotrexate in 95.9% (n=349) of cases.

RESULTS:

The patients in the PBSC group had faster neutrophil (p<.001) and platelet engraftment (p=.03) but increased rates of acute GVHD (p<.001) vs. those in the BM group. There was no significant difference between the groups in chronic GVHD, transplant-related mortality, relapse and survival rates.

CONCLUSIONS:

Although allogeneic PBSC transplant results in a faster hematopoietic engraftment, there was an increase in acute GVHD. There was no clear benefit in relapse rate and no evidence that transplantation with PBSC benefits patient survival in our institution.
Clinical characteristics and outcome of pediatric patients with stage IV Hodgkin lymphoma
Authors: Belgaumi Asim , Al-Kofide Amani A. , Khafaga Yasser , Joseph Nicey , Jamil-Malik Rubina , Siddiqui Khawar S. , Sabbah Rajeh S.
Published: July 2014

BACKGROUND AND OBJECTIVES:

While treatment outcomes for patients with Hodgkin lymphoma (HL) have improved remarkably, patients with disseminated disease still have a poorer outcome. stage IV HL is often reported with other ‘advanced stage’ categories, confusing the specific contribution of disease dissemination to the outcome. This single-institution report looks at characteristics and outcomes of this specific category.

PATIENTS AND METHODS:

The medical records of pediatric HL patients (<14 years) from 1975 through 2003 were retrospectively reviewed and the data analyzed.

RESULTS:

Stage IV patients (n=67) had more poor-risk characteristics than patients in stages I-III (n=300) (B symptoms 86.6% vs. 19.3%, bulky disease 57.6% vs. 45.5% and mediastinal mass 77.6% vs. 29.7%; P<.001 for all characteristics). The liver was the most common extralymphatic site (in 51.5% of patients with stage IV disease. Stage IV patients received chemotherapy (CT) alone (n=55) or combined modality therapy (CMT) (n=12). Fifty-four patients (80.6%) achieved complete remission, 2 (3%) partial remission, 10 (14.9%) had progressive disease and 1 was lost to follow up. Overall survival was 79.4% and event-free survival (EFS) was 63.9% at 5 years. There was a non-significant benefit for CMT (OS=91.7% v. 77.1%, P=.3; EFS=70.7% v. 62.7%, p=.3). Ten of 12 relapsed and only 1 of 10 progressive disease patients were salvaged. On multivariate analysis, failure to achieve complete remission with CT was associated with a poorer outcome.

CONCLUSION:

Stage IV disease is associated with poor risk features and confers a worse outcome than stage I-III disease. Achievement of complete remission with CT is an important prognostic feature. Slow responders may require novel and/or aggressive therapy to achieve complete remission.
Studies on biomarkers for oxidative stress in patients with chronic myeloid leukemia
Authors: Singh Raj K. , Tripathi Anil K. , Tripathi Payal , Singh Sushma , Singh Ranjana , Ahmad Rizwan
Published: July 2014

BACKGROUND:

Chronic myeloid leukemia (CML) is a myeloproliferative disorder with a unique genetic rear-rangement, the philadelphia chromosome. High reactive oxygen species (ROS) levels favor oxidative stress, which could play a vital role in normal processes and various pathophysiologies including neoplasm. Biomarkers of oxidative stress are measured as products of oxidized proteins and lipids. plasma levels of protein carbonyl (PC), thiobarbituric acid reactive substances (TBARS) and total lipid hydroperoxide (LOOH) were used as biomarkers of oxidative stress in the past. The aim of this study was to evaluate the products of protein oxidation and lipid peroxidation in plasma as biomarkers of oxidative stress in CML patients.

PATIENTS AND METHODS:

The study included 40 CML patients and 20 age- and sex-matched healthy volunteers. of 40 CML patients, 28 were in chronic phase (CML-CP) and 12 in accelerated phase (CML-AP). plasma levels of PC, TBARS and LOOH as biomarkers of oxidative stress were evaluated by spectrophotometric methods.

RESULTS:

There were significant differences (p<.05) in plasma levels of PC, TBARS and LOOH in CML, CML-CP and CML-AP patients as compared to controls.

CONCLUSION:

PC, TBARS and LOOH might reflect oxidative stress in CML patients and might be used as biomarkers in such patients.
Polymorphic (CAG)n repeats in the androgen receptor gene
Authors: Shaik Noor Ahmad , Govindan Sujatha , Kodati Vijayalakshmi , Rao Kaipa Prabhakar , Hasan Qurratulain
Published: July 2014

BACKGROUND:

Endometriosis and uterine leiomyomas are leading hormone responsive, benign uterine disorders responsible for high morbidity in women of reproductive age group. A polymorphic (CAG)n repeat length located in exon 1 of the androgen receptor (AR) gene has been proposed as a risk marker for both endometriosis and leiomyomas in some ethnic groups. The present study was carried out to assess the frequency of AR (CAG)n repeat polymorphism as a risk marker for endometriosis and uterine leiomyomas in Asian Indian women.

METHODS:

DNA was isolated from peripheral blood samples of 331 subjects, which include 90 endometriosis cases, 140 cases of leiomyomas and 101 healthy age- and sex-matched controls. PCR was carried out to amplify exon 1 of the AR gene. All the PCR amplicons were analysed initially on 2% agarose gel electrophoresis, followed by bidirectional sequencing to calculate the number CAG repeats in individuals.

