Co-expression of galectin-3 and vimentin in triple negative breast cancer cells promotes tumor progression, metastasis and survival.

BACKGROUND: Lack of druggable targets and complex expression heterogeneity of known targets is common among TNBC subtypes. An enhanced expression of galectin-3 in TNBCs has already been documented. We have observed a tumor progression-dependent galectin-3 expression in TNBCs compared to adjacent epithelium and non TNBCs. OBJECTIVE: To unravel the association of galectin- 3 in tumor progression, aggressiveness and drug resistance in TNBC patients. METHODS: Galectin-3 expression in 489 breast cancer tissues was correlated with clinicopathological features and the results were validated in cell lines and mouse model by silencing galectin-3 using shRNA and the proteins were profiled by western blot and qRT-PCR. Protein interaction was analyzed by GFP Trap and Mass spectrometry. RESULTS: Galectin-3 expression correlated with tumor stage in TNBC and a lower galectin-3 expression was associated with poor patient survival. The positive correlation between galectin-3, vimentin and CD44 expression, pinpoints galectin-3 contribution to epithelial to mesenchymal transition, drug resistance and stemness. Vimentin was found as an interacting partner of galectin-3. Duplexing of galecin-3 and vimentin in patient samples revealed the presence of tumor cells co-expressing both galectin-3 and vimentin. In vitro studies also showed its role in tumor cell survival and metastatic potential, elementary for tumor progression. In vivo studies further confirmed its metastatic potential. CONCLUSIONS: Tumor progression dependent expression pattern of galectin 3 was found to indicate prognosis. Co-expression of galectin-3 and vimentin in tumor cells promotes tumor dissemination, survival and its metastatic capability in TNBCs.

Clinical profile and outcome of children with anaplastic large cell lymphoma treated with short-course chemotherapy - ten years experience from a tertiary care center in a LMIC.

Anaplastic large-cell lymphoma (ALCL) constitutes 10-15% of non-Hodgkin lymphoma in children. With short-course chemotherapy, outcome has improved up-to 90% in developed-countries. There is limited-data on outcome of pediatric ALCL treated with ALCL99 protocol from low-middle income countries. Children ≤14 years, diagnosed with ALCL between 1st January 2007 and 31st December 2016 were analyzed. Details regarding clinical-presentation and treatment were recorded and outcome was analyzed. Fourteen-children were diagnosed. Median-age was 114 months (range 24 - 162 months). Male:female ratio was 3.6:1. Stage-I, II and III disease was seen in three (21.4%), three (21.4%), and eight (57.1%) children, respectively. Low, standard and high-risk disease was seen in two (14.2%), six (42.9%) and six (42.9%), respectively. All children were treated using ALCL99 protocol. Three (21.4%) children had disease-progression/relapse and five (35.7%) died (three from treatment-related mortality, and two from disease). At median follow-up of 54-months, four-year EFS and OS were 64.3% and 64.3%, respectively. Log-rank test demonstrated female gender (p = 0.005), stage-III disease (p < 0.001), visceral-organ involvement (p = 0.035), high-risk disease (p = 0.016) and, serum albumin ≤3.5 g/dL (p = 0.031) associated with significantly worse 4-year EFS. Cox-regression analysis demonstrated female gender associated with poor EFS (p = 0.02) and female gender and visceral-organ involvement associated with poor OS (p = 0.02, p = 0.011, respectively). Good survival could be achieved for children with ALCL using uniform treatment protocol in a resource-limited setting, especially among low and standard-risk children. Female-sex, high-risk disease, stage-III disease, visceral organ involvement and low albumin levels were associated with poor outcome, however these findings need to be corroborated in larger studies.

Clinico pathological characteristics and survival outcome in oral cavity cancer with masticator space involvement (T4b) - A single institutional experience.

