bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Autopsy Study of Cerebrovascular Atherosclerosis in the Elderly
Authors: Shenoy Asha S. , Bhosale Mayur N. , Amonkar Gayathri P. 
Published: December 2022

Background:
Stroke is an important cause of mortality with intracranial atherosclerosis as an important risk factor. Geographical variation in the pattern of atherosclerosis is well documented with various studies in stroke patients showing that African Americans and Japanese people tend to have intracranial vascular occlusion, whereas Caucasians more often have extracranial atherosclerotic lesions.

Methods:
This is a prospective study of 50 cases of Indian elderly patients over 60 years of age where we have studied the CNS vasculature in detail including intracranial atherosclerosis with regards to its incidence, severity, distribution, plaque composition and associated risk factors. We compared the atherosclerotic pathology in the intracranial vessels and the extracranial vessels including the carotids.

Results:
Out of 50 cases 31 showed intracranial atherosclerosis. Anterior circulation was more commonly affected. A total of 87 of the intracranial arteries showed atherosclerotic plaques, most common nature of the plaques being fibrofatty. Majority of the intracranial vessels showed mild stenosis and multiple vessels were involved in 15 cases while single vessel involvement was seen in 16 cases with the middle cerebral artery being the most common single vessel involvement. Infarcts were seen in 7 cases and all these cases had history of hypertension. Cerebral atrophy was seen in 28 cases. All cases showing frontoparietal and generalized atrophy had carotid artery stenosis. Of the 100 carotid arteries studied (2 per case) 59 showed atherosclerosis. Majority of the carotid arteries showed mild degree of atherosclerosis and the content was predominantly fatty.

Conclusion:
This study concludes that the pattern of atherosclerosis is different in the Indian population as compared to the western literature. Intracranial atherosclerosis is more common in Indian population with the anterior portion of circle of Willis being more commonly affected.
Analysis of Neuromyelitis Optica Spectrum Disorder in an Indian Cohort using International Consensus Diagnostic Criteria
Authors: Gnanashanmugam G , Somasundaram S P , Parimalam N , Rajmohan V , Pranesh M B 
Published: December 2022

Context:
Updates on clinical, investigatory, and therapeutic aspects of neuromyelitis optica (NMO) spectrum disorders are rapidly evolving. Recently published international consensus diagnostic criteria (ICDC) allowed clinicians to rapidly diagnose the expanding spectrum of NMO spectrum disorders more accurately.

Aims:
The aim of the study was to retrospectively analyze 36 consecutive cases of comprehensively evaluated NMO spectrum disorders using the ICDC.

Patients and Methods:
We retrospectively collected 36 cases of NMO spectrum disorders who attended our unit between August 2012 andOctober 2016 and fulfilled the ICDC. All patients underwent magnetic resonance imaging (MRI) of the brain and whole spine with contrast, anti-aquaporin 4 antibody, and detailed blood investigations to rule out systemic vasculitis and other alternate diagnoses.

Results:
Female-to-male ratio was 6.2:1; 50% of the cases were in the 20–40-year age group. Six patients (16.67%) had combined optic neuritis and myelitis. Nine patients (25%) had pure longitudinally extending transverse myelitis LETM with positive anti aquaporin 4 antibody AQ4Ab. Fourteen patients (38.9%) had myelitis and optic neuritis separately. Nine patients (25%) had area postrema syndrome. Two patients (5.6%) had acute brainstem syndrome and one (2.8%) had hypothalamic syndrome. LETM was commonly found in the cervical level (69.4%). Four patients (11.1%) had no spinal cord involvement. Anti-aquaporin 4 antibody was positive only in 23 cases (63.9%).

Conclusions:
Initial presentation of NMO spectrum disorder is often due to brain lesions. The ICDC criteria have enhanced clinician's ability to diagnose NMO spectrum disorder in the early stages. In our study, ICDC criteria helped us to diagnose 33% additional cases that would have been missed if the old 2006 revised criteria was applied.
Fluoxetine or Venlafaxine for Early Post Stroke Depression
Authors: Nambiar Vivek K. , Parvathy J , Philip Tania M. , Abhijith K , Sreeni S , Panicker Naveen K. , Ajai Amrutha V. , Dhanya T. S. 
Published: December 2022

Context:
Post stroke depression (PSD) is an under diagnosed morbidity of stroke and can negatively affect the prognosis of the patient.

