Low-grade malt lymphoma of the nasopharynx in young adults: Successful treatment of a rare diagnosis at a rare site by radiotherapy.

INTRODUCTION: Mucosa Associated Lymphoid Tissue (MALT) lymphoma is the third most common subgroup of Non-Hodgkin's lymphoma and is the most common type of primary extranodal lymphoma. They are rarely found in the nasopharyngeal region and their mean age at presentation is the sixth decade of life. MATERIALS AND METHODS: We present the clinical, pathological, treatment and 5-year follow-up data of 5 cases of nasopharyngeal MALT lymphoma treated with definitive radiotherapy at our hospital, between 2009 and 2011. RESULTS: The average age of diagnosis was 27 years which is more than a decade earlier than what has been reported previously. Clinical symptoms included nasal obstruction, tinnitus and hearing loss. All five patients had locoregional disease. They were treated by definitive radiotherapy to a dose between 30 to 40 Gy. At 5 years of follow-up, 4 patients were in complete remission while one had disease relapse. CONCLUSION: The younger age of presentation compared to older reports in this rare subsite was an interesting finding in our study. The authors speculate that rising levels of particulate air pollution may have played a part in the etiology in this younger population. Our series shows that despite the younger age, the disease displays an indolent course and responds well to radiotherapy alone as the primary treatment. Recurrence or disseminated disease is also highly treatable with systemic chemotherapy.

Utility of 18-Flurodeoxyglucose Positron Emission Tomography-Computed Tomography ( 18 FDG PET-CT) in Gallbladder Cancer: Experience from a Tertiary Care Hospital.

Introduction Gallbladder cancer (GBC) is one of the most common and aggressive malignancies of the Indo-Gangetic plains. Despite its widespread use in GBC cases, the role of 18-flurodeoxyglucose positron emission tomography-computed tomography ( 18 FDG PET-CT) in the management of this disease is not well defined. In our study, we present the practice trends of the utilization of this investigative modality in our hospital and its benefits in aiding diagnosis, staging, and surveillance for recurrence. Materials and Methods All cases of suspected and biopsy-proven GBCs who underwent PET-CT at our institute between 2016 and 2019 were retrospectively evaluated for the indication of PET-CT testing and its impact on the management of the case. The indications were classified into three categories: (i) staging and metastatic workup, (ii) response assessment post-chemotherapy, and (iii) post-therapy surveillance of patients. Results A total of 79 PET-CT scans were carried out during the study period. PET-CT was used for less than one-third of the total patients of GBC presenting at our center. Initial staging and workup (49%) was the most common indication followed by surveillance (28%) and response assessment (23%). PET-CT had a substantially better sensitivity in detecting distant metastases compared to conventional imaging in both initial workup and during follow-up. PET-CT provided additional information in 42% scans that led to change in the management of the patient. As a response assessment tool PET-CT aided not only in evaluating efficacy of therapy but also for documenting progressive disease for patients on therapy. Conclusion PET-CT is a valuable tool to not only rule out metastatic disease while selecting patients for surgery but also for post-therapy surveillance for recurrence in patients of GBC. Larger prospective studies may help in finally elucidating the exact role of PET-CT in this disease.

The Role of Frailty Scores to Predict the Outcomes in Non Operative Treatment of Valgus Impacted Neck of Femur Fractures.

OBJECTIVES: The management of valgus-impacted neck of femur fracture is controversial between operative and conservative treatments. This study aimed to investigate the usefulness of the Clinical frailty Score for predicting the prognosis of patients who underwent non-operative treatment for the valgus-impacted neck of femur fracture (NOF). METHODS: A single-centred retrospective review of patients admitted with valgus impacted NOF. Data were collected from patients' records, including demographics, Clinical Frailty Score (CFS), Nottingham Hip Fracture Score (NHFS) and Abbreviated Mental Test Score (AMTS). Patients were followed up to 24 months postoperatively. RESULTS: Fifty-eight patients who were treated non-operatively with a mean follow-up of 2.6 years met our inclusion criteria. Twenty-nine patients failed the non-operative treatment and required replacement surgeries, while 29 had successful outcomes (50%). There were no differences between the two groups' mean age and gender distributions (P 0.527 and 0.139, respectively). The successful group had significantly higher CFS (P 0.013), worse AMTS and higher mortality risk based on the NHFS (P 0.006 and P < 0.001, respectively). CONCLUSION: This study demonstrates that CFS, AMTS and NHFS can be used as predictors when considering non-operative treatment for the valgus-impacted neck of femur fracture. Patients who are frail, demented and high risk based on the NHFS have higher success rates with non-operative treatment.

