Alumina - Stabilized SEI and CEI in Potassium Metal Batteries.

Aluminum oxide (Al2O3) nanopowder is spin-coated onto both sides of commercial polypropene separator to create artificial solid-electrolyte interphase (SEI) and artificial cathode electrolyte interface (CEI) in potassium metal batteries (KMBs). This significantly enhances the stability, including of KMBs with Prussian Blue (PB) cathodes. For example, symmetric cells are stable after 1,000 cycles at 0.5 mA/cm2-0.5 mAh/cm2 and 3.0 mA/cm2-0.5 mAh/cm2. Alumina modified separators promote electrolyte wetting and increase ionic conductivity (0.59 vs. 0.2 mS/cm) and transference number (0.81 vs. 0.23). Cryo-stage focused ion beam (cryo-FIB) analysis of cycled modified anode demonstrates dense and planar electrodeposits, versus unmodified baseline consisting of metal filaments (dendrites) interspersed with pores and SEI. Alumina-modified CEI also suppresses elemental Fe crossover and reduces cathode cracking. Mesoscale modeling of metal - SEI interactions captures crucial role of intrinsic heterogeneities, illustrating how artificial SEI affects reaction current distribution, conductivity and morphological stability.

Periprosthetic metastases in carcinoma of unknown primary: A rare association.

ABSTRACT: Septic or aseptic loosening may cause bone loss around artificial prosthesis leading to prosthesis failure. This occurrence due to metastatic infiltration of bone or surrounding soft tissues is rare but has been occasionally reported. We report a case of an elderly lady presenting with swelling and pain at the site of previous hemiarthroplasty performed for traumatic injury. On evaluation, she was found to have a lytic femur lesion with a large soft-tissue component around the prosthetic joint. Biopsy suggested a metastatic carcinoma of renal origin, but screening of kidneys did not reveal any primary lesion. She had additional skeletal metastatic lesions but no other primary site was detected either. She was given palliative radiotherapy and systemic therapy (sunitinib) based on the histologic diagnosis of renal cell origin but did not tolerate it. Thereafter, she is continuing on zoledronate every 4 weeks and best supportive management since 4 months from diagnosis.

Treatment outcomes of adjuvant radiotherapy in adrenocortical carcinoma - A 13-years experience from a tertiary care centre.

Purpose: Adrenocortical carcinoma (ACC) is a rare and highly aggressive malignant neoplasm, usually diagnosed in advanced stage. Role and efficacy of adjuvant radiotherapy has not been well defined. The objective of this study is to describe the various clinical characteristics and prognostic factors affecting the survival of ACC along with the role radiotherapy on overall survival and relapse free survival. Methods: A retrospective analysis of 30 patients registered between 2007 and 2019 was carried out. The medical records containing clinical and treatment details were analysed. Data was analysed using SPSS 25.0. Survival curves were computed using Kaplan-Meier method. Univariate and multivariate analyses were performed to analyze the prognostic factors affecting the outcome. A p value of less than 0.05 was considered to be statistically significant. Results: The median age of patients was 37.5 years (range, 5-72 years). 20 patients were females. Twenty-six patients had advanced stage (III/IV) disease while only four patients presented in early stage. Twenty-six patients underwent total adrenalectomy. Eighty three percent patients received adjuvant radiation therapy. The median follow up was 35.5 months (range, 7 monthss-132months). The estimated three- and 5-years overall survival (OS) was 67.2% and 23.3%, respectively. Capsular invasion and positive margins were the independent prognostic factors influencing both OS and relapse free survival (RFS). Out of 25 patients who received adjuvant radiation, only three patients had local relapse. Conclusion: ACC is a rare and aggressive neoplasm with majority of patients presenting in advanced stage. Surgical resection with negative margins remains the mainstay of treatment. Capsular invasion and positive margins are independent prognostic factors for survival. Adjuvant radiation reduces the risk of local relapse and is well tolerated. Radiation can be used effectively in adjuvant and palliative settings in ACC.

What Did the Pandemic Teach Us About Palliative Radiation in Head and Neck Cancer?

Objective: To assess the feasibility and efficacy of palliative radiotherapy dose regimens for patients with locally advanced head and neck cancer. Methods: Fifty patients of previously untreated, inoperable, stage IVA and IVB squamous cell carcinoma of the head and neck, deemed unfit for radical treatment, were included in the study from May 2020 to June 2020. Two palliative radiotherapy regimens were used. First was a single fraction radiation with 8 Gy for patients with limited life expectancy and poor performance status, which was repeated after 4 weeks in case of good symptom relief. The second regimen was used for patients with good performance status and consisted of fractionated radiation with 30 Gy in 10 fractions over 2 weeks, which was followed by supplementary radiation with 25 Gy in 10 fractions over 2 weeks in patients with good symptomatic response at 2 weeks. Symptoms were assessed at baseline and at the end of 4 weeks after treatment completion using the numerical rating score. Patients were followed up for a median of 4.5 months and assessed for symptom control and overall survival. Results: Forty-eight patients completed treatment and were included for analysis. Of the 24 patients who received single fraction radiation, 13 (54.2%) were given the second dose. Improvement in pain and dysphagia were reported in 57.9% and 60% patients, respectively. A total of 55.5% noted decrease in size of the neck node. Twenty-four patients received fractionated radiation and 15 (62.5%) were given the second course after 2 weeks. Relief in pain and dysphagia was reported in 68.2% and 63.6% patients, respectively. There were no grade 3/4 toxicities. Symptom control lasted for at least 3 months in 30% of the patients who received single fraction radiation and 54.2% of the patients who received fractionated radiation. The estimated 6-month overall survival of the entire cohort was 51.4%. Conclusion: Judicious use of palliative radiation in advanced incurable head and neck cancers provides effective and durable symptom relief and should be used after careful consideration of patient prognosis, logistics of treatment, and goals of care.