Aims:
We intended to study the prevalence of PSD and the commonly used anti-depressants and their outcome in patients with PSD.

Settings and Design:
A prospective observational study was conducted in the patients admitted to the stroke unit of a tertiary care centre.

Methods and Materials:
Diagnosis of post stroke depression was made by the Hamilton Depression Rating Scale (HDRS) during the two-week period after stroke or in the clinic follow up. A comparison of clinical outcome and adverse events of the two anti-depressants used, i.e. venlafaxine and fluoxetine were done by a follow up of up to 6 months.

Statistical Analysis Used:
Independent sample test was used for statistical purposes in the study

Results:
Out of the 326 stroke patients admitted in the department, 73 had PSD and 60 patients out of this were assigned into the study. Forty patients were males, and the mean age of the sample population was found to be 62.13 ± 11.14. Major risk factors identified were hypertension, diabetes mellitus, and dyslipidemia. Venlafaxine showed better outcome and less adverse events compared to fluoxetine. Major adverse events observed were hyponatremia, headache, insomnia, and anxiety.

Conclusions:
PSD in the early phase affects a substantial number of the stroke patients. Venlafaxine has got a better outcome and adverse event profile compared to fluoxetine in this group of patients. However, larger multicenter studies will provide more helpful data in this area.
Cerebral Venous Sinus Thrombosis with Bilateral Inverse Duane's Retraction Syndrome—A Case Report
Authors: Nene Devavrat H , Yadav Ravi 
Published: December 2022

Background:
Cerebral venous sinus thrombosis (CVST) is a life-threatening condition with a predilection for a younger age group. Patients with CVST can have features of raised intracranial pressure that can be suspected clinically based on ophthalmological findings such as bilateral abduction restriction, papilledema.

Case Description:
A 27-year-old gentleman presented with 15 days history of headache and seizures with complete abduction restriction of both eyes along with retraction of globe and narrowing of palpebral fissure on abduction. His MRI brain showed superior sagittal sinus thrombosis without any parenchymal lesion.

Conclusion:
The final diagnosis in our case was bilateral inverse Duane's retraction syndrome with CVST, a co-occurrence that has not been reported in the past and can be missed if the eye movements are attributed to raised intracranial pressure alone.
Role of Multivoxel MR Spectroscopy Progressive Supranuclear Palsy – A Preliminary Study
Authors: Mangalore Sandhya , Kumar Manoj , Pal Pramod , Saini Jitender , Pasha Shaik , Yadav Ravi 
Published: December 2022

Background:
Progressive supranuclear palsy [PSP] is a neurodegenerative condition with characteristic clinical and imaging features.

Aim:
This is an exploratory MRS study to look at metabolic changes that occur due to the disease by using MR spectroscopic methods in subtypes of the PSP, that is, classic [PSP-c] and Parkinsonian [PSP-p].

Materials and Methods:
A total of 12 PSPs subjects were included in this study, of which 8 subjects were clinically diagnosed as PSP-C and 4 subjects with PSP-P. We also included 6 healthy controls to compare metabolites between PSP groups. A multi-voxel MRS was performed using the Philips 3T MRI system, and postprocessing and metabolic peak fitting and quantification were performed using the Tarquin spectroscopic data-processing software. Individual patient MRS ratios of various metabolites were tabulated and analyzed to look for metabolic differences between these groups.

Results:
Significant differences were noted in various neurometabolites including GABA, Glutamate, Glutamine, Tau and NAA / creatinine ratio.

Conclusion:
Our preliminary findings indicate that MRS may act as an in vivo metabolic biomarker in various pathological conditions. Alteration and distribution of these metabolites may act as a marker for symptomatology and clinical presentation. MRS also has the potential for use in prognostic or in assessing the treatment response.
Exposure to Toxocara Canis is not Associated with New-Onset Epilepsy
Authors: Rishi Vivek , Singh Rajveer , Goyal Manoj Kumar , Modi Manish , Garg Vivek , Thakur J. S. , Sehgal R. K. , Khandelwal N. , Jain Gourav , Kumar Amith S. , Choudhary Aditya , Prabhakar Sudesh , Lal Vivek 
Published: December 2022

Purpose:
The association between exposure to Toxocara canis and epilepsy is at the best contentious. Most of previous studies were retrospective, community-based, and contradictory to one another. As the impact of a positive association on the magnitude of epilepsy will be huge especially in developing countries where toxocariasis is common owing to poor hygienic practices, this study was carried out to determine whether exposure to T. canis predisposes to development of epilepsy.