Development and Applications of Embedded Passives and Interconnects Employing Nanomaterials.

The advent of nanotechnology has initiated a profound revolution in almost all spheres of technology. The electronics industry is concerned with the ongoing miniaturization of devices and as such requires packaging technologies that will make the devices more compact and resilient. 3D packaging, system in package, and system on chip are the various packaging techniques that utilize nanoscale components for their implementation. The active components of the ICs have kept pace with Moore's law, but the passive components have proven an impediment in the race for miniaturization. Moreover, the toxic effects and nano-scale problems associated with conventional soldering techniques have entailed the active involvement of nanotechnology in the search for answers. Recent advances in these fields and the diverse nanomaterials which are being employed to resolve these issues have been discussed in detail.

Light-Emitting-Diode-Assisted, Fungal-Pigment-Mediated Biosynthesis of Silver Nanoparticles and Their Antibacterial Activity.

Nanoparticle synthesis, such as green synthesis of silver nanoparticles (AgNPs) using biogenic extracts, is affected by light, which changes the characteristics of particles. However, the effect of light-emitting diodes (LEDs) on AgNP biosynthesis using fungal pigment has not been examined. In this study, LEDs of different wavelengths were used in conjunction with Talaromyces purpurogenus extracellular pigment for AgNP biosynthesis. AgNPs were synthesized by mixing 10 mL of fungal pigment with AgNO3, followed by 24 h exposure to LEDs of different wavelengths, such as blue, green, orange, red, and infrared. All treatments increased the yield of AgNPs. The solutions exposed to blue, green, and infrared LEDs exhibited a significant increase in AgNP synthesis. All AgNPs were then synthesized to determine the optimum precursor (AgNO3) concentration and reaction rate. The results indicated 5 mM AgNO3 as the optimum precursor concentration; furthermore, AgNPs-blue LED had the highest reaction rate. Dynamic light scattering analysis, zeta potential measurement, transmission electron microscopy, and Fourier transform infrared spectroscopy were used to characterize the AgNPs. All LED-synthesized AgNPs exhibited an antimicrobial potential against Escherichia coli and Staphylococcus aureus. The combination of LED-synthesized AgNPs and the antibiotic streptomycin demonstrated a synergistic antimicrobial activity against both bacterial species.

Fungal Pigment-Assisted Silver Nanoparticle Synthesis and Their Antimicrobial and Cytotoxic Potential.

The biological production of nanoparticles has taken center stage among the various generation methods available owing to its environment-friendly characteristics and reduced energy requirements. A protocol for pigment-assisted silver nanoparticle (AgNP) synthesis was established, employing an extracellular composite pigment produced by the Ascomycota Talaromyces purpurogenus (presently Talaromyces purpureogenus). The extracellular pigment can reduce the precursor silver salt into nanoparticles in the presence of sodium hydroxide and light. Transmission electron microscopy may be used to characterize the bio-generated nanoparticles, which can also be tested for their biological properties using antimicrobial and anticancer assays.

Use of a Checklist Approach on a Telecobalt in an Attempt to Reduce Human Errors in Radiotherapy Delivery and Improve Therapeutic Ratio.

BACKGROUND: The process of radiotherapy treatment planning and delivery involves multiple steps and professionals causing it to be prone to errors. Radiotherapy centers equipped with old telecobalt machines have certain peculiar challenges to workflow. We designed and tested a checklist for radiotherapy technicians (RTTs) to reduce chances of error during treatment delivery on a telecobalt machine. MATERIALS AND METHODS: A physical checklist was designed for RTTs to use in the pretreatment pause using a template advocated by the American Association of Physicists in Medicine. It was tested on 4 RTTs over 1000 radiotherapy delivery sittings. RESULTS: The checklist helped to rectify 41 documentary lapses and 28 errors in radiotherapy treatment parameters while also identifying 12 instances where treatment plan modifications were due and 30 where the patient was due for review by the radiation oncologist. The average time to go through the checklist was between 2.5 and 3 min. CONCLUSIONS: The development and use of the checklist has helped in reducing errors and also improving workflow in our department. It is recommended to utilize such physical checklists in all radiotherapy centers with telecobalt machines. The success of the checklist depends upon leadership, teamwork, acceptance of a need to inculcate a "safety culture," with voluntary error-reporting and a willingness to learn from such errors.