INTRODUCTION: Oral cavity cancer with the masticator space involvement is considered as very advanced localised diseas e and staged as T4b in AJCC 8th edition. NCCN guidelines consider this as inoperable. This study intends to compare the different treatment modalities in T4b oral cavity cancer and their impact on survival. PATIENTS AND METHODS: This is a retrospective study of 150 patients with T4b oral cavity ca, from 2013to 2015 and follow up data till 31 st July 2019 were collected. All patients had biopsy proven SCC and CT evidence of masticator space involvement. RESULTS: Total of 150 patients were included. 102 patients had received curative treatment and 48 patients had received palliative treatment. In the curative group 84% were treated with surgery and adjuvant treatment and remaining had received RT with or without chemotherapy. 90% patients in the surgically treated group had attained margin negative resection. 4 year OS in the curatively treated group was 58.9% and in the palliative group was 12%. The surgically treated patients in the curative arm had a significant survival advantage over the patients who had received only RT with or without chemotherapy, (63.5% v/s 34%, p = 0.001). CONCLUSION: Curatively treated oral cavity cancer with masticator space involvement has survival outcome comparable to the published survival data of those without masticator space involvement. Radical intent treatment, preferably surgery should be offered to all patients with masticator space involvement, if negative margin is anticipated from preoperative imaging.

Dosimetric comparison of 3DCRT and IMRT in radical chemoradiotherapy of squamous cell carcinoma esophagus.

BACKGROUND: Radical chemoradiation is the standard of treatment for locally advanced squamous cell carcinoma of esophagus and for patients with operable disease, but who are medically unfit or unwilling for surgery. As the esophagus is a central organ, the planning target volume (PTV) is central, lies close to the spinal cord and heart, and is surrounded by the lung, which is a radiosensitive organ. Irradiation of these critical structures is reduced by the use of three-dimensional conformal radiation therapy (3DCRT). Intensity-modulated radiation therapy (IMRT) has the potential to improve the uniformity of dose distribution to the tumor and reduce the dose received by surrounding normal tissues. AIM AND OBJECTIVES: 1. To compare the dose distribution, conformity, and homogeneity indices in radical radiotherapy of squamous cell carcinoma of esophagus using 3DCRT and IMRT techniques 2. To compare the doses received by critical structures such as heart, lung, spinal cord, and liver. MATERIALS AND METHODS: All cases of squamous cell carcinoma esophagus treated with radical chemoradiation to a dose of 50 Gy in 25 fractions using 3DCRT technique from January 2018 to July 2019 were included. IMRT plans were generated for these cases.The parameters that represent dose distribution to the target volume and the dose received by the organs at risk were obtained from the dose-volume histogram. The difference in the mean values of the parameters between the two techniques was calculated. The statistical significance of the difference was determined using Student's t-test and Wilcoxon signed-rank test. RESULTS: The volume of PTV receiving 105% and 107% of prescribed dose was significantly lower with IMRT (3.540% and 0.008%, respectively) compared to 3DCRT (7.654% and 0.623%). The homogeneity index was better with IMRT (0.088 vs. 0.107) than 3DCRT. Conformity index was found to be better with IMRT (1.149 vs. 1.573). Mean heart dose (18.216 vs. 24.591 Gy) and the volume of heart receiving 30 Gy were reduced with IMRT. The volume of lung receiving 20 Gy and the volume receiving 5 Gy were not significantly different between 3DCRT and IMRT. Maximum dose to spinal cord was similar with 3DCRT and IMRT. CONCLUSIONS: IMRT avoids areas of excessive irradiation within the PTV. IMRT improves dose conformity to the target volume and homogeneity of dose distribution within the PTV. The cardiac dose is significantly reduced with IMRT. The mean lung dose remains similar to 3DCRT. There is no significant increase in the volume of lung receiving low-dose radiation with IMRT.

Preoperative incremental shuttle walk test for morbidity and mortality prediction in elective major colorectal surgery.

