Achieving negative superficial resection margins with NBI and white light in carcinoma oral cavity: Could it be a norm?

INTRODUCTION: In India, oral cavity cancer rates are the highest, largely due to tobacco and areca nut use. The primary goal of oncologic surgery is complete tumor resection with adequate margins, yet no accepted guidelines exist margin identification. NBI enhances mucosal lesion detection and may improve margin assessment in OSCC. AIMS: This study aims to evaluate the proportion of negative superficial resection margins using NBI and to compare these results with margins assessed using white light (WL) examination. MATERIALS AND METHODS: The study at AIIMS, Rishikesh, included 38 patients with T1-T3 biopsy-proven OSCC. Surgical margins were marked using WL and NBI. Histopathology classified margins as clear (>5mm), close (1-5 mm), or involved. Sensitivity, specificity, and predictive values of NBI were calculated. RESULTS: The average NBI examination duration was 227 s. Negative margins were achieved in 68.42 % (>5mm) and 78.94 % (>3mm) of NBI cases, compared to 71.05 % and 84.21 % for WL. NBI had a sensitivity of 12.50 %, specificity of 96.67 %, and overall accuracy of 78.95 %. DISCUSSION: NBI showed high specificity but low sensitivity. This could be due to the smaller number of patients in NBI positive group. In the present study, the single positive margin identified with NBI could also have been detected with the combined approach of white light and palpation, ensuring that no positive margins were missed. CONCLUSION: NBI can complement WL for margin assessment in oral SCC but requires a long learning curve and a dedicated team. Integrating NBI into standard protocols could improve surgical outcomes and reduce recurrence.

Aortic Pseudoaneurysm as an Unusual Cause of Vocal Palsy.

The recurrent laryngeal nerve travels a variable course on either side due to the differences in the structures related during development. The nerve is at risk of injury due to a number of pathologies in any of these structures. We came across a very rare pathology causing vocal palsy in a 62-year-old male with hoarseness of voice. Laryngoscopy examination showed left vocal cord palsy without any obvious laryngeal mass. Contrast-enhanced computed tomography study of the neck and chest revealed aortic arch pseudoaneurysm with left vocal cord palsy.

El factor de crecimiento queratinocítico humano recombinante induce la progresión de la supervivencia celular mediada por Akt en ratones enfisematosos / Recombinant Human Keratinocyte Growth Factor Induces Akt Mediated Cell Survival Progression in Emphysematous Mice

Introducción: El enfisema se ha asociado a una disminución de la expresión de VEGF y VEGFR-2 y a la presencia de un número elevado de células alveolares apoptósicas. El factor de crecimiento queratinocítico estimula la síntesis de VEGF, lo cual proporciona, a su vez, un mantenimiento de la estructura pulmonar normal a través de la vía de Akt. En este estudio hemos investigado el posible papel del rHuKGF en la mejora de la falta de regulación de la vía de supervivencia celular mediada por Akt en ratones enfisematosos. Métodos: Se establecieron 3 grupos experimentales: grupos de enfisema, tratamiento y control. Los pulmones de los ratones se trataron terapéuticamente en 3 ocasiones mediante la instilación orofaríngea de 10 mg de rHuKGF/kg de peso corporal tras la inducción del enfisema mediante elastasa pancreática porcina. Posteriormente, se obtuvo tejido pulmonar de los ratones para la realización de exámenes de histopatología y biología molecular. Resultados y discusión: Las microfotografías de histopatología y el análisis del índice de destrucción han mostrado que el agrandamiento del espacio aéreo inducido por la elastasa y la pérdida de alvéolos se recuperaron en el grupo de tratamiento. El rHuKGF estimula la producción de VEGF, que a su vez induce la vía de supervivencia celular mediada por Akt en los pulmones enfisematosos. Se produjo un aumento significativo de la expresión de mRNA de VEGF, VEGFR, PI3K y Akt, mientras que hubo una disminución notable de Pten, caspasa-9 y Bad en el grupo de tratamiento en comparación con el grupo de enfisema, y los resultados fueron comparables a los del grupo de control. Además, la expresión de VEGF a nivel proteico concordaba con la observada a nivel de mRNA. Conclusión: Los suplementos terapéuticos de rHuKGF mejoran la mala regulación de la vía de Akt en el trastorno del enfisema, dando lugar a una supervivencia celular alveolar a través de una activación de la vía de la supervivencia celular dependiente de VEGF endógena. Así pues, el rHuKGF podría ser un posible fármaco para el tratamiento del enfisema

