Tolerance and toxicity of neoadjuvant docetaxel, cisplatin and 5 fluorouracil regimen in technically unresectable oral cancer in resource limited rural based tertiary cancer center

BACKGROUND

Recent studies indicate neoadjuvant chemotherapy (NACT) can result in R0 resection in a substantial proportion of patients with technically unresectable oral cavity cancers. However, data regarding the efficacy and safety of docetaxel, cisplatin and 5 fluorouracil (TPF) NACT in our setting is lacking. The present audit was proposed to evaluate the toxicities encountered during administration of this regimen. It was hypothesized that TPF NACT would be considered feasible for routine administration if an average relative dose intensity (ARDI) of ≥0.90 or more in at least 70% of the patients.

MATERIALS AND METHODS

Technically unresectable oral cancers with Eastern Cooperative Oncology Group PS 0-2, with biopsy proven squamous cell carcinoma underwent two cycles of NACT with TPF regimen. Toxicity and response rates were noted following the CTCAE 4.03 and RECIST criteria. Descriptive analysis of completion rates (completing 2 cycles of planned chemotherapy with ARDI of 0.85 or more), reason for delay, toxicity, and response are presented.

RESULTS

The NACT was completed by all patients. The number of subjects who completed all planned cycles of chemotherapy are with the ARDI of the delivered chemotherapy been equal to or >0.85 was 11 (91.67%). All toxicity inclusive Grade 3-5 toxicity was seen in 11 patients (91.67%). The response rate of chemotherapy was 83.33%. There were three complete response, seven partial response, and two stable disease seen post NACT in this study.

CONCLUSION

Docetaxel, cisplatin and 5 fluorouracil regimen can be routinely administered at our center with the supportive care methods and precautionary methods used in our study.

Spectral Reflectance Properties of Gossypium hirsutum Leaves after Heavy Metal Toxicity

The study demonstrated a link between heavy metal induced stress and optical properties of the leaves of Gossypium hirsutum. This work was conducted using the pot culture experiment. Three replications and four concentrations of Chromium (5%, 10%, 20% and 35%) with a control to assess the growth of plants were used. This experiment was conducted till 80 days. On 80th day the experiment was terminated and the leaves were plucked and air-dried. Portion of the air-dried, powdered cotton leaves was used for the Fourier Transformed Infra-Red (FT-IR) spectral analysis and the remaining portion was used for analyzing the biochemical constituents of the leaves (chlorophyll a, b, and total C and N contents). The Fourier Transformed Infra-Red spectrum indicated the aliphatic alcohol, inorganic bridge, C-OH stretch, C-H deformation, aromatic C=C stretch, OH stretch of H bond, aliphatic C-H stretch and OH stretch of aromatic C-H. The shifting and overlapping of the spectrum was observed after heavy metal induced toxicity when compared with that of the control spectra. This was supported by the biochemical analysis of chlorophyll a, b, and total carbon and nitrogen contents. This method was a preliminary study, which may be instrumental in developing optimal procedures for interpreting a particular stress of plants through analysis of their leaf reflectance spectrum.

Vitamin D deficiency in childhood-a review of current guidelines on diagnosis and management

Vitamin D deficiency has emerged as a significant public health problem throughout the world. Even in the Indian context,it has been reported to be present in majority of children in spite of wide availability of sunlight. Recent guidelines have defined vitamin D status as severe deficiency, deficiency, sufficiency and risk for toxicity as 25(OH)D levels <5, <15, >20 and >50ng/mL, respectively.The manifestations of deficiency may vary from hypocalcemic seizures, tetany in infancy and adolescence to florid rickets in toddlers. Treatment is necessary for all individuals with deficiency whether symptomatic or not and consists of vitamin D supplementation as Stoss therapy or daily or weekly oral regimens with equal efficacy and safety, combined with calcium supplements. Routine supplementation starting from newborn period is being increasingly endorsed by various international organizations. Prevention by sensible sunlight exposure, food fortification and routine supplementation are the currently available options for tackling this nutritional deficiency.

Risks of concomitant trauma to the knee in lower limb long bone shaft fractures: A retrospective analysis from a prospective study population

BACKGROUND

Numerous associated injuries (bony and/or soft tissue lesions) occur commonly in conjunction with fractures of the femoral shaft in young patients after high-energy injuries. Knee ligamentous injuries, historically called as the internal derangements of the knee or IDK, are mostly not visible in plain radiographs taken in the emergency and these injuries are likely to be overlooked by clinicians because first attention always goes to open wounds and radiologically visible injuries of the limb whenever a patient is received in a trauma unit.

