Surgical outcomes of T4b oral cancers: assessment of prognostic factors and a need to re-evaluate the current staging system.

T4b oral cancer is a broad umbrella term for all advanced oral cancers, the prognosis of which varies drastically for disease of the same stage, according to the extent of the masticator space involvement. This was a retrospective observational study including all consecutive T4b oral squamous cell carcinoma patients treated surgically between January 2015 and January 2016 and followed up until January 2020. The disease was classified as upper disease or lower disease based on the anatomical location in relation to an imaginary plane passing through the base of the retromolar trigone. The prime objective was to evaluate overall survival and prognostic factors affecting overall survival. The projected 5-year overall and disease-free survival rates were 40.7% and 35.6%, respectively. The assessment of prognostic factors revealed that lower disease (lower anatomical subsites), bone invasion, and lymph nodal spread significantly affected survival. Patients with disease in an upper anatomical location without bone and nodal involvement can achieve fairly good survival (projected 5-year overall survival of 64.2%) when compared to the other subsets of patients. We propose a re-evaluation of the current staging system based on the prognostic features, so that all patients are not considered under a single stage, since their survival differs significantly.

A proposed "Radiological Evaluation Score for Bone Tumors" (REST): An objective system for assessment of a radiograph in patients with suspected bone tumor.

BACKGROUND: Although radiographs have been widely used in the evaluation of patients with suspected bone tumors, the lack of an objective radiological assessment method leads to a challenge in reaching correct diagnosis. The study aimed to propose a Radiological Evaluation Score for Bone Tumors (REST) which includes eight radiological factors [characteristics, content, cortical breach, distinctiveness, distribution, periosteal reaction, fracture, and soft tissue swelling] to form a single score along with its validation by multidisciplinary observers. METHODS: We reviewed the radiographs of 100 patients with a primary bone tumor which were selected at random from the database between January 2017 and January 2019 of a tertiary cancer center. Four reviewers (two orthopedic oncologists and two surgical oncologists) independently assessed the radiographs, based on the reporting system of REST. We constituted two groups according to the probable diagnosis of bone tumor (suspected benign tumor and suspected malignant tumor). RESULTS: The mean score in the suspected benign tumor group was 1.1 (range 0-3, 95% CI 0.8-1.3) and in malignant tumor group was 6.1 (range 2-8, 95% CI 5.8-6.4). A receiver operator characteristic (ROC) curve for REST was with a cutoff of 3.5, with the most diagnostic value area under curve (AUC) of 0.99. The sensitivity was 98% and specificity was 100% with a positive predictive value of 100% and a negative predictive value of 98%. The inter-observer correlation coefficient was 0.985 (p value < 0.05), and Fleiss kappa value for the prediction of the benign or malignant lesion was 0.97 (p value < 0.05). The characteristics and content of tumor, cortical erosion, distinctiveness, distribution, periosteal reaction, and soft tissue mass had a significant correlation with the aggressiveness of bone lesion p value < 0.05. CONCLUSIONS: The Radiological Evaluation Score for Bone Tumors (REST) is a structured reporting and objective method for the assessment of radiographs in patients with suspected bone tumors. This method is a reliable and helpful tool for clinicians in their outdoor patient department to differentiate a radiograph of a suspected benign tumor from a malignant bone tumor.

Salvage surgery for recurrent carcinoma of the oral cavity: assessment of prognostic factors.

Salvage surgery is the most acceptable therapeutic option for disease control of loco-regional recurrences in oral cancers. Prognostic factors need to be assessed to select patients for salvage surgery who would benefit the most. This was a single-centre retrospective observational study conducted between 2015 and 2018. A total of 168 patients with recurrent oral cavity carcinoma who underwent salvage surgery were included for analysis. The primary endpoints of the study were to evaluate overall survival (rOS) after salvage surgery and prognostic factors affecting survival. In this study, the median rOS was 18 months and the median disease-free survival (rDFS) was 14 months. Advanced stage (hazard ratio (HR) 2.387, 95% confidence interval (CI) 1.496-3.808; P = 0.001) and multimodality treatment (HR 1.642, 95% CI 1.139-2.367; P = 0.008) in the initial disease, as well as nodal spread (HR 3.794, 95% CI 1.580-9.111; P = 0.008) and perineural invasion (HR 2.167, 95% CI 1.358-3.455; P = 0.001) in the recurrent disease, were found to adversely affect survival after salvage surgery. With thorough assessment of the prognostic factors and appropriate patient selection, survival may be favourable after salvage surgery for recurrent oral cavity carcinoma.

A proposed ''A to Z RAM (Radiograph Assessment Method)'' for triage of patients with a suspected bone tumour.