Patients and Methods:
This case-controlled observational study was carried out a tertiary healthcare center in North India on 120 patients with newly diagnosed epilepsy who presented within 3 months of diagnosis. A total of 120 age- and sex-matched individuals from the same community were chosen as controls. Epilepsy was defined according to ILAE 1993 definition. Serological testing for T. canis was carried out using commercially available ELISA kits. All the positive samples were subjected to Western blot testing for confirmation.

Results:
The prevalence of antibodies to T. canis was similar in cases (16/120; 13.3%) and controls (16/120; 13.3%). Among the various risk factors, history of pica was significantly associated with T. canis seropositivity, while lack of hand washing was significantly associated with higher risk of epilepsy.

Conclusion:
Our study could not find any association between exposure to T. canis and epilepsy.
Predictors of pathological complete response following neoadjuvant chemoradiotherapy for rectal cancer
Authors: Mehraj Asif , Baba Arshad A , Khan Bushra , Khan Mudassir Ahmad , Wani Rauf A , Parray Fazl Q , Chowdri Nisar A 
Published: December 2022

Background:
Neoadjuvant chemoradiotherapy (NACRT) is an established treatment option for locally advanced rectal cancer (LARC). Patients achieving pathological complete response (pCR) following NACRT have better oncological outcomes and may be subjected to wait and watch policy as well. The aim of this study was to identify predictors of pCR in LARC following NACRT.

Materials and Methods:
A retrospective analysis of a prospectively maintained colorectal cancer database from January 2018 to December 2019 was undertaken. A total of 129 patients of LARC who were subjected to conventional long course NACRT, followed by surgery were included in the study. Pathological response to NACRT was assessed using Mandard grading system and response was categorized as pCR or not-pCR. Correlation between various clinico pathological parameters and pCR was determined using univariate and multivariate logistic regression analysis.

Results:
Mean age of patients was 53.79 ± 1.303 years. Complete pathological response (Mandard Gr 1) was achieved in 24/129 (18.6%) patients. Age of patients more than 60 years (P = 0.011; odds ratio [OR] 3.194, 95% confidence interval [CI] 1.274-8.011), interval between last dose of NACRT and surgery >8 weeks (P = 0.004; OR 4.833, 95% CI 1.874-12.467), well-differentiated tumors (P < 0.0001; OR 32.00, 95% CI 10.14–100.97) and node-negative disease (P = 0.003; OR 111.0, 95% CI 2.51–48.03) proved to be strong predictors of pCR.

Conclusion:
Older age, longer interval between NACRT and surgery, node-negative disease and favorable tumor grade help in achieving better pCR rates. Awareness of these variables can be valuable in counseling patients regarding prognosis and treatment options.
Ki-67, CD105, and α-smooth muscle actin expression in oral squamous cell carcinoma corresponds with different forms of tobacco consumption habits
Authors: Gadbail Amol Ramchandra , Sarode Sachin C. , Chaudhary Minal S. , Gondivkar Shailesh M. , Tekade Satyajit Ashok , Yuwanati Monal , Sarode Gargi S. , Hande Alka , Patil Shankargouda 
Published: December 2022

Background:
Association with variety of etiological agents is one of the characteristic features of oral squamous cell carcinoma (OSCC). We hypothesized the existence of tobacco consumption habit-based heterogeneity in the immunohistochemical expression of carcinogenesis relevant molecular markers in OSCC. Hence, the present study was conducted to investigate the carcinogenesis relevant three commonly expressed markers (Ki-67, CD105, and α-smooth muscle acting [SMA]) in various forms of tobacco consumption habits in OSCC patients.

Materials and Methods:
A total of 217 patients of OSCC were included in the study, and based on the habit, they were broadly categorized into tobacco lime (TL), TL and areca nut (TLAN), and areca nut (AN). Further, categorization was done on the basis of absence or presence of additional habit of smoking. Immunohistochemistry (IHC) was performed using Ki-67, CD105, and α-SMA markers on formalin-fixed paraffin-embedded tissues.