MATERIALS AND METHODS

A total of 93 cases of lower limb long bone fractures were retrospectively analyzed from materials of a prospective study conducted on consecutive patients having high-velocity injuries to lower limb long bones with a view to confirm or rule out concomitant ipsilateral IDK in cases of femoral and tibial shaft fractures, that already employed a policy of focused clinical examination followed by arthroscopy of the ipsilateral knee, immediately after operative fracture fixation under the same anesthesia. The goal was to determine the incidence of concomitant internal derangement of the ipsilateral knee and to understand any value of adding arthroscopy to detect concomitant IDK in lower limb long bone fractures besides careful intraoperative examination to propose a recommendation thereof.

RESULTS

Concomitant knee injury was found in 14 femoral fractures and 1 tibial fracture. Fifteen out of 93 (16%) such cases had concomitant knee ligamentous or meniscal injures. A total of 13 anterior cruciate and 4 posterior cruciate tears, 11 collateral ligament tears, and 10 meniscal injuries were confirmed in these 15 knees. Femoral shaft fractures were associated with a high incidence of serious ligamentous, meniscal, and chondral injury. Twelve out of 41 femoral fractures had chondral injuries (contusion), especially of the patello-femoral articulation, identifiable during arthroscopy.

CONCLUSION

One should have high index of suspicion about internal knee injuries and capsule-ligamentous injuries while dealing with femoral shaft fractures in particular. Arthroscopy of knee may safely enhance the diagnosis of simultaneous IDK. We propose that when MR imaging is not possible and when contraindication for arthroscopy does not exist, a careful clinical examination followed by arthroscopy of the knee may be considered a useful adjunct in femoral shaft fractures as it can readily confirm IDK by its ability to objectively look, probe, and distinguish fragile tissue from a normal one. Further study in larger number of subjects is needed to validate our findings.

The six degrees of freedom motion of the human head, spine, and pelvis in a frontal impact

OBJECTIVE

The goal of this study is to characterize the in situ 6-degree-of-freedom kinematics of the head, 3 vertebrae (T1, T8, and L2), and the pelvis in a 40 km/h frontal impact.

METHODS

Three postmortem human surrogates (PMHS) were exposed to a deceleration of 15 g over 125 ms and the motion of selected anatomical structures (head, T1, T8, L2, and pelvis) was tracked at 1000 Hz using an optoelectric stereophotogrammetric system. Displacements of the analyzed structures are reported in the sagittal and the transverse planes. Rotations of the structures are described using the finite helical axis of the motion.

RESULTS

Anterior displacements were 530.5 ± 39.4 mm (head), 434.7 ± 20.0 mm (T1), 353.3 ± 29.6 mm (T8), 219.9 ± 19.3 mm (L2), and 78.9 ± 22.1 mm (pelvis). The ratio between peak anterior and lateral displacement was up to 19 percent (T1) and 26 percent (head). Magnitudes of the rotation of the head (69.9 ± 1.5°), lumbar (66.5 ± 9.1°), and pelvis (63.8 ± 11.8°) were greater than that of the thoracic vertebrae (T1: 49.1 ± 7.8°; T8: 47.7 ± 6.3°). Thoracic vertebrae exhibited a complex rotation behavior caused by the asymmetric loading of the shoulder belt. Rotation of the lumbar vertebra and pelvis occurred primarily within the sagittal plane (flexion).

CONCLUSION

Despite the predominance of the sagittal motion of the occupant in a pure (12 o'clock) frontal impact, the asymmetry of belt loading induced other relevant displacements and rotations of the head and thoracic spine. Attempts to model occupant kinematics in a frontal impact should consider these results to biofidelically describe the interaction of the torso with the belt.

Non-linear modeling using fuzzy principal component regression for Vidyaranyapuram sewage treatment plant, Mysore - India

Fuzzy principal component regression (FPCR) is proposed to model the non-linear process of sewage treatment plant (STP) data matrix. The dimension reduction of voluminous data was done by principal component analysis (PCA). The PCA score values were partitioned by fuzzy-c-means (FCM) clustering, and a Takagi-Sugeno-Kang (TSK) fuzzy model was built based on the FCM functions. The FPCR approach was used to predict the reduction in chemical oxygen demand (COD) and biological oxygen demand (BOD) of treated wastewater of Vidyaranyapuram STP with respect to the relations modeled between fuzzy partitioned PCA scores and target output. The designed FPCR model showed the ability to capture the behavior of non-linear processes of STP. The predicted values of reduction in COD and BOD were analyzed by performing the linear regression analysis. The predicted values for COD and BOD reduction showed positive correlation with the observed data.

5,5,7,12,12,14-Hexamethyl-1,8-bis-(4-nitro-benz-yl)-1,4,8,11-tetra-aza-cyclo-tetra-deca-ne

The asymmetric unit of the title compound, C₃₀H₄₆N₆O₄, contains one half-mol­ecule. The C(benzene)—C(CH₂)—N—C(—Me) torsion angle is −79.89 (13)° suggesting a synclinal orientation of the nitro­benzene ring with respect to the macrocycle. The conformation of the macrocycle is stabilized by intra­molecular N—H⋯N hydrogen bonds.