Radiation for Palliation: Role of Palliative Radiotherapy in Allevieating Pain/Symptoms in a Prospective Observational Study at Two Tertiary Care Centers.

PURPOSE: Approximately one-third of patients attending the tertiary care center require palliative management. The purpose of this study was to investigate the role of palliative radiation in alleviating the pain and symptoms and improvement in quality of life (QOL). METHODS: This was a prospective study aimed to evaluate patients attending two oncology centers and those who require palliative radiation. During 3 years, 1365 patients attended radiation oncology center for various malignancies. Of these patients, 304 patients were treated with palliative radiation for various indications. These patients were followed up for a period of up to 6 months for symptom relief and improved QOL. RESULTS: About 22% of patients received palliative radiation primarily for carcinoma lung, breast, and prostate malignancy. Analysis revealed elderly patients in the age group of 50-70 being the most commonly affected and most common presentation was pain, swelling, and headache. The most common site of metastases was bone including the spine and brain. Most commonly employed schedule of palliative radiation was 30 Gy in 10 fractions and 20 Gy in 5 fractions. Patients responded well to palliative radiation and had improved pain relief and QOL. CONCLUSIONS: Palliative radiation is an important part of the management of cancer care and when given improves QOL, and significant pain relief.

Radiation Fibrosis Syndrome: the Evergreen Menace of Radiation Therapy.

Fibrosis is a descriptive appellation referring to the obliteration of normal tissue components replaced by matrix and disorganized and varied collagen fibrils that result in the loss of organ function and frequent tissue contraction leading to death or significant deterioration in the quality of life. Radiation fibrosis syndrome (RFS) is a progressive fibrotic tissue sclerosis with various clinical symptoms in the irradiation field. It is usually a late complication of radiation therapy and may occur weeks or even years after treatment. It may affect the musculoskeletal, soft tissue, neural tissue, and cardiopulmonary systems. RFS is a serious and lifelong disorder that, nevertheless, may often be prevented when identified and rehabilitated early. Genetic factors likely play a significant role in the development of chronic fibrotic response to radiation injury that persists even after the initial insult is no longer present. Management of this syndrome is a complex process comprising medication, education, rehabilitation, and physical and occupational therapy. A bibliographical search was carried out in PubMed using the following keywords: "radiation fibrosis," "radiation fibrosis syndrome," and "radiation-induced fibrosis." We also reviewed the most relevant and recent series on the current management of RFS, and the reviewed data are discussed in this article. This review discusses the pathophysiology, evaluation, and treatment of neuromuscular, musculoskeletal, and functional disorders as late effects of radiation treatment.

Biosynthesis of Silver Nanoparticles Mediated by Extracellular Pigment from Talaromyces purpurogenus and Their Biomedical Applications.

In recent years, green syntheses have been researched comprehensively to develop inexpensive and eco-friendly approaches for the generation of nanoparticles. In this context, plant and microbial sources are being examined to discover potential reducing agents. This study aims to utilize an extracellular pigment produced by Talaromyces purpurogenus as a prospective reducing agent to synthesize silver nanoparticles (AgNPs). Biosynthesized AgNPs were characterized by transmission electron microscopy (TEM), dynamic light scattering (DLS), electron probe micro analyser (EPMA), and zeta potential. The pigment functional groups involved in the generation of AgNPs were investigated using Fourier transform infrared spectroscopy. TEM images showed that the generated nanoparticles were spherical, hexagonal, rod-shaped, and triangular-shaped with a particle size distribution from 4 to 41 nm and exhibited a surface plasmon resonance at around 410 nm. DLS and zeta potential studies revealed that the particles were polydispersed and stable (-24.8 mV). EPMA confirmed the presence of elemental silver in the samples. Biosynthesized AgNPs exhibited minimum inhibitory concentrations of 32 and 4 µg/mL against E. coli and S. epidermidis, respectively. Further, cytotoxicity of the AgNPs was investigated against human cervical cancer (HeLa), human liver cancer (HepG2), and human embryonic kidney (HEK-293) cell lines using 5-fluorouracil as a positive control. A significant activity was recorded against HepG2 cell line with a half-maximal inhibitory concentration of 11.1 µg/mL.

