Primary adrenal plasmablastic lymphoma presenting as lymphomatous meningitis - A diagnostic perplexity.

A rare presentation of primary plasmablastic lymphoma (PBL) of the adrenal gland, as lymphomatous meningitis in a patient living with HIV.

Patterns of Recurrence, Long-term Survival and Toxicity Analysis of Endometrial Adenocarcinoma Patients Reclassified Under the Recent ESMO-ESGO-ESTRO Stratification: Seven-Year Results From a Single Institution.

AIM: The aim of this study was to report the patterns of recurrence, locoregional control, and survival of patients diagnosed with endometrial adenocarcinomas over a 7-year period after reclassifying them under the recent ESMO-ESGO-ESTRO (European Society of Medical Oncology/European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology) consensus classification. METHODS: Archives of a single institution from 2008 to 2014 were studied and patients with stages I-II endometrial adenocarcinoma were reclassified as per the new classification for uniformity. On magnetic resonance imaging, if found to be stage I, total abdominal hysterectomy with bilateral salpingo-oophorectomy alone was performed. The indications for adjuvant external beam radiotherapy (EBRT) and vaginal brachytherapy (VBT) were based on standard recommendations. Survival was calculated from Kaplan-Meier curves, and toxicity was recorded using Common Terminology Criteria for Adverse Events version 3. RESULTS: Of the 132 patients registered, 101 patients were included for analysis. A total of 18 patients have died, and information on outcome is available for 84% of patients. Five patients were metastatic at presentation. Five patients received definitive EBRT + intracavitary brachytherapy because of surgical inoperability, four of whom are disease-free locoregionally with median overall survival of 33.8 months. Of the 91 patients operated on, the incidence of low, intermediate, high-intermediate, and high risk was 34%, 29%, 2%, and 19%, whereas 16% were stage III. The overall recurrence rates were 10%, 15%, and 23% for low, intermediate, and high risk, respectively. With median follow-up of 32 months (range, 2-93 months), the disease-free survival for low, intermediate, and high risk and stage III were 92%, 81%, and 64% and 55%, whereas the mean survival for the same groups were 53, 44, and 34 and 22 months, respectively (P = 0.047). External beam radiotherapy resulted in significantly higher proctitis than VBT alone (P = 0.02). The median time to cystitis, proctitis, and enteritis were 27, 19, and 28 months, respectively. CONCLUSIONS: Recurrence rates, survival rates, and the patterns of recurrence are comparable with published literature and partly validates the ESMO-ESGO-ESTRO consensus statement. Addition of EBRT significantly increases risk of late proctitis as compared with VBT alone.

An Esthetic Approach for Rehabilitation of Long-Span Edentulous Arch Using Artificial Intelligence.

Successful full-mouth rehabilitation requires contemporary and advanced treatment planning, especially in distal extension cases. Multiple treatment modalities are available in those cases. Treatment outcome in these patients remains challenging. Though implants are one of the treatment options in such scenarios, fixed removable partial dentures with precision attachments are the best treatment options for patients who cannot afford expensive treatment. We have made an attempt to describe a case report of a long-span edentulous arch by incorporating the ideas and information received from Chat Generative Pre-trained Transformer (GPT).

Paraneoplastic Manifestation of Primary Squamous Cell Cancer of the Thyroid Gland.

Paraneoplastic manifestation (PNM) of cancers is a non-metastatic, non-invasive systemic effect of malignancies due to chemokines and hormones produced by the primary neoplasm. Squamous cell cancers (SCCs) are known to present with PNM. Primary SCC of thyroid accounts for <1% of all thyroid malignancies and carries a very poor prognosis. We present a rare case of SCC arising from the thyroid gland who presented with fever, leukemoid reaction and hypercalcemia as part of PNM. A 67-year-old male patient presented with two months history of intermittent high-grade fever, weakness, loss of weight and appetite. Examination revealed a large (~10 cm) hard swelling over the right side of the neck. Investigations revealed neutrophilic leukocytosis, elevated C-reactive protein (CRP) and procalcitonin and hypercalcemia with a normal thyroid-stimulating hormone (TSH). The fever workup was negative for infection. Fine-needle aspiration cytology (FNAC) and core biopsy of the thyroid mass revealed malignant cells with squamous differentiation. An extensive search for possible other primary was ruled out by triple endoscopy. The combination of fever, neutrophilic leukocytosis, hypercalcemia and squamous malignancy was consistent with a diagnosis of PNM of SCC. A fluorodeoxyglucose-positron emission tomography (FDG-PET) CT scan showed a heterogeneously enhancing mass lesion in the right lobe of the thyroid with some retrosternal extension. He underwent total thyroidectomy with bilateral central compartment neck dissection. Final histopathology revealed moderately differentiated SCC of the thyroid. Concurrent chemoradiation was given. Despite continued chemotherapy, he succumbed to illness within six months of diagnosis. Primary SCC of thyroid (PSCCT) is a rare malignancy. It is a highly aggressive tumor having a poor prognosis with a median survival time of about 9-12 months and less clearly defined therapy due to its rarity. Paraneoplastic manifestation of PSCCT is known. As fever, leukemoid reaction and hypercalcemia can be a paraneoplastic manifestation, one should think of PSCCT.

