Neoadjuvant chemoradiation versus adjuvant chemotherapy for locally advanced adenocarcinoma of the rectosigmoid junction.

AIM: The optimal treatment approach for adenocarcinoma of the rectosigmoid junction remains unclear. The aim of this work was to compare outcomes of neoadjuvant chemoradiation (NCR) and adjuvant chemotherapy (AC) treatment for cancer of the rectosigmoid junction. METHOD: This was a nationwide, retrospective cohort study (2004-2015) using hospital-based cancer outcomes data (National Cancer Database). All patients who underwent resection with curative intent for locally advanced [American Joint Committee on Cancer (AJCC) Stages II and III] adenocarcinoma of the rectosigmoid junction were included. Exclusion criteria were age less than 18 or over 75 years, Charlson-Deyo score > 2, AJCC Stages I and IV and unstaged tumours. Treatment with NCR was compared with treatment with AC, the primary outcome being overall survival. Other end-points were resection margin status, the presence of lymphovascular invasion and postoperative length of stay. RESULTS: A total of 2828 patients were included in this study, of whom 1701 (59.7%) received NCR. NCR was more frequently utilized in patients who were black (10.3% vs 7.6%, P < 0.05) and underwent treatment at academic institutions (37.9% vs 22.5%, P < 0.05). Treatment with NCR did not differentially influence survival following risk adjustment (hazard ratio 1.17, CI 0.98-1.40; P = 0.085). NCR was independently associated with a decreased likelihood of a positive resection margin (OR 0.44, CI 0.33-0.58; P < 0.001) and lymphovascular invasion (OR 0.51, CI 0.40-0.67; P < 0.001). However, treatment with NCR was associated with the need for prolonged hospitalization compared with AC (7.3 days vs 6.5 days; P = 0.015). The study was limited by its retrospective design, external validity and risk of tumour misclassification. CONCLUSION: NCR currently seems to be favoured over AC for the management of locally advanced adenocarcinoma of the rectosigmoid junction. This approach may not be justified as NCR is associated with prolonged hospitalization needs without a clear survival benefit when compared with AC. Prospective studies are warranted to definitively compare outcomes of NCR and AC in this patient population.

A "Global Safety Net" to reverse biodiversity loss and stabilize Earth's climate.

Global strategies to halt the dual crises of biodiversity loss and climate change are often formulated separately, even though they are interdependent and risk failure if pursued in isolation. The Global Safety Net maps how expanded nature conservation addresses both overarching threats. We identify 50% of the terrestrial realm that, if conserved, would reverse further biodiversity loss, prevent CO2 emissions from land conversion, and enhance natural carbon removal. This framework shows that, beyond the 15.1% land area currently protected, 35.3% of land area is needed to conserve additional sites of particular importance for biodiversity and stabilize the climate. Fifty ecoregions and 20 countries contribute disproportionately to proposed targets. Indigenous lands overlap extensively with the Global Safety Net. Conserving the Global Safety Net could support public health by reducing the potential for zoonotic diseases like COVID-19 from emerging in the future.

A Global Deal For Nature: Guiding principles, milestones, and targets.

The Global Deal for Nature (GDN) is a time-bound, science-driven plan to save the diversity and abundance of life on Earth. Pairing the GDN and the Paris Climate Agreement would avoid catastrophic climate change, conserve species, and secure essential ecosystem services. New findings give urgency to this union: Less than half of the terrestrial realm is intact, yet conserving all native ecosystems-coupled with energy transition measures-will be required to remain below a 1.5°C rise in average global temperature. The GDN targets 30% of Earth to be formally protected and an additional 20% designated as climate stabilization areas, by 2030, to stay below 1.5°C. We highlight the 67% of terrestrial ecoregions that can meet 30% protection, thereby reducing extinction threats and carbon emissions from natural reservoirs. Freshwater and marine targets included here extend the GDN to all realms and provide a pathway to ensuring a more livable biosphere.

Correlation of pulmonary function tests with body fat percentage in young individuals.

The present study was planned to assess the correlation of pulmonary functions with body fat percentage in young individuals. A total of 132 (males--68, females--64) young students (18 to 21 years) with moderately sedentary lifestyle were recruited in this study. Their height, weight, body mass index (BMI) and waist to hip ratio (WHR) were measured. Pulmonary function tests (static and dynamic) were recorded on a computerized portable Schiller lung function unit SP-1. The percentage of body fat was estimated by measuring skin fold thickness at four sites (4SFT-biceps, triceps, subscapular and suprailiac) with the help of Harpenden's caliper. In males body fat % showed negative correlation with expiratory reserve volume (ERV), forced vital capacity (FVC), maximum ventilatory volume (MVV), peak expiratory flow rate (PEFR) and forced expiratory volume at the end of first second (FEV1). It was observed that in females body fat % had negative correlation with ERV, FVC, and MVV. These results indicate that increase in percentage of body fat and central pattern of fat distribution may affect the pulmonary function tests.