Background and Aims: The incremental shuttle walk test (ISWT) is a simple reproducible and non-invasive test for assessing cardiopulmonary function. The maximum oxygen consumption is less than 10 ml/kg/min for ISWT distance of less than 250 m. This study aimed to evaluate the effectiveness of ISWT in predicting morbidity and mortality in elective colorectal oncosurgery and to find the correlation of ISWT with the Duke Activity Status Index (DASI), Borg dyspnoea score, and peak oxygen uptake (VO2 max). Methods: This prospective study involved 46 patients aged more than 60 years with American Society of Anesthesiologists physical status I and II undergoing elective colorectal surgery under general anaesthesia with an epidural block. ISWT was conducted preoperatively and patients were monitored for 30 days postoperatively. For a comparative analysis, patients were divided into two groups: group 1- who could walk 250 m and group 2 - could not walk 250m. Categorical data were evaluated using the Chi-square test, while continuous data were evaluated using the Student's t-test. The strength of correlation was determined using Pearson's correlation coefficient. Results: Postoperative complications (P = 0.001) and lengthy stay in hospital and intensive care unit (P = 0.001) were experienced by all patients who were unable to complete the ISWT distance of 250 m. ISWT distance of 250 m corresponds to a DASI score of 10.5, which is equivalent to a calculated VO2 max of 14.1ml/kg/min. Conclusion: The ISWT with a cutoff distance of 250 m is a reliable predictor of postoperative morbidity in patients undergoing colorectal oncosurgery.

A randomized control trial to study the effect of bilateral Gow-gates block on visibility of surgical field and hemodynamic response in patients with carcinoma tongue.

BACKGROUND AND AIMS: Regional anesthesia in oncosurgery is a current research topic. The use of nerve blocks near the surgical site gives good analgesia, surgical field visibility and hemodynamic profile. Our aim was to evaluate the effect of the Gow gate mandibular nerve block in tongue surgeries. METHODS: ASA 1 & 2 patients posted for surgery for carcinoma of tongue were included in the study. After randomization Bilateral Gowgates block was given to Group G. Group M received IV Morphine only. The investigator B who was blinded to which group the patient belonged conducted the anesthesia and did the outcome assessment. The hemodynamic response to surgical manipulation was noted. The visibility of the surgical field was assessed by the surgeon using Surgical visibility scale. Postoperative pain was assessed by assessing dose requirement of opioids and paracetamol. The mean difference between the two groups were tested using student's t-test for normally distributed variables and Mann-Whitney U test for non-normal variables. RESULTS: Hemodynamic stress response during surgical stimulation was significantly lower in group G. Surgical field visibility score was better in the group G (p0.002). The use of morphine intraoperatively in group G was less (p= 0.001) CONCLUSION: Bilateral Gow gates block improves visibility of surgical field and hemodynamic response in patients undergoing surgery for carcinoma tongue.

Comparison of preoperative assessment tools in older patients undergoing cancer surgery: A prospective study.

INTRODUCTION: Surgery in older adults with cancer is complex due to multiple age related confounding factors. There are many scoring systems available for preoperative risk stratifications of older patients. Currently very few prospective studies comparing the various commonly used scales are available. This is the first study which compares the established preoperative risk assessment tools of Eastern Cooperative Oncology Group Performance Scale (ECOG) and American Society of Anaesthesiologists Physical Status Scale (ASA) with frailty scores of Modified Frailty Index (MFI) and Clinical Frailty Scale (CFS). MATERIAL AND METHODS: This is a prospective observational study of older patients with cancer who underwent oncosurgery in a tertiary cancer centre during the one-year study period. Patients were scored on the CFS, MFI, ASA and ECOG scales. All patients were followed up for 30 days immediately following surgery and their post operative complications were documented. Univariate and multivariate analyses were done and a p value of ≤0.05 was considered statistically significant. RESULTS: Of the 820 patients studied, 15.6% had prolonged hospital stay, 9.1% had 30-day morbidity, 0.7% had readmission, and mortality was 1.1%. High-risk scores on the ASA and CFS were significantly associated with prolonged postoperative stay, readmission, morbidity, and mortality (p < 0.05). High-risk scores on the ECOG was significantly associated with prolonged hospital stay (p = 0.027), 30-day morbidity (p = 0.003), and mortality (p = 0.001), but not with readmission. There was no significant association between MFI score and the postoperative variables studied (p > 0.05). On multivariate analysis, morbidity was significantly associated only with male gender (p = 0.015), higher cancer stage (p = 0.005), higher ASA score (p = 0.029), and prolonged hospital stay (p = 0.001). Mortality was significantly associated only with emergency surgery (p = 0.012) and prolonged hospital stay (p = 0.004), and prolonged hospital stay was significantly associated with advanced cancer stage (p = 0.001) and emergency surgery (p = 0.02). CONCLUSIONS: In older patients undergoing cancer surgery, ASA and CFS are predictors of prolonged postoperative stay, morbidity, mortality, and readmission. A high-risk ECOG score is predictive of prolonged post operative stay, 30-day morbidity, and mortality, but not of readmission. Score on MFI is not a predictor of postoperative outcomes. Newer predictive tools which include cancer- specific factors are required for better management of these patients.