INTRODUCTION: We propose a ''A to Z RAM (Radiograph Assessment Method)'' for evaluation of Radiograph of patients with a suspected bone tumour. METHODS: In the current study, ten radiological features with letters 'A, B, C, D, E, F and Z' were used and which included the age of the patient, involved part of the bone, characteristics, content, distinctiveness, the exterior of the bone, fracture, and zone of transition. Four independent observers (orthopaedic oncologists and surgical oncologists) evaluated a set of 30 radiographs of bone tumour selected at random from our hospital database based on A to Z RAM. We classified the lesions into two groups according to the traffic signal system; Green (suspected benign lesion) and Red (suspected malignant lesion). RESULTS: There were 18 (60%) benign bone lesions and 12 (40%) malignant lesions in the current study. 91.6% of malignant tumours and 88.8% of the benign tumours were identified correctly by the four observers. The inter-observer variability with Fleiss kappa was 0.884 (95% CI 0.7-1.03 p-value < 0.05), suggestive of agreement not by chance. These radiographs were again reassessed by the four observers after 3 months. The interobserver variability by Fleiss kappa was 1.0 (95% CI 0.8-1.1) suggesting complete agreement amongst the observers. Both orthopaedic oncologists had intra-observer kappa as 1.0 each and both surgical oncologists had 0.795 and 0.930 respectively. CONCLUSION: The proposed A to Z RAM is an easy to use and reproducible method for reviewing radiographs in the out-patient department along with clinical findings for better management of patients with suspected bone lesions. The A to Z RAM can be a medical triage tool and subdivide bone lesions into two subgroups i.e. suspected benign lesion with a suggestion of further investigations with MRI and biopsy and suspected malignant lesion with a suggestion of MRI or early referral to a tertiary cancer center with expertise in orthopaedic oncology. IMPLICATIONS FOR PRACTICE: The A to Z RAM (Radiologic Assessment Method) is a reproducible method for reviewing radiographs in the out-patient department and can be an aid for better management of patients. A to Z RAM is useful as a medical triage system, subdividing patients according to the probable diagnosis into a suspected benign lesion and suspected malignant lesion.

Livestock vaccination in India: an analysis of theory and practice among multiple stakeholders.

An effective and efficient disease prevention and control strategy is of paramount importance to improve the quality and quantity of livestock production in the Indian context. Although livestock vaccination is considered an emerging innovation of socioeconomic importance in the Indian dairy industry, the rate of adoption and diffusion of vaccination technology is very low at field level. In this context, the authors examined the efforts of the Government of India to protect livestock health and control disease, considered the lessons learnt from rinderpest eradication, looked at field practices and the reality on the ground, and studied the perceptions of multiple stakeholders with regards to the relevance, profitability and sustainability of vaccination. In this study, the authors consider policy implications for the Indian dairy industry using the responses of 360 dairy farmers, 80 research scientists and 40 extension workers in India. The study revealed that scientists and extension experts rated vaccination highly in terms of its relevance, profitability and sustainability, while the perception of farmers was less favourable. The study also observed that, even after implementation of various disease control programmes with heavy financial expenditure, there was a wide gap between farmers and scientists and between farmers and extension workers with regards to their perceptions of the relevance, profitability and sustainability of vaccination, while the gap was very narrow between scientists and extension workers. It can be concluded, therefore, that there is a need to generate innovations for disease control that are perceived as relevant, profitable and sustainable so as to encourage higher levels of diffusion and adoption at field level. This study recommends that farmers partner with researchers and extension workers to ensure effective generation and transfer of new dairying technologies, leading to higher production and productivity in the Indian dairy sector.

En Inde, l'amélioration qualitative et quantitative de la productivité des élevages passe nécessairement par la mise en place de stratégies efficaces et efficientes de prévention et de contrôle des maladies animales. Les producteurs de lait et de produits laitiers considèrent la vaccination du bétail comme une innovation importante au plan socio-économique mais le niveau d'adoption et de diffusion des technologies vaccinales demeure très faible sur le terrain. Ce constat a incité les auteurs à effectuer une étude visant à analyser les efforts déployés par le gouvernement indien pour protéger la santé du bétail et pour lutter contre les maladies, à déterminer le niveau de prise en compte des leçons de l'éradication de la peste bovine, et à décrire les pratiques et la situation concrète sur le terrain ainsi que la manière dont les diverses parties prenantes perçoivent la pertinence, la rentabilité économique et les effets dans le temps de la vaccination. Dans cette étude, les auteurs ont interrogé 360 éleveurs de vaches laitières, 80 chercheurs et 40 agents de vulgarisation en Inde afin de déterminer les effets des politiques zoosanitaires sur le secteur de l'élevage laitier indien. L'étude a montré que la pertinence, la rentabilité économique et les effets dans le temps de la vaccination étaient perçus très favorablement par les chercheurs et par les agents de vulgarisation, tandis que la perception des éleveurs était moins positive. L'étude a également permis de constater que l'écart manifeste entre la perception des éleveurs d'un côté et celle des chercheurs et des agents de vulgarisation de l'autre concernant la pertinence, la rentabilité et l'effet dans le temps de la vaccination subsistait même après la mise en oeuvre à grands frais de programmes de lutte contre les maladies animales, tandis que cet écart était minime entre les chercheurs et les agents de vulgarisation. Les auteurs concluent sur la nécessité de veiller à ce que les innovations mises en place en matière de lutte contre les maladies animales soient perçues comme pertinentes, rentables et durables, afin de promouvoir une meilleure appropriation et diffusion de ces méthodes sur le terrain. Les auteurs préconisent le recours à des partenariats entre les éleveurs, les chercheurs et les agents de vulgarisation afin d'assurer une conception et un transfert efficaces des technologies dans le secteur de la production de lait et d'améliorer ainsi la production et la productivité du secteur laitier indien.