Introduction: Emphysema has been associated with decreased VEGF andVEGFR-2 expression and the presence of high numbers of apoptotic alveolar cells. Keratinocyte growth factor stimulates VEGF synthesis which in turn confers normal lung structure maintenance via the Akt pathway. In this study the potential role of rHuKGF in the improvement of deregulated Akt mediated cell survival pathway in emphysematous mice was investigated Methods: Three experimental groups, i.e., emphysema, treatment and control groups, were prepared. Lungs of mice were treated on 3 occasions by oropharyngeal instillation of 10 mg rHuKGF per kg body weight after induction of emphysema with porcine pancreatic elastase. Subsequently, lung tissues from mice were collected for histopathology and molecular biology studies. Results and discussion: Histopathology photomicrographs and destructive index analysis have shown that elastase-induced airspace enlargement and loss of alveoli recovered in the treatment group. rHuKGF stimulates VEGF production which in turn induces the Akt mediated cell survival pathway in emphysematous lungs. mRNA expression of VEGF, VEGFR, PI3K and Akt was significantly increased while Pten, Caspase-9 and Bad was notably decreased in treatment group when compared with emphysema group, being comparable with the control group. Moreover, VEGF protein expression was in accordance with that found for mRNA. Conclusion: Therapeutic rHuKGF supplementation improves the deregulated Akt pathway in emphysema, resulting in alveolar cell survival through activation of the endogenous VEGF-dependent cell survival pathway. Hence rHuKGF may prove to be a potential drug in the treatment of emphysema

Recombinant Human Keratinocyte Growth Factor Induces Akt Mediated Cell Survival Progression in Emphysematous Mice.

INTRODUCTION: Emphysema has been associated with decreased VEGF and VEGFR-2 expression and the presence of high numbers of apoptotic alveolar cells. Keratinocyte growth factor stimulates VEGF synthesis which in turn confers normal lung structure maintenance via the Akt pathway. In this study the potential role of rHuKGF in the improvement of deregulated Akt mediated cell survival pathway in emphysematous mice was investigated. METHODS: Three experimental groups, i.e., emphysema, treatment and control groups, were prepared. Lungs of mice were treated on 3 occasions by oropharyngeal instillation of 10mg rHuKGF per kg body weight after induction of emphysema with porcine pancreatic elastase. Subsequently, lung tissues from mice were collected for histopathology and molecular biology studies. RESULTS AND DISCUSSION: Histopathology photomicrographs and destructive index analysis have shown that elastase-induced airspace enlargement and loss of alveoli recovered in the treatment group. rHuKGF stimulates VEGF production which in turn induces the Akt mediated cell survival pathway in emphysematous lungs. mRNA expression of VEGF, VEGFR, PI3K and Akt was significantly increased while Pten, Caspase-9 and Bad was notably decreased in treatment group when compared with emphysema group, being comparable with the control group. Moreover, VEGF protein expression was in accordance with that found for mRNA. CONCLUSION: Therapeutic rHuKGF supplementation improves the deregulated Akt pathway in emphysema, resulting in alveolar cell survival through activation of the endogenous VEGF-dependent cell survival pathway. Hence rHuKGF may prove to be a potential drug in the treatment of emphysema.

Antimicrobial Potential and Chemical Characterization of Serbian Liverwort (Porella arboris-vitae): SEM and TEM Observations.

The chemical composition of Porella arboris-vitae extracts was determined by solid phase microextraction, gas chromatography-mass spectrometry (SPME GC-MS), and 66 constituents were identified. The dominant compounds in methanol extract of P. arboris-vitae were ß-caryophyllene (14.7%), α-gurjunene (10.9%), α-selinene (10.8%), ß-elemene (5.6%), γ-muurolene (4.6%), and allo-aromadendrene (4.3%) and in ethanol extract, ß-caryophyllene (11.8%), α-selinene (9.6%), α-gurjunene (9.4%), isopentyl alcohol (8.8%), 2-hexanol (3.7%), ß-elemene (3.7%), allo-aromadendrene (3.7%), and γ-muurolene (3.3%) were the major components. In ethyl acetate extract of P. arboris-vitae, undecane (11.3%), ß-caryophyllene (8.4%), dodecane (6.4%), α-gurjunene (6%), 2-methyldecane (5.1%), hemimellitene (4.9%), and D-limonene (3.9%) were major components. The antimicrobial activity of different P. arboris-vitae extracts was evaluated against selected food spoilage microorganisms using microbroth dilution method. The Minimal Inhibitory Concentration (MIC) varied from 0.5 to 1.5 mg/mL and 1.25 to 2 mg/mL for yeast and bacterial strains, respectively. Significant morphological and ultrastructural alterations due to the effect of methanolic and ethanolic P. arboris-vitae extracts on S. Enteritidis have also been observed by scanning electron microscope and transmission electron microscope, respectively. The results provide the evidence of antimicrobial potential of P. arboris-vitae extracts and suggest its potential as natural antimicrobial agents for food preservation.