Results:
TLAN (62.21%) was the most common habit noted in OSCC patient followed by TL (20.73%) and AN (15.20%). The additional habit of smoking was observed in 31.11% and 25.92% of TL and TLAN habits of OSCC patients, respectively. All the three markers (Ki-67, CD105, and α-SMA) showed statistically significant differences in the habit group such as TL, TLAN, and AN (P < 0.001). Although the expression of all the three markers was increased in TL as compared with TLAN, differences were not statistically significant. When these markers were compared in with and without smoking category, only TLAN with smoking and TLAN without smoking showed statistically significant differences in the expression of all three markers.

Conclusions:
Ki-67 CD105 and α-SMA immunohistochemical expression in OSCC corresponds with different forms of tobacco consumption habits. Habit-related unique carcinogenesis events are reflected at IHC level thus providing proof of concept for future studies.
Regorafenib and trifluridine/tipiracil in real clinical practice
Authors: García-Beloso Nerea , Romero-Ventosa Elena Yaiza , Gayoso-Rey Mónica , López-López Aida , Robles-Torres David , de Castro Noemí Martínez-López , Piñeiro-Corrales Guadalupe 
Published: December 2022

Background:
Colorectal cancer is the ninth leading cause of death in Spain. The latest therapeutic developments in the advanced stages of this disease are the oral drugs trifluridine/tipiracil and regorafenib.

Objective:
Results of clinical trials (CTs) are not in real conditions and therefore, we want to study the effectiveness and the safety profile in the usual clinical practice and compare it with the bibliography.

Materials and Methods:
A retrospective and unicentric study was carried out in a health area of 500,000 inhabitants. Patients who started treatment with regorafenib and/or trifluridine/tipiracil were included from the date of marketing until June 2019. Patient-related variables, pathology, effectiveness, and treatment toxicity were collected. The statistical analysis was carried out with the PSPP program.

Results:
Fifty-four patients were analyzed. Men accounted for 59.3% of patients. Regorafenib was the treatment for 22.2% of patients and 77.8% received trifluridine/tipiracil. The reason for the drug's suspension was the disease progression in 85.2% of patients. No patient had a full response and 3.2% achieved partial response. The median progression-free survival time in treatments with regorafenib was 2.5 months (95% confidence interval [CI]: 0.0–5.4) and the overall survival time was 3.1 months (95% CI: 0.0–6.7), while in treatments with trifluridine/tipiracil, these data were, respectively, 2.8 (95% CI: 2.5–3.2) and 5.7 months (95% CI: 3.8–7.6). Side effects occurred in 91.7% of patients treated with regorafenib and in 100% of treated with trifluridine/tipiracil. Hematological adverse reactions were, on average, 0.4 ± 0.5/patient with regorafenib and 1.5 ± 0.9 with trifluridine/tipiracil. General (77.8%) and gastrointestinal disorders (50%) were common with both drugs.

Conclusions:
The effectiveness results of standard clinical practice are lower than those described in CTs and in the literature. The toxicity profile does reproduce what is described in the bibliography.
A prospective randomized comparison of simultaneous integrated boost with sequential boost intensity-modulated radiotherapy in locally advanced head and neck cancer
Authors: Mani Nilesh , Aggarwal Sushil K. , Kumar Ishan , Mandal Abhijit , Jaiswal Garima , Ranjan Rakesh , Jaiswal Anil K. , Gupta Neha , Singh Ankita , Mourya Ankur , Aggarwal Lalit M. , Choudhary Sunil 
Published: December 2022

Purpose:
A comparison of simultaneous integrated boost (SIB) with sequential boost (SEQ) using intensity-modulated radiotherapy along with concurrent cisplatin in locally advanced head and neck cancer (HNC) was made with regard to their survival outcomes and toxicity profile.

Materials and Methods:
A total of 34 patients were enrolled between October 2016 and March 2019. They were randomized into two arms, SIB and SEQB. All patients were treated with 6 MV photon beam on Linear Accelerator with weekly concurrent cisplatin at 35 mg/m2. Overall survival (OS) and disease-free survival (DFS) were the primary end points and acute and late toxicities were the secondary end points.