Risk factors and prevalence of cervical squamous intraepithelial lesions among women in south India: A community-based cross-sectional study.

Background: ">Cervical cancer in India accounts for one-fifth of the global burden. Well-defined precancerous stages help early detection of the disease. Apart from human papillomavirus, the risk factors include age, education, occupation, early age at marriage and first delivery, abortions, and multiple sexual partners. Prevalence and risk factors for cervical squamous intraepithelial lesions (SIL) among women by Pap smear screening in south India were analyzed through a cross-sectional study. Methods: ">Women from rural and urban area were motivated by local accredited social health activists to attend pre-fixed Pap smear clinics in government hospitals. Pap smears collected in these clinics were taken to the Regional Cancer Centre, Thiruvananthapuram, processed, and cytology reports were prepared. Multiple logistic regression analysis was used to identify risk factors for SIL and high-grade SIL (HSIL). Results: ">The number of SIL was 67 out of 10,580 and HSIL was 39. Having higher education (Odds Ratio, OR:0.05(95% Confidence Interval, CI: 0.01-0.2), being married but living single (OR : 5.3, 95%CI:2.4-11.5), Having >2 abortions (OR:21, 95% CI:4.5-24), having younger age at delivery (OR : 0.1, 95% CI:0.01-0.3) and having unhealthy cervix (OR: 16.4, 95% CI:6.2-42.7) were the factors found to be the associated risk factors in multiple regression analysis. Conclusion: ">Pap smear screening can be focused on women with risk factors such as low education, married but living single, having >2 abortions, younger age at delivery, and unhealthy cervix on per speculum examination.

Correlation of TIRADS and Bethesda Scoring Systems with Final Histopathology of Thyroid Nodules - An Institutional Experience.

Fine needle aspiration cytology (FNAC) reduces the number of unnecessary thyroid surgeries for patients with benign nodules and appropriately triages patients with thyroid cancer to appropriate treatment. This was a observational study done on cases presenting with clinical suspicion of thyroid malignancy which underwent ultrasonography followed by FNAC of thyroid nodule. Ultrasonographic characterization of nodules was based on Thyroid Imaging Reporting and Data System (TIRADS) and cytology reporting was based on Bethesda system. All recruited patients underwent thyroidectomy. Pre-operative cytology and ultrasonography features were compared with final histopathology report. In our study, Bethesda system of cytology reporting for thyroid nodules had a better sensitivity, specificity and diagnostic accuracy than TIRADS system of ultrasound reporting. Bethesda system in FNAC had a larger area under the ROC curve (0.91) as compared to ultrasound TIRADS (0.70). Malignancy rate of TIRADS 5 nodules was 97.1% with significant p value (0.022). 100% of Bethesda VI lesions were malignant according to final histopathology report. Ultrasound TIRADS could pre-operatively predict malignancy in 63.6% of indeterminate thyroid nodules which were malignant according to post-operative histopathology. The overall concordance of ultrasound TIRADS, Bethesda system and histopathology was 69.8%. Higher TIRADS and Bethesda scoring among thyroid nodules was associated with increased risk of malignancy. US TIRADS is a good predictor of malignancy in indeterminate thyroid nodules.

Stage migration and treatment outcome in carcinoma tongue - A comparison of seventh and eighth AJCC pathological staging systems.