Microcystic adenoma of pancreas: a case report.

Microcystic adenomas of the pancreas are rare benign neoplasms that occur most frequently in elderly females. Characteristically, the tumors have a spongy gross appearance and are composed of innumerable cysts lined by flat, and cuboidal cells which are rich in glycogen. They commonly present with abdominal discomfort or pain. In this case report, we present a cystic neoplasm of pancreas in a 65-year-old lady who clinically presented with discomfort in the abdomen and hyperglycaemia. Proximal pancreatectomy was done. Histopathological examination of surgical specimen confirmed the diagnosis of "Microcystic Adenoma ofPancreas". Despite of the rarity, microcystic adenoma should kept in the mind as the differential diagnosis of cystic lesions of pancreas.

Cervical thymic cyst: a case report.

Cervical thymic cysts are rare benign lesions. It should be considered in the differential diagnosis of cervical cysts in paediatric age group. This paper presents a case of a 6 years male child who presented with gradually increasing painless mass on right side of neck. Surgical excision was done. Histopathological study revealed features diagnostic of thymic cyst. It was clinically diagnosed as branchial cleft cyst. Though rare, thymic cysts should be included in the differential diagnosis of neck masses, especially in children.

Effect of female sex hormones on cardiorespiratory parameters.

INTRODUCTION: Female sex hormones, estrogen and progesterone regulate various phases of the menstrual cycle. Hormonal changes tend to affect various parameters of physical fitness. Maximum oxygen uptake (VO2 max) is a measure of aerobic power. This study was planned to assess effect of different phases of menstrual cycle on cardiorespiratory parameters like pulse rate, respiratory rate and VO2 max. METHODS: 100 female medical students in the age group of 17-22 years were studied for three consecutive menstrual cycles. Weight, resting pulse rate, respiratory rate and VO2 max were measured during premenstrual phase (20th-25th day) and postmenstrual phase (5th to 10th day). RESULTS: It was observed that there was a significant increase in body weight, pulse rate, and respiratory rate during premenstrual phase. There was a decrease in VO2 max during the premenstrual phase. CONCLUSION: This study indicates that there is decreased cardio-respiratory efficiency during premenstrual phase.

Management of severe cicatricial entropion using shared mucosal grafts.

OBJECTIVE: To retrospectively analyze our experience using nasal turbinate and hard palate mucosal grafts as shared buttress grafts between the upper and lower eyelid for reconstruction in severe cicatricial entropion. SURGICAL TECHNIQUES: A horizontal tarsectomy is performed in the upper and lower eyelid approximately 2 mm posterior to the gray line. The distal tarsal segments are then dissected and rotated 180 degrees. A graft of nasal turbinate mucosa or hard palate mucosa measuring 1.5 x 3 cm is harvested. The graft is sutured to the cut edge of tarsus in the upper and lower eyelid. The rotated distal tarsal segment is stabilized against the graft using 5 mattress sutures. After 3 weeks, the graft is split by sharp dissection between the upper and lower eyelids. METHODS: The medical records of 12 consecutive patients, representing 15 shared buttress grafts, were reviewed. There were 5 hard palate and 10 nasal turbinate mucosal grafts placed. Follow-up ranged from 2 months to 7 years. RESULTS: The amount of corneal stipple, as well as subjective patient comfort, improved after eyelid margin reconstruction in 12 of the 15 eyes. One patient's visual acuity improved by more than 2 lines after surgery. There were no cases of failure of graft survival and no complications directly related to the shared graft technique. Recurrent entropion and trichiasis were noted in 3 eyelids more than a year after graft placement, reflecting ongoing cicatrization in these eyelids. Hard palate mucosal grafts were irritating to the corneal surface, requiring removal of the epithelium using a diamond burr and bandage contact lens wear. Nasal turbinate mucosal grafts were better tolerated by the corneal surface and had the added benefit of mucous production. CONCLUSIONS: Eyelid reconstruction using nasal turbinate and hard palate mucosal tissues as a shared buttress graft is a viable treatment option for patients with severe cicatricial entropion. Resolution of trichiasis and mechanical corneal abrasion was noted in 13 (86%) of 15 patients with no specific complications related to the technique. The shared buttress technique successfully autostents the healing eyelid margins, makes good use of the large turbinate mucosal graft, and minimizes trips to the operating room. When the mechanical requirements of eyelid margin reconstruction do not require the sturdiness of hard palate mucosa, nasal turbinate mucosa is a preferable graft tissue because it is better tolerated by the corneal surface and produces mucous.

Determination of micro amounts of uranium by a molybdenum blue method.