Aspergilloma in Non-tuberculous Cavities in the Lung: Not to Get Startled.

Aspergillus which is normally found as a colonizer in healthy individuals can manifest in various forms in patients with diseased lung or immunocompromised status. Aspergilloma is one such manifestation whereby the fungus makes its way into preexisting cavities in the lung, the most common underlying etiology being old tuberculous cavities, especially in countries with high TB prevalence. However, we hereby report two cases of Aspergillus infestation as aspergilloma in cavities because of extremely rare causes, namely pulmonary thromboembolism and idiopathic pulmonary fibrosis, respectively.

Midline EEG Functional Connectivity As Biomarker for Conscious States in Sleep and Wakefulness.

Functional connectivity (FC) between different cortical regions of the brain has long been hypothesized to be necessary for conscious states in several modeling and empirical studies. The work presented herein estimates the FC between two bipolar midline electroencephalogram (EEG) recordings to evaluate its utility in discriminating consciousness levels across wakefulness and sleep. Consciousness levels were defined as Low, Medium, and High depending upon the ability of a subject to self-report their experiences at a later stage. The sleep EDF [expanded] dataset available in the Physionet data repository was used for analyses. FC was estimated using the debiased estimator of the squared Weighted Phase Lag Index (dWPLI2) metric. A total of 40 features extracted from the FC spectra for 10 EEG sub-bands were considered. FC trends demonstrated the highest alpha synchrony in the 'Low' conscious state. While the 'Medium' conscious state demonstrated superior phase synchronization in the low-gamma band, the 'High' conscious state was characterized by comparatively lower phase synchronization in all frequency bands. A Multi-Layer Perceptron (MLP) framework using a combination of 7 features yielded the highest cross-validation accuracy of 95.15% in distinguishing these conscious states. The study results provide a pertinent validation for the hypothesis that midline EEG FC is a reliable and robust signature of conscious states in sleep and wakefulness.

Brain Functional Connectivity as Biomarker for Propofol-Induced Alterations of Consciousness.

Understanding neural correlates of consciousness and its alterations poses a grand challenge for modern neuroscience. Even though recent years of research have shown many conceptual and empirical advances, the evolution of a system that can track anesthesia-induced loss of consciousness is hindered by the lack of reliable markers. The work presented herein estimates the functional connectivity (FC) between 21 scalp electroencephalogram (EEG) recordings to evaluate its utility in characterizing changes in brain networks during propofol sedation. The sedation dataset in the University of Cambridge data repository was used for analyses. FC was estimated using the debiased estimator of the squared Weighted Phase Lag Index (dWPLI2). Spectral FC networks before, during, and after sedation was considered for 5 EEG sub-bands. Results demonstrated significantly higher alpha band FC during baseline, mild and moderate sedation, and recovery stages. A striking association between frontal brain activity and propofol-sedation was also noticed. Furthermore, inhibition of frontal to parietal and frontal to occipital connections were observed as characteristic features of propofol-induced alterations in consciousness. A random subspace ensemble framework using logistic model tree as the base classifier, and 18 functional connections as features, yielded a cross-validation accuracy of 98.75% in discriminating baseline, mild and moderate sedation, and recovery stages. These findings validate that EEG-based FC can reliably distinguish altered conscious states associated with anaesthesia.

Can we identify the category of imagined phoneme from EEG?