Background: The eighth edition of the American Joint Committee on Cancer (AJCC) for oral cancer has incorporated additional pathological features like depth of invasion (DOI) and extranodal extension (ENE) into T and N staging. The incorporation of these two factors will impact the staging and, hence, the treatment decisions. The aim of the study was to clinically validate the new staging system in predicting the outcome in patients treated for carcinoma oral tongue. The study also examined the correlation of pathological risk factors with survival. Methods: We studied 70 patients with squamous cell carcinoma of the oral tongue who underwent primary surgical treatment at a tertiary care center in the year 2012. All these patients were restaged pathologically according to the new AJCC eighth staging system. The 5-year overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan-Meier method. Akaike information criterion and concordance index were calculated between both staging systems to identify a better predictive model. Log-rank test and univariate Cox regression analysis were conducted to find out the significance of different pathological factors on outcome. Results: Incorporation of DOI and ENE resulted in 47.2% and 12.8% stage migration, respectively. DOI less than 5 mm was associated with a 5-year OS and DFS of 100% and 92.9%, respectively, compared to 88.7% and 85.1%, respectively, when the DOI was more than 5 mm. Presence of lymph node involvement, ENE, and perineural invasion (PNI) were associated with inferior survival. The eighth edition had lower Akaike information criterion and improved concordance index values compared with the seventh edition. Conclusion: The eighth edition of AJCC allows better risk stratification. Restaging of cases based on the eighth edition AJCC staging manual resulted in significant upstaging with difference in survival.

Outcomes of pediatric mixed phenotype acute leukemia treated with lymphoid directed therapy: Analysis of an institutional series from India.

There is limited data regarding pediatric mixed phenotype acute leukemia (MPAL) and there is no global consensus on its management yet. In this retrospective study, we analyzed the outcomes of children diagnosed with MPAL at our institute. This study included children ≤ 14 years with MPAL who presented to a tertiary cancer center in India from January 1st 2009 to December 31st 2015. Over a seven-year period, 1390 patients with leukemia presented to our institute of which 22 patients (1.5%) had MPAL. Sixteen patients (72.7%) had B/myeloid leukemia, while 4 (18.1%) and 2 (9%) patients had T/myeloid and B/T leukemia respectively. Twenty-one patients were treated with a modified BFM ALL 95 protocol. 76.1% (n = 16) of patients had a good prednisolone response (GPR) on day 8 and end-of-induction (EOI) marrow was in remission in 90.5% (n = 19). A poor prednisolone response (PPR) on day 8 correlated with an inferior relapse-free survival (25% vs 79.5%, P=.025). The 4-year event-free survival (EFS) and overall survival (OS) for the entire group was 60.8% and 64.9% respectively while the EFS for patients who had a GPR and remission at the EOI (n = 15) was 80% as compared to 16.7% in patients with PPR or induction failure. Lymphoid directed chemotherapy is seen to have good survival outcomes in pediatric MPAL. However, a PPR on day 8 or a positive EOI marrow may be an indication for more aggressive treatment.

Does addition of postmastectomy radiotherapy improve outcome of patients with pT1-2, N0 triple negative breast cancer as compared to breast conservation therapy?

BACKGROUND: Triple-negative breast cancers (TNBCs) form a heterogeneous group of cancers typically exhibiting an aggressive behavior resulting in increased risk of locoregional relapse (LRR) and distant metastases. The effect of radiotherapy on LRR risk and overall survival (OS) in women treated with mastectomy alone for early-stage TNBC remains unclear. AIM: The aim of this study is to compare the locoregional recurrence rate, disease-free survival (DFS), and OS following breast conservation therapy (BCT) or modified radical mastectomy (MRM) alone in women with stage I and IIA TNBC and to assess the impact of tumor and treatment-related factors. MATERIALS AND METHODS: Patients with early-stage (pT1-2, N0) TNBC-treated between January 1, 2010, and December 31, 2011, were identified from the hospital-based registry records. The mean age was 48 years. Forty-nine patients underwent BCT, and 121 underwent MRM. The majority of the patients in both groups had T2 and grade 3 disease. None of the patients had margin positive status after surgery. Five patients had lymphovascular invasion (LVI). RESULTS: At a median follow-up of 50 months (range: 4-83 months), there was no locoregional recurrence (LRR) in either arm. Eight patients relapsed, six developed distant metastases, and one patient each had a new primary in the contralateral breast and ovary. Two patients died of disseminated cancer, one each in the BCT and MRM groups. The five-year DFS was 95.8% and 91.1% for the BCT group and MRM group, respectively, (P = 0.83). The corresponding 5-year OS was 98% and 97.5% (P = 0.527). There was no statistically significant difference in outcome based on age, grade, LVI, or margin status between both groups. CONCLUSION: This retrospective analysis identified no statistically significant difference in outcome regarding LRR, DFS, or OS in patients treated without adjuvant radiation for women with pT1-T2N0 TNBC who underwent MRM in comparison to BCT.