Efficacy and safety of concurrent chemoradiotherapy with or without Nimotuzumab in unresectable locally advanced squamous cell carcinoma of head and neck: Prospective comparative study - ESCORT-N study.

BACKGROUND: Nimotuzumab is an anti-epidermal growth factor receptor monoclonal antibody which can be added to chemoradiotherapy (CRT) to improve efficacy for management of locally advanced squamous cell carcinoma of the head and neck (LASCCHN). We prospectively evaluated the efficacy and safety of nimotuzumab with CRT for LASCCHN and compared with CRT alone. MATERIALS AND METHODS: In this prospective study, 29 LASCCHN (Stage III-IVb) patients received Nimotuzumab plus CRT or CRT alone. Treatment included six cycles of cisplatin (40-50 mg/week) or carboplatin (area under the curve-based), nimotuzumab (200 mg/week), and radiotherapy (60-70 Gy). Tumor response was evaluated as per response evaluation criteria in solid tumors criteria. MoS was estimated using the Kaplan-Meier method. Toxicity and adverse events (AE's) were assessed as per CTCAE v 4.0. RESULTS: At 24 weeks after completion of treatment, the tumor response rate (complete response, partial response, stable disease) was 53.3% and 35.7% favoring nimotuzumab arm while progression of disease was 40% and 35.7% in Nimotuzumab plus CRT and CRT groups, respectively. However, the objective response rate was 57% and 30% in favor of nimotuzumab arm. At median follow-up of 45.5 months, MoS was 33 months in Nimotuzumab plus CRT and 27 months in CRT group. The 5-year survival rate was 33.3% in Nimotuzumab plus CRT versus 7.1% in CRT group. Nimotuzumab was observed to be safe with no additional AE's such as hypersensitivity, hypomagnesemia, and allergic reaction was reported. CONCLUSION: Addition of Nimotuzumab to standard CRT showed improved survival rate in unresectable, LASCCHN patients without producing additional toxicity.

The Impact of Positron Emission Tomography/Computed Tomography Addition to Contrast-Enhanced Computed Tomography Findings during Radiation Treatment Planning of Locally Advanced Carcinoma Esophagus.

INTRODUCTION: Does metabolic imaging help in better definition of target during radiation treatment planning by bringing about changes in dimensions of the primary tumor in terms of diameter, length, and picking up new skip lesions or nodal stations which in turn prevents geographic misses by including more 18F-fluorodeoxyglucose avid regions not visible on conventional imaging? MATERIALS AND METHODS: We compared the length and radial dimensions of the primary tumor as well as changes brought about due to addition of new nodal stations, involved structures, and skip lesions in 50 patients of carcinoma esophagus treated between 2011 and 2013, as seen on contrast-enhanced computed tomography (CT) thorax and positron emission tomography (PET)/CT and drew conclusions regarding the technical changes brought about in treatment planning by the additional input of PET/CT. RESULTS AND CONCLUSIONS: PET-CT tremendously changes treatment plans by expanding the gross tumor volume and including regions which might otherwise have been missed on purely CT-based plans. Of the 50 patients, it changed the contouring and treatment planning of 35 patients and did not impact the remaining 15. Whether this translates into better long-term controls requires further validation by randomized controlled trials, which was not our present objective.

Biosynthesis and characterization of gold nanoparticles: Kinetics, in vitro and in vivo study.

This study reports a facile, cost effective, nontoxic and eco-friendly method for the synthesis of gold nanoparticles. In this paper, leaf extract of Mentha piperita was successfully used to reduce chloroauric acid, leading to synthesis of gold nanoparticles (AuNPs). The synthesized nanoparticles were further characterized by UV-visible spectroscopy, Fourier transform infrared spectroscopy, dynamic light scattering, transmission electron microscopy and field emission scanning electron microscopy. Kinetics studies like effect of volume of leaf extract, precursor, pH, temperature for the synthesis of AuNPs were studied spectrophotometrically. Synthesized AuNPs were found to possess hexagon structure where size of nanoparticles was ~78nm in diameter. These biologically synthesized AuNPs exhibited significant activity against cancerous cell lines MDA-MB-231 and A549 and was compared with the normal 3T3-L1 cell line. Anti-inflammatory and analgesic activities were studied on a Wistar rat model to gauge the impact of AuNPs for a probable role in these applications. AuNPs gave positive results for both these activities, although the potency was less as compared to the standard drugs. These results suggested that the leaves extract of Mentha piperita is a very good bioreductant for the synthesis of AuNPs and have potential for various biomedical and pharmaceutical applications.