Phonemes are classified into different categories based on the place and manner of articulation. We investigate the differences between the neural correlates of imagined nasal and bilabial consonants (distinct phonological categories). Mean phase coherence is used as a metric for measuring the phase synchronisation between pairs of electrodes in six cortical regions (auditory, motor, prefrontal, sensorimotor, so-matosensory and premotor) during the imagery of nasal and bilabial consonants. Statistically significant difference at 95% confidence interval is observed in beta and lower-gamma bands in various cortical regions. Our observations are inline with the directions into velocities of articulators and dual stream prediction models and support the hypothesis that phonological categories not only exist in articulated speech but can also be distinguished from the EEG of imagined speech.

Identification of Patterns of Cognitive Impairment for Early Detection of Dementia.

Early detection of dementia is crucial to devise effective interventions. Comprehensive cognitive tests, while being the most accurate means of diagnosis, are long and tedious, thus limiting their applicability to a large population, especially when periodic assessments are needed. The problem is compounded by the fact that people have differing patterns of cognitive impairment as they progress to different forms of dementia. This paper presents a novel scheme by which individual-specific patterns of impairment can be identified and used to devise personalized tests for periodic follow-up. Patterns of cognitive impairment are initially learned from a population cluster of combined normals and cognitively impaired subjects, using a set of standardized cognitive tests. Impairment patterns in the population are identified using a 2-step procedure involving an ensemble wrapper feature selection followed by cluster identification and analysis. These patterns have been shown to correspond to clinically accepted variants of Mild Cognitive Impairment (MCI), a prodrome of dementia. The learned clusters of patterns can subsequently be used to identify the most likely route of cognitive impairment, even for pre-symptomatic and apparently normal people. Baseline data of 24,000 subjects from the NACC database was used for the study.

Electrodermal Activity Based Pre-surgery Stress Detection Using a Wrist Wearable.

Surgery is a particularly potent stressor and the detrimental effects of stress on people undergoing any surgery is indisputable. When left unchecked, the pre-surgery stress adversely impacts people's physical and psychological well-being, and may even evolve into severe pathological states. Therefore, it is essential to identify levels of preoperative stress in surgical patients. This paper focuses on developing an automatic pre-surgery stress detection scheme based on electrodermal activity (EDA). The measurement set up involves a wrist wearable that monitors EDA of a subject continuously in the most non-invasive and unobtrusive manner. Data were collected from 41 subjects [17 females and 24 males, age: 54.8 ± 16.8 years (mean ± SD)], who subsequently underwent different surgical procedures at the Sri Ramakrishna Hospital, Coimbatore, India. A supervised machine learning algorithm that detects motion artifacts in the recorded EDA data was developed. It yielded an accuracy of 97.83% on a new user dataset. The clean EDA data were further analyzed to determine low, moderate, and high levels of stress. A novel localized supervised learning scheme based on the adaptive partitioning of the dataset was adopted for stress detection. Consequently, the interindividual variability in the EDA due to person-specific factors such as the sweat gland density and skin thickness, which may lead to erroneous classification, could be eliminated. The scheme yielded a classification accuracy of 85.06% on a new user dataset and proved to be more effective than the general supervised classification model.

Smartphone-based kanamycin sensing with ratiometric FRET.

Smartphone-based fluorescence detection is a promising avenue for biosensing that can aid on-site analysis. However, quantitative detection with fluorescence in the field has been limited due to challenges with robust excitation and calibration requirements. Here, we show that ratiometric analysis with Förster resonance energy transfer (FRET) between dye pairs on DNA aptamers can enable rapid and sensitive kanamycin detection. Since our detection scheme relies on ligand binding-induced changes in the aptamer tertiary structure, it is limited only by the kinetics of ligand binding to the aptamer. Our FRET-based kanamycin binding aptamer (KBA) sensor displays two linear ranges of 0.05-5 nM (detection limit of 0.18 nM) and 50-900 nM of kanamycin. The aptamer displays high specificity even in the presence of the 'natural' background from milk. By immobilizing the aptamer in the flow cell, our KBA sensor design is also suitable for repeated kanamycin detection. Finally, we show that the ratiometric FRET-based analysis can be implemented on a cheap custom-built smartphone setup. This smartphone-based FRET aptamer scheme detects kanamycin in a linear range of 50-500 nM with a limit of detection (LOD) of 28 nM.