RESULTS:

The CAG repeat ranges detected in endometriosis cases were 4-33 (Mode-19) and in leiomyomas cases 5-34 (Mode-20), whereas in controls it was 5-34 (Mode-22). A distinct variation was observed in the three groups at 14, 18, 19, 20 and 22 (CAG)n repeats, which were statistically analyzed using chi-square and odds ratio tests. 19 CAG repeats were found to be higher in endometriosis cases (19.09%) when compared with controls (9.04%), while 20 CAG repeats were higher in leiomyomas cases (14.02%) compared to controls (6.14%). A statistically significant (p<0.05) association was observed in 19 and 20 CAG repeats in endometriosis and leiomyomas, respectively.

CONCLUSION:

This is the first report from an Asian Indian population proposing that 19 and 20 CAG repeats of the AR gene are associated with endometriosis and leiomyoma and can be regarded as high-risk markers.
Effect of genetic alterations of cytarabinemetabolizing enzymes in childhood acute lymphoblastic leukemia
Authors: Banklaui Chumphorn , Jindadamrongwech Sumalee , Sawangpanich Ruchchadol , Apibal Suntaree , Hongeng Suradej , Paisooksantivatana Karan , Pakakasama Samart
Published: July 2014

BACKGROUND:

Single nucleotide polymorphisms (SNPs) of deoxycytidine kinase (dCK) and cytidine deaminnase (CDA) are known to alter their enzymatic activities, which affect the metabolism of cytarabine. Currently, treatment of childhood acute lymphoblastic leukemia (ALL) includes cytarabine, especially in high-risk patients. Therefore, we hypothesized that a genetic variation of dCK and CDA genes may influence the risk of cytarabinerelated toxicities and early response to treatment.

PATIENTS AND METHODS:

We included children diagnosed with ALL and lymphoblastic lymphoma (LL) stage III and IV. The patients received a modified St Jude Total Therapy Study XV protocol. Cytarabine was used during induction remission (low-dose cytarabine) and reinduction II (high-dose cytarabine) phases. Genotyping of dCK-360C>G and -201C>T and CDA 79A> C and 208G>A was performed. Minimal residual disease (MRD) at the end of the induction phase was measured using flow cytometry.

RESULTS:

Ninety-four children with ALL (n=90) and LL (n=4) were analyzed. The median age at diagnosis was 5.8 years (range, 0.4-15 years). All four SNPs showed predominant wild type alleles. There was no CDA-208A allele in our population. Children with dCK-360G allele were at risk of mucositis after receiving low-dose cytarrabine (OR =3.7; 95%CI, 1.2--11.3). Neither dCK nor CDA polymorphisms affected the MRD status at the end of induction phase.

CONCLUSION:

The dCK-360G allele was found to increase the risk of mucositis after exposure to low-dose cytarabine in childhood ALL therapy.
Feasibility study of docetaxel, oxaliplatin and capecitabine combination regimen in advanced gastric or gastroesophageal adenocarcinoma
Authors: Goel Gaurav , Jauhri Mayank , Negi Anita , Aggarwal Shyam
Published: July 2014

BACKGROUND

At present, there is no standard regimen for the treatment of gastroesophageal cancer. Docetaxel, cisplatin and fluorouracil (DCF) has been shown to be an effective regimen; however, toxicity is an area of concern in the palliative case setting. Capecitabine and oxaliplatin have been shown to be as effective as fluorouracil and cisplatin, respectively. To reduce the toxicity of DCF while maintaining efficacy, we conducted this study to evaluate the efficacy of docetaxel, oxaliplatin and capecitabine (DOX) combination in advanced gastroesophageal cancer.

METHODS

Patients with histologically confirmed metastatic or locally advanced adenocarcinoma of the stomach or gastroesophageal junction received docetaxel 25 mg/m2 and oxaliplatin 50 mg/m2 on days 1 and 8 with capecitabine 625 mg/m2 twice daily from day 1-14, in 21-day cycles. The primary endpoint was overall response rate (ORR).

RESULTS

Of 21 patients, there were 1 6 males and 5 females with a median age of 57 years, range 37-80 years. The primary tumor was located at the gastroesophageal junction in 7 patients and in other parts of the stomach in the remaining 14 patients. One patient had locally advanced tumor without distant metastases and 20 patients presented with metastatic disease. Grade 3/4 toxicities included diarrhea (24%), hand-foot syndrome (5%) and febrile neutropenia (5%). The ORR was 29%. The median survival was 8.4 months. At the time of analysis, 5 of the 21 patients (24%) were alive.

CONCLUSIONS

The DOX combination is tolerable, active and a promising day-care regimen for advanced gastroesophageal cancer.
Protein C levels in β-thalassemia major patients in the east Nile delta of Egypt
Authors: Hassan Tamer H. , Elbehedy Rabab M. , Youssef Doaa M. , Amr Ghada E.
Published: July 2014

BACKGROUND AND OBJECTIVES:

Thalassemic patients have an increased risk for thromboembolic complications. To determine if this might be due to a deficiency in protein C we investigated the status of the protein C anticoagulant pathway in thalassemia major patients and its relationship to the hypercoagulable state.

PATIENTS AND METHODS

Fifty patients with β-thalassemia major (30 non-splenectomized and 20 splenectomized) and 20 healthy children as a control group were tested for levels of serum ferritin, liver enzymes, serum albumin, fibrinogen, protein C and protein S, thrombin antithrombin complex (TAT) and D-dimer.

RESULTS

Thalassemic patients had lower levels of protein C and S and higher levels of D-dimer and TAT than the control group. These findings were more obvious in splenectomized patients and in those with infrequent blood transfusion.

CONCLUSIONS

Protein C plays a major role in the hypercoagulable state in thalassemic patients. These findings raise the issue as to whether it would be cost-beneficial to recommend prophylactic antithrombotic therapy in high-risk thalassemic patients. A wider prospective study is necessary to delineate under which circumstances therapy might be needed, and at what level of protein C deficiency to start prophylactic antithrombotic therapy.