Phytofabrication of bioinduced silver nanoparticles for biomedical applications.

Synthesis of nanomaterials holds infinite possibilities as nanotechnology is revolutionizing the field of medicine by its myriad applications. Green synthesis of nanoparticles has become the need of the hour because of its eco-friendly, nontoxic, and economic nature. In this study, leaf extract of Rosa damascena was used as a bioreductant to reduce silver nitrate, leading to synthesis of silver nanoparticles (AgNPs) in a single step, without the use of any additional reducing or capping agents. The synthesized nanoparticles were characterized by the use of UV-visible spectroscopy, fourier transform infrared spectroscopy, dynamic light scattering, transmission electron microscopy, and field emission scanning electron microscopy. Time-dependent synthesis of AgNPs was studied spectrophotometrically. Synthesized AgNPs were found to possess flower-like spherical structure where individual nanoparticles were of 16 nm in diameter, whereas the agglomerated AgNPs were in the range of 60-80 nm. These biologically synthesized AgNPs exhibited significant antibacterial activity against Gram-negative bacterial species but not against Gram-positive ones (Escherichia coli and Bacillus cereus). Anti-inflammatory and analgesic activities were studied on a Wistar rat model to gauge the impact of AgNPs for a probable role in these applications. AgNPs tested positive for both these activities, although the potency was less as compared to the standard drugs.

Cup anteversion in hip resurfacing: validation of EBRA and the presentation of a simple clinical grading system.

The use of large metal on metal bearings has led to a reduction in the risk of dislocation post hip arthroplasty. Because of this, and also because of the technical difficulties associated with resurfacing surgery in particular, it could be argued that a less meticulous approach to acetabular cup placement has developed in comparison with conventional metal on polyethylene arthroplasty. Resurfacing cups may produce significant clinical problems when placed at the extremes of version, including increased production of metal debris and psoas tendonitis. Presented in this article is evidence that EBRA software (Einzel-Bild-Roentgen-Analysis, University of Innsbruck, Austria) can be used to reliably assess the version of resurfacing cups, when radiographs are of sufficient quality. The cups have characteristic appearances when placed at the extremes of version. These characteristics can allow the surgeon to identify poorly positioned cups without the use of software.

Metal-on-metal hip resurfacing in osteonecrosis of the femoral head.

BACKGROUND: The treatment of end-stage osteonecrosis of the femoral head remains a challenge to the orthopaedic surgeon. Historically, total hip arthroplasty for this condition has been associated with poor rates of survival and function when compared with total hip arthroplasty for the treatment of osteoarthritis. The purpose of this study was to determine the medium-term clinical and radiographic results of metal-on-metal hip resurfacing arthroplasty in patients with end-stage osteonecrosis of the femoral head. METHODS: From June 1994 to March 2004, a consecutive single-surgeon series of seventy-three hip resurfacing procedures were performed in sixty patients for the treatment of end-stage osteonecrosis of the femoral head. The cohort included forty-two men (ten of whom had a bilateral resurfacing) and eighteen women (three of whom had a bilateral resurfacing). The mean age was forty-three years (range, seventeen to sixty-nine years). A clinical and radiographic review was performed. RESULTS: There were four revision operations and one planned revision of the seventy-three hips during the follow-up period. Two of these revisions were necessitated by aseptic failure of the femoral component. This represents an overall survival rate of 93.2% at a mean of 6.1 years of follow-up (range, two to twelve years). CONCLUSIONS: On the basis of this study, metal-on-metal resurfacing of the hip for osteonecrosis can be considered a safe and effective form of surgery for this group of patients. Longer-term follow-up is required to confirm the expected continued success of this form of arthroplasty in this difficult-to-treat population. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.