A new and highly sensitive spectrophotometric method has been developed for the determination of micro amounts of uranium by a molybdenum blue method. The method is based on the observation that at low acidities uranium(IV) reduces ammonium molybdate to molybdenum blue, the absorbance of which is proportional to the amount of uranium present. The variables affecting development of the colour have been investigated and the conditions optimized. Beer's law is found to hold good for uranium concentrations between 1 and 20 ppm, with a precision of 2%. The effect of diverse ions has been studied. The method is useful for the determination of uranium present as an impurity (down to 0.1%) in plutonium, neptunium or thorium.

Indigenous knowledge and uses of medicinal plants by local communities of the Kali Gandaki Watershed Area, Nepal.

A field survey was conducted in the villages of Ramdi, Malunga, Balam, Beltari, Mirmi, Burgha and Ridi in the Kali Gandaki watershed, Nepal; 48 medicinal plants belonging to 31 families were reported, each with local names, traditional uses, methods of preparation and route of administration. Traditional medicine remains an integral part of the health system in these areas. Local people have remarkable knowledge of species identity and their uses as crude drugs.

Effect of Azadirachta indica leaves on testis and its recovery in albino rats.

Histological and biochemical changes in the testis of rats treated with the leaf powder of A. indica are reported. The pattern of recovery is also studied at 8, 16 and 24 day after withdrawal of the treatment. In the treated rats, a general reduction in the diameters of seminiferous tubule, nuclei of the germinal elements and a mass atrophy of the spermatogenic elements has been observed. The Leydig cells are found to be atrophic. Biochemically, a decrease in the protein content and the activity of acid phosphatase and an increase in the total free sugar, glycogen, cholesterol contents and the activities of alkaline phosphatase and lactate dehydrogenase have been observed. A gradual recovery is observed in both the histological and biochemical parameters after 8.16 and 24 day of cessation of the treatment. The result suggest a possible reversible antiandrogenic property of the leaves of A. indica in male albino rats.

Alterations in brain tumor DNA detected by a fingerprinting probe.

We used a novel DNA fingerprinting probe O-chi-1 (ref. 1) to detect differences in the hybridization pattern of brain tumor DNA and paired normal tissue of a given individual. Representatives of meningiomas (two), glioblastoma multeforme (three) and astrocytoma (one) were studied. Alterations, which included amplification as well as the loss of a normal band in tumor DNA, were observed in four of the six tumours. While the increased intensity of a band can be taken to imply increased copy number, the disappearance of bands could either be due to loss of DNA sequence or rearrangement resulting in different sized bands.

Lumbosacral actinomycosis in an immunocompetent individual: An extremely rare case.

Actinomycosis is a gram positive commensal bacteria. In predisposed individuals like immunocompromised patients, it can cause myriad lesions involving virtually any organ of the body. Involvement of spinal cord with its compression is rare though. We are reporting here a case of 30-year-old immunocompetent male who presented with weakness of left lower limb. Radiologically differential diagnosis was tuberculosis or lymphoma of spinal cord. Histopathology showed actinomycotic colonies that were periodic Schiff (PAS) positive and revealed gram positive filamentous bacteria.

Association of Occupational & Prediabetes Statuses with Obesity in middle aged Women.

BACKGROUND: The association between Type 2 Diabetes Mellitus and Obesity is very close. The prediabetes status i.e Impaired Fasting Glucose (IFG) reflects an intermediate condition between normality and diabetes. The socioeconomic position (SEP) is one of the non traditional determinants of type 2 DM. The occupational status, which is a good indicator of the socioeconomic status, also indicates the level and the type of stress that they are exposed to, as well as the individual lifestyle choices. The present work was planned to study the relationship of the prediabetic status with obesity and the occupational status by estimating the Fasting Blood Glucose (FBG) levels. OBJECTIVES: To study the association of the occupational status with the fasting blood glucose levels and obesity in middle aged women. METHOD: The Fasting Blood Glucose levels and the BMI were estimated in 300 asymptomatic middle aged women who had no family history of Type 2 Diabetes Mellitus (D.M.), who had been divided into the Control (I), the Pre - obese (IIa) and the Obese groups (IIb). The occupational status was broadly divided into the categories of housewives and service women. The results was analysed statistically by using the correlation coefficient and the 'z' test. RESULT: The mean FBG levels in the pre - obese and the obese groups were higher than those in the control group. We found significant differences in the FBG levels in the normal weight, the pre - obese as well as in the obese groups among the service women, but no significant correlation was found in the pre - obese and the obese groups. Among the housewives, we found significant differences in the FBG levels of the normal weight and the obese groups, but not in the pre - obese group. Also, no significant correlation was found in the pre - obese and obese groups among the service women. CONCLUSION: The BMI may be good risk predictor for Type 2 D.M. irrespective of the occupational status, especially in middle aged women.