Factor analysis and discriminant analysis of wastewater quality in Vidyaranyapuram sewage treatment plant, Mysore, India: a case study

Wastewater treatment plant monitoring is an essential part of effective wastewater management. The analysis of eight physico-chemical parameters of untreated wastewater was carried out at Vidyaranyapuram sewage treatment plant, Mysore, India. Factor analysis (FA) was applied to the untreated wastewater data matrix, and pollution was found to be the most contributing factor, explaining 22.31% of the total variance (chloride, biochemical oxygen demand, chemical oxygen demand and total dissolved solids). The second most contributing factor was found to be nitrification which explained 21.11% of the total variance (pH and nitrate), whereas the salinization factor contributed 16.98% of the total variance (total solids and total suspended solids). FA regression scores could not satisfactorily classify the data matrix with respect to the seasonal variations. Discriminant analysis (DA) was used to find the seasonal variations in the data matrix, and the standard mode DA explained 66.6% of total variance by grouping the cases with respect to seasons.

Accuracy of spot urine protein creatinine ratio in measuring proteinuria in chronic kidney disease stage 3 and 4

We studied the accuracy of spot urine protein creatinine ratio (SpUr-PCR) to assess 24 h urine protein excretion (24 h-UP) in patients with chronic kidney disease (CKD). A total of 100 proteinuric CKD patients of stages 3 and 4 were studied. 24 h urine was collected to measure 24 h-UP and creatinine. A random day time urine sample was analyzed to measure the PCR. A formula to estimate 24 h creatinine excretion was derived from linear regression analysis and a correction factor was introduced to assess whether this improves the accuracy of the SpUr PCR in predicting 24 h-UP. Accuracy of the SpUr-PCR was assessed by Pearson's correlation, regression analysis, and Bland Altman analysis. Mean age was 51.85 ± 12 years and 81% of the patients were male. SpUr-PCR predicted 24 h-UP with good accuracy (r = 0.86 on a data transformed to a logarithmic scale, P < 0.001) and there was a good agreement between these two measures of proteinuria. However, SpUr-PCR was inaccurate in the subgroup with nephrotic range proteinuria (r = 0.35, P = 0.062), but when a correction factor for 24-h urine creatinine (24 h-UCr) was introduced, the accuracy of SpUr-PCR improved significantly in this group (r = 0.45, P = 0.013). Introduction of the correction factor improved the degree of agreement between these two measures in women, but not the correlation. Overall, SpUr-PCR accurately predicted 24 h-UP. Adding a correction factor for 24 h-UCr improved correlation in the subgroup of patients with the nephrotic range proteinuria and the degree of agreement in female patients, and hence may be used in expressing proteinuria measured by SpUr-PCR to improve its accuracy in them.

High voltage electrical burn injuries in teenage children: case studies with similarities (an Indian perspective)

From 1992 to 2012, a total of 911 paediatric burns were admitted and treated at Kanchi Kamakoti Childs Trust Hospital Intensive Burn Care Unit, of these 28 children had suffered electrical injuries and burns. 7 teenagers suffered high voltage electrical burn injuries: 2 were involved in train accidents which caused fatal electrical injuries, and 5 had electrical burn injuries caused by similar types of accidents, requiring Paediatric Intensive Care Unit (PICU) care, repeated surgeries and extensive rehabilitation. A common factor among these latter 5 patients was that they were injured by overhead high electrical voltage cables. Their management was labour intensive and highly costly. In this report, the type of accident, the electrical voltage that produced burns and the treatment details are elaborated. Findings included similarities in age and type of accident, and failure to implement safety procedures and apply standard norms of high voltage transmission feeder lines.

Quality evaluation of millet-soy blended extrudates formulated through linear programming

Whole pearl millet, finger millet and decorticated soy bean blended (millet soy) extrudates formulations were designed using a linear programming (LP) model to minimize the total cost of the finished product. LP formulated composite flour was extruded through twin screw food extruder at different feed rate (6.5-13.5 kg/h), screw speed (200-350 rpm, constant feed moisture (14% wb), barrel temperature (120 °C) and cutter speed (15 rpm). The physical, functional, textural and pasting characteristics of extrudates were examined and their responses were studied. Expansion index (2.31) and sectional expansion index (5.39) was found to be was found maximum for feed rate and screw speed combination 9.5 kg/h and 250 rpm. However, density (0.25 × 10(-3) g/mm(3)) was maximum for 9.5 kg/h and 300 rpm combination. Maximum color change (10.32) was found for 9.5 kg/h feed rate and 200 rpm screw speed. The lower hardness was obtained for the samples extruded at lowest feed rate (6.5 kg/h) for all screw speed and feed rate at 9.5 kg/h for 300-350 rpm screw speed. Peak viscosity decreases with all screw speed of 9.5 kg/h feed rate.