Clinicopathological features and outcomes of adrenocortical carcinoma: A single institution experience.

INTRODUCTION: Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with aggressive behavior. Most of our knowledge about this rare tumor is based on retrospective case series. This study aimed at analyzing the clinicopathological features and outcomes of patients treated at a tertiary cancer center in India. PATIENTS AND METHODS: We retrospectively reviewed the data of patients with ACC registered from January 2006 to December 2015. RESULTS: Thirty-seven patients were included in the study, 20 males and 17 females. Median age was 49 (18-78) years. Hormonal overproduction was noticed in 27% of patients. Median tumor size was 10 cm (2-22). Seventeen patients had metastatic disease and 20 patients were localised at diagnosis. Median follow-up was 22 months and median overall survival (OS) was 23.46 months. OS at 2 years and 5 years was 46.1% and 21%, respectively. The median disease-free survival (DFS) was 20 months. DFS at 2 years and 5 years was 45% and 24%, respectively. Age, sex, tumor size, hormonal overproduction, tumor laterality, and stage of the disease did not influence survival. However, advanced stage was associated with higher risk for recurrence. (P = 0.03). CONCLUSION: ACC is a rare endocrine malignancy with very poor survival rates. Rate of recurrence is high even after complete surgery. Systemic treatment options are limited. Newer agents are needed to improve outcome.

Intraoperative pectoral nerve block (Pec) for breast cancer surgery: A randomized controlled trial.

BACKGROUND AND AIMS: In centers with high turnover of breast surgeries, pectoral nerve block (Pec II) is time-consuming and requires ultrasound familiarity for administration. We decided to block the same nerves under vision after resection to evaluate postoperative analgesic effects. MATERIAL AND METHODS: Sixty patients scheduled for modified radical mastectomy were enrolled in this prospective, randomized, placebo-controlled, triple-blinded study. All patients received standardized general anesthesia. After surgical resection, infiltration of either ropivacaine (Group A) or saline (Group B) was given under vision at two points: 20 ml in the fascia over serratus anterior and 10 ml in the fascia between pectoralis major and minor at the level of the third rib. The primary outcomes measured were the time to first request for analgesia after extubation and total dose of analgesics needed, and secondary outcome included pain scores using the Numerical Rating Scale over 24 h. Analgesics used postoperatively were fentanyl citrate and paracetamol. We used Student's t-test to analyze quantity of analgesics needed, the nonparametric Mann-Whitney U-test for time to first request of analgesic, and Fisher's exact test for pain scores. RESULTS: No patient in Group A required fentanyl. The mean time to first request for analgesia and mean dose of paracetamol required was 353.93 ± 135.03 min and 2.71 ± 0.462.71 g in Group A and 27.17 ± 18.08 min and 3.53 ± 1.074 g in Group B [P = 0.002]. Significantly more patients in Group A had mild pain scores compared to Group B. CONCLUSION: Pec II block with ropivacaine delivered under vision reduced analgesic requirement and pain scores significantly.