En el contexto de la India, para mejorar la producción bovina tanto en calidad como en cantidad es de capital importancia disponer de una estrategia eficaz y eficiente de prevención y control de enfermedades. Aunque la vacunación del ganado está considerada una innovación incipiente de gran importancia socioeconómica para el sector lechero del país, sobre el terreno se dan índices muy bajos de adopción y difusión de las técnicas de vacunación. En tales circunstancias, los autores examinaron las iniciativas del Gobierno de la India para proteger la salud del ganado y combatir sus enfermedades, repasaron las enseñanzas extraídas de la erradicación de la peste bovina, observaron la praxis y las realidades sobre el terreno e indagaron en la percepción que tienen numerosos interlocutores del sector de la pertinencia, rentabilidad y sostenibilidad de las vacunaciones. A partir de las respuestas aportadas por 360 productores, 80 investigadores y 40 agentes de extensión del país, los autores estudian las repercusiones normativas para la industria lechera india. El proceso puso de manifiesto que los científicos y especialistas en extensión otorgan a la vacunación un lugar de privilegio por lo que respecta a su pertinencia, rentabilidad y sostenibilidad, mientras que a los productores les merece una opinión menos positiva. Los autores observaron igualmente que, aun tras la implantación de diversos programas de lucha zoosanitaria que supusieron cuantiosas inversiones económicas, existía un gran desfase entre los productores, por un lado, y los científicos y agentes de extensión, por el otro, en cuanto a la valoración que hacían de la pertinencia, rentabilidad y sostenibilidad de las vacunaciones, mientras que las opiniones de científicos y agentes de extensión apenas diferían. Cabe concluir, por lo tanto, que para inducir sobre el terreno mayores niveles de adopción y difusión es indispensable generar innovaciones de lucha zoosanitaria que sean percibidas como algo pertinente, rentable y sostenible. Los autores recomiendan que los productores trabajen en asociación con los investigadores y agentes de extensión para lograr así que se generen y transfieran eficazmente nuevas tecnologías de producción lechera, lo que a su vez redundará en un aumento de la producción y productividad del sector lechero indio.

A retrospective clinicopathological study of 131 cases with endometrial cancers--is it possible to define the role of retroperitoneal lymphadenectomy in low-resource settings?

AIM: The study objectives were evaluation of clinicopathological characteristics, correlations between the preoperative and postoperative tumor grades, and their implications on lymph node metastasis. MATERIALS AND METHODS: We conducted a retrospective descriptive study of 131 cases of endometrial cancer examined and treated at a tertiary regional cancer institute between the years 2003 and 2009. We reviewed the oncology database as well as the clinical records and surgico-pathological registry of all these patients. Statistical Methods Used: All the summary measure computation and Chi-square test for comparing more than one proportion was done in spreadsheet (Excel). RESULTS: The multiparity association with endometrial cancer was commonly seen 113/131 (86.2%). Twelve (9.7%) patients preoperatively diagnosed as Grade 1 tumors upgraded to Grade 3 changes in postoperative specimens and six of these 12 patients (50%) had lymph node metastasis. A total of 14/131 (10.6%) cases had lymph nodes metastasis. CONCLUSIONS: There is a poor correlation between the preoperative and the postoperative tumor grades. Routine pelvic lymphadenectomy may be a valuable method in low-risk cases and para-aortic lymphadenectomy may be limited to high-risk endometrial cancers.

Women and political representation.

PIP: A remarkable progress in women's participation in politics throughout the world was witnessed in the final decade of the 20th century. According to the Inter-Parliamentary Union report, there were only eight countries with no women in their legislatures in 1998. The number of women ministers at the cabinet level worldwide doubled in a decade, and the number of countries without any women ministers dropped from 93 to 48 during 1987-96. However, this progress is far from satisfactory. Political representation of women, minorities, and other social groups is still inadequate. This may be due to a complex combination of socioeconomic, cultural, and institutional factors. The view that women's political participation increases with social and economic development is supported by data from the Nordic countries, where there are higher proportions of women legislators than in less developed countries. While better levels of socioeconomic development, having a women-friendly political culture, and higher literacy are considered favorable factors for women's increased political representation, adopting one of the proportional representation systems (such as a party-list system, a single transferable vote system, or a mixed proportional system with multi-member constituencies) is the single factor most responsible for the higher representation of women.^ieng