A synthetic formulation, Dhanwantharam kashaya, delays senescence in stem cells

OBJECTIVES

Mesenchymal stem cells (MSCs) derived from post-natal tissues offer a suitable source of MSCs for cellular therapy. Limitation of the use of MSCs for therapeutic purposes is attributed to the onset of senescence and slowing down of proliferation upon repeated passaging. Dhanwantram kashaya (DK), a synthetic herbal formulation, is widely used in Ayurvedic medicine as a growth stimulant in children and for nerve regeneration. In this study, we evaluated the effects of DK on the proliferation, viability and senescence of human Wharton jelly MSCs (WJMSCs) in vitro.

RESULTS

Using the MTT proliferation assay and live/dead trypan blue analysis, we found that DK increased proliferation of WJMSCS up to three folds when supplemented in the culture media. The BrdU cell proliferation assay showed a substantial increase in WJMSCs treated with DK. Notably, the β-galactosidase senescence assay revealed that drug treated WJMSCs at late passage still had intact and viable WJMSCs whereas the untreated cells exhibited profound senescence.

CONCLUSION

These studies indicate that DK enhances the quality of WJMSCs by not only increasing the proliferation rate and decreasing their turnover time but also by delaying senescence. We have, thus, identified for the first time that a traditional Ayurvedic formulation, Dhanwantram kashaya, used as a growth enhancer, is able to improve the yield and quality of stem cells in vitro and could be an effective non-toxic supplement for culturing WJMSCs for clinical applications.

Reference values for oxygen saturation by pulse oximetry in healthy children at sea level in Chennai

There is little information on oxygen saturation (SaO2) values in children in developing countries.

AIM

To determine the reference values for oxygen saturation by pulse oximetry in healthy children living at sea level in Chennai and aged between 1 mth and 5 yrs.

DESIGN AND SETTING

A prospective study was conducted in Kanchi Kamakoti CHILDS Trust Hospital from February to May 2005.

METHODS

A total of 626 healthy children aged between 1 mth and 5 yrs were examined for heart rate, respiratory rate and SaO2.

RESULTS

The mean SaO2 levels for children in the age groups 1-3 mths, 3 mths to 1 yr, 1-3 years and 3-5 years were 98.5%, 98.8%, 98.9% and 99.1%, respectively. The overall mean and median SaO(2) values for the children in the different age groups were 99%. The mean -2 SD values of oxygen saturation in the age groups were 96.5%, 96.4%, 96.3% and 97.1%, respectively, with an overall mean of 96.6%.

CONCLUSION

The reference value for mean SaO2 in healthy children aged between 1 mth and 5 yrs and living at sea level in Chennai city was 98.5% or more, but the -2SD values had a mean of 96.6%.

β1-Integrin cytoskeletal signaling regulates sensory neuron response to matrix dimensionality

Neuronal differentiation, pathfinding and morphology are directed by biochemical cues that in vivo are presented in a complex scaffold of extracellular matrix. This microenvironment is three-dimensional (3D) and heterogeneous. Therefore, it is not surprising that more physiologically-relevant cellular responses are found in 3D culture environments rather than on two-dimensional (2D) flat substrates. One key difference between 2D and 3D environments is the spatial arrangement of cell-matrix interactions. Integrins and other receptor proteins link the various molecules presented in the extracellular environment to intracellular signaling cascades and thus influence a number of neuronal responses including the availability and activation of integrins themselves. We have previously reported that a 3D substrate induces an important morphological transformation of embryonic mouse dorsal root ganglion (DRG) neurons. Here, we investigate the hypothesis that β1-integrin signaling via focal adhesion kinase (FAK) and the RhoGTPases Rac and Rho influences neuronal morphology in 2D vs 3D environments. We report that β1-integrin activity and FAK phosphorylation at tyrosine 397 (FAKpY397) are linked to neuronal polarization as well as neurite outgrowth and branching. Rac and Rho expression are decreased in 3D vs 2D culture but not correlated with β1-integrin function. These results suggest that proper β1-integrin activity is required for the elaboration of physiologic DRG morphology and that 3D culture provides a more appropriate milieu to the mimic in vivo scenario. We propose that neuronal morphology may be directed during development and regeneration by factors that influence how β1-integrin, FAK and RhoGTPase molecules integrate substrate signals in the 3D microenvironment.

Prophylactic central neck dissection for papillary thyroid cancer (Br J Surg 2013; 100: 410–418)

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