Significance of DNA Replication Licensing Proteins (MCM2, MCM5 and CDC6), p16 and p63 as Markers of Premalignant Lesions of the Uterine Cervix: Its Usefulness to Predict Malignant Potential

Cervical cancer continues to be a leading cancer among women in many parts of the world. Nation-wide screening with the Pap smear has not been implemented in India due to the lack of adequately trained cytologists. Identification of biomarkers to predict malignant potential of the identified low risk lesions is essential to avoid excessive retesting and follow up. The current study analyzed the expression patterns of DNA replication licensing proteins, proliferation inhibitor protein p16INK4A and tumor suppresser protein p63 in cervical tissues and smears to assess the ability of these proteins to predict progression. Methods: Cervical smears and corresponding tissues were immunostained using mouse monoclonal antibodies against MCM2, MCM5, CDC6, p16 and p63. Smears were treated with a non-ionic surfactant sodium deoxycholate prior to immuno-cytochemistry. The standard ABC method of immunohistochemistry was performed using DAB as the chromogen. The immunostained samples were scored on a 0-3+ scale and staining patterns of smears were compared with those of tissue sections. Sensitivity and specificity for each of these markers were calculated taking histopathology as the gold standard. Result: All the markers were positive in malignant and dysplastic cells. MCM protein expression was found to be up-regulated in LSIL, HSIL and in malignancies to a greater extent than p16 as well as p63. CDC6 protein was preferentially expressed in high grade lesions and in invasive squamous cell carcinomas. A progressive increase in the expression of DNA replication licensing proteins in accordance with the grades of cervical intraepithelial lesion suggests these markers as significant to predict malignant potential of low grade lesions in cervical smears. Conclusion: MCMs and CDC6 can be applied as biomarkers to predict malignant potential of low grade lesions identified in screening programmes and retesting / follow up might be confined to those with high risk lesions alone so that overuse of resources can be safely avoided.

Role of preoperative investigations in elderly patients undergoing oncosurgical procedures - A retrospective review audit.

BACKGROUND AND AIMS: The aim of the study was to evaluate the efficacy and usefulness of the current practice of various investigations and consultations being done during preanesthetic evaluation in patients undergoing oncosurgical procedures in our hospital. We also evaluated the delay caused due to these and its value in predicting postoperative complications. MATERIAL AND METHODS: The preanesthetic charts of 300 elderly patients >65 years of age were reviewed, and the incidence of abnormal investigations and number of consultations advised were noted. The incidence and predictive values of these were assessed. RESULTS: More than half the number of patients had more than one comorbidity and were advised various consultations based on history, National Institute of Clinical and Health Excellence (NICE) guidelines, and institutional protocol. Multiple visits to preanesthetic clinic were required in patients who had abnormal thyroid tests or respiratory complaints which was the main reason for delay in scheduling surgery. However, despite multiple comorbidities not more than 12.7% of the blood tests ordered were found to be abnormal. Abnormal blood tests were not significantly associated with higher incidence of postoperative complications. CONCLUSION: Blood investigations do not predict postoperative complication rate and do not influence anesthetic management of elderly patients undergoing oncosurgical procedures but are rather influenced by surgical procedure and presence of comorbidities. Hence, preanesthetic clinic should assess patients based on other predictive tests rather than relying on blood investigations alone.

A survey on the use of low flow anaesthesia and the choice of inhalational anaesthetic agents among anaesthesiologists of India.

BACKGROUND AND AIMS: With the availability of modern workstations and heightened awareness on the environmental effects of waste anaesthesia gases, anaesthesiologists worldwide are practicing low flow anaesthesia (LFA). Although LFA is being practiced in India, hard evidence on the current practice of the same from anaesthesiologists practicing in India is lacking and hence, we conducted this survey. METHODS: A questionnaire containing 16 questions was distributed among a subgroup of anaesthesiologists who attended the 2014 National Conference of Indian Society of Anaesthesiologists. The filled-in questionnaires were computed and analysed with SPSS version 11. RESULTS: The response rate to the survey was 82%. About 73% of the respondents practiced LFA routinely, with 65% having workstations. Most of the anaesthesiologists used fresh gas flows <1.5 L/min with 45.1% using O2 concentrations at a range of 30-40%. ETCO2 monitoring was used routinely by most whereas use of agent analysers and bispectral index monitoring were restricted. The availability of scavenging system was also limited to only 33.5%. Majority preferred N2 O as carrier gas and sevoflurane as volatile agent of their choice. CONCLUSION: Our survey revealed that practice of LFA in India has numerous lacunae. Provision of better monitoring facilities, workstations as well as awareness regarding the environmental issues of waste anaesthetic gases need to be addressed.