Results:
The median follow-up period was 40.6 and 37.3 months for SIB and SEQB, respectively. At the end of 5 years, the median OS was 40.6 and 37.3 months (P = 0.947) and the median DFS was 35.1 and 37.3 months in the SIB and SEQB arms, respectively (P = 0.991). Complete response at 3 months was 64.7% and 76.5% and partial response was 23.5% and 17.6%, whereas progressive disease was 11.8% and 5.9% in SIB and SEQB arms, respectively. Acute dermatitis, mucositis, dysphagia, and salivary gland toxicities were higher in the SIB arm compared to the SEQB arm.

Conclusion:
SIB and SEQ arms were comparable in terms of OS and DFS. However, the acute toxicities were higher in the SIB arm, although the difference was not significant, compared to the SEQB arm.
Comparison of normal tissue doses in deep inspiration breath-hold and free breathing methods for radiotherapy of left-sided breast cancer using 4D-XCAT digital phantom
Authors: Shahzadeh Sara , Barough Mehdi Salehi , Ganjoorian Hamed , Gholami Somayeh 
Published: December 2022

Purpose:
To evaluate normal lung and heart tissue doses for treatment of left-sided breast cancer in deep inspiration breath-hold (DIBH) and free breathing (FB) as a function of breast size and diaphragm displacement using 4D-XCAT digital phantom in a simulation study.

Materials and Methods:
4D-XCAT digital phantom was used to create 36 left-sided breast cancer digital phantom datasets with different breast height (BH) of 40, 50, and 60 mm, breast length (BL) of 16, 17, and 18 mm, and diaphragm excursion of 20, 25, 30, and 35 mm. For each dataset, DIBH and FB treatment plans were prepared using planning computerized radiotherapy-three dimensional (PCRT-3D) treatment planning system (TPS) with superposition computational algorithm. Dose differences in DIBH and FB plans were assessed in terms of mean lung dose (MLD), the lung volume receiving ≤20 Gy (V20), normal tissue complication probability (NTCP) of the lung, mean heart dose (MHD), and the heart volume receiving ≤30 (V30).

Results:
DIBH reduced mean dose and V20 and NTCP of the lung in all cases, by up to 4.37 Gy, 7.62%, and 18.95%. Mean dose and V30 of the heart were also significantly reduced by 5.02 Gy and 8.23%.

Conclusions:
The use of DIBH for left-sided breast cancer radiotherapy offers excellent possibilities for sparing critical normal tissue without compromising radiation dose to the target.
Promoter methylation status of key genes and its implications in the pathogenesis of endometriosis, endometrioid carcinoma of ovary and endometrioid endometrial cancer
Authors: Kumari Priti , Sharma Indu , Saha Subhas Chandra , Srinivasan Radhika , Sharma Anuradha 
Published: December 2022

Background:
Epigenetic processes play an important role in various physiological processes as well as in the pathogenesis of many diseases. The role of altered DNA methylation in the pathogenesis of endometriosis and associated ovarian and endometrial cancers has not been explored in detail. Therefore, this study aimed to determine the promoter methylation status of genes involved in key biological processes in the pathogenesis of these three gynecological diseases.

Methods:
Tissue samples of endometriosis, endometrioid carcinoma of the ovary, endometrioid endometrial cancer, and control endometrium (n = 10 each) were obtained. DNA was extracted and subjected to bisulfite conversion using commercially available kits. The methylation status of COX2, VEGF, HIF1A, TNF, MYC, and TP53 genes was checked by methylation-specific PCR. The mRNA levels of MYC and TP53 were determined using qRT-PCR in all tissue samples.

Results:
The promoter methylation status of COX2, VEGF, HIF1A, and TNF genes was significantly reduced in all three diseased study subjects (P < 0.05), whereas no significant difference was observed in the promoter methylation frequency of MYC and TP53 genes. Transcriptional expression of the MYC gene was significantly increased in all diseased groups (P < 0.001) whereas, transcriptional expression of the TP53 gene was significantly reduced in endometriosis and endometrioid carcinoma of the ovary and significantly increased in endometrioid endometrial cancer subjects compared to control subjects (P < 0.001).

Conclusion:
The findings suggest that the promoter regions of pro-inflammatory and pro-angiogenic genes involved in the common molecular pathophysiology of these three disorders were significantly hypomethylated and could be the reason for their over-expression associated with them. This indicates the role of epigenetics in the pathogenesis of these three diseases.