Impact of Telemedicine on Healthcare Delivery in Gastrointestinal Cancer Patients during the COVID-19 Pandemic.

Background: COVID-19 pandemic necessitated to change the normal OPD practices in view of lockdown and to decrease the exposure of patients and health care workers. Hence our institute adopted the telemedicine route to cater to the needs and grievances of patients. In this article we have analysed the impact of telemedicine on gastrointestinal cancer patients in Radiotherapy and Oncology OPD during COVID-19 pandemic. Methodology: Retrospective data was extracted from the files of the patients who were seen through telemedicine. Time period for this study was kept from 1st September 2020 to 31st October 2020. Patients with only gastrointestinal malignancies were enrolled in the study. Patients were called telephonically to get their feedback on the telemedicine experience. Every patient completed a set of questionnaires. Physical OPDs were also running simultaneously with appointments made through telemedicine to reduce crowding and maintain social distancing. Results: In total, data of 157 patients was obtained. Sixty three percent of the patients were from rural background while 37% had urban residence. Median age of the patients was 55 years (range,13-80years). Thirty eight percent patients had stage IV,51.6% had stage III while 8.9% had early-stage malignancies. Sixty percent of the patients had either received or were on radical treatment while 39.5% were taking palliative treatment. Approximately 53% of OPD visits could be avoided with telemedicine. Overall, the experience of telemedicine received an encouraging response with 87.3% of patients responding affirmatively to repeat the telemedicine if given opportunity. Conclusion: Telemedicine has led to un-interrupted delivery of cancer care, particularly for patients who were on active surveillance and live at remote places from the hospital. Our study demonstrated patient and healthcare staff safety along with the benefits of health care facilities to patients during this period of pandemic, though assessment of long-term impact on patient outcomes and health care systems needs to be done.

Clinical behaviour and outcome in pediatric glioblastoma: current scenario.

Pediatric glioblastoma (pGBM) is a rare entity accounting for only approximately 3% of all childhood brain tumors. Treatment guidelines for pGBM have been extrapolated from those in adult glioblastoma. Rarity of pGBM and underrepresentation of pediatric population in major studies precludes from defining the ideal treatment protocol for these patients. Maximum safe resection is performed in most of the cases followed by postoperative radiotherapy in children over 3 years of age. Benefit of temozolomide is unclear in these patients. Here, we present the clinicopathological details and outcome of six pGBM patients treated at our institute in 2018-2019.

Role of Arthroscopic Surgery in Degenerative Knees with Mechanical Symptoms.

BACKGROUND: This study was conducted to evaluate functional outcome in patients undergoing/underwent arthroscopic surgery for degenerative knees with mechanical symptoms or acute exacerbation of symptoms, not amenable to conservative measures. MATERIALS AND METHODS: This was a longitudinal type of study (prospective and retrospective). For the prospective cohort, followup was done at an interval of 2 weeks, 6 weeks, 6 months and 1 year to record visual analog scale (VAS), International Knee Documentation Committee (IKDC), and short form-8 (SF-8) scores. For the retrospective cohort, hospital records were studied to record the preoperative VAS score. Preoperative IKDC and SF-8 scores were recorded at final followup based on recall method (patient's memory). Furthermore, postoperative VAS, IKDC, and SF-8 scores at final followup were recorded. RESULTS: There were a total of 46 knees (28 retrospective and 18 prospective) in 44 patients. The mean age was 52.34 ± 11.73 years. There were 28 female knees and 18 male knees. The mean followup of patients in the retrospective cohort was 55 months (range: 13-126 months), whereas all patients in prospective cohort completed the minimum followup of 1 year. The improvements in VAS, IKDC, and SF-8 were statistically significant. Forty-one cases were successful and five cases were failure. All successful patients (41 cases) said "yes" and all failure cases (05) said "no" to the question-"If given a choice, would you still like to get the same surgery done for the same problem??". There was one complication deep venous thrombosis. CONCLUSION: We recommend arthroscopic surgery in patients with degenerative knees, with mechanical symptoms and acute exacerbation of symptoms, not amenable to conservative measures.

Factors influencing extended hospital stay in patients undergoing metastatic spine tumour surgery and its impact on survival.

Metastatic spine tumour surgeries (MSTS) are indicated for preservation or restoration of neurological function, to provide mechanical stability and pain alleviation. The goal of MSTS is to improve the quality of life of the patients with spinal metastases and rarely for oncological control which is usually achieved by adjuvant therapies. Hence outcome measures such as length of stay (LOS) and rate of complications after MSTS are important indicators of quality but there is limited literature evidence for the same. We carried out a retrospective study to determine the incidence and the factors influencing normal (nLOS) and extended length of stay (eLOS) after MSTS. Data of 220 consecutive patients who underwent MSTS between 2005 and 2015 were retrieved from hospital electronic records. The preoperative, intraoperative and postoperative variables, discharge destinations as well as socioeconomic factors were analyzed. eLOS defined as positive when the LOS exceeded the 75th percentile for this cohort, was the key outcome indicator. Univariate and multivariate logistic regression analyses were performed to determine the predictive factors of eLOS. The overall median LOS was 7 days (1-30 days) and 55 patients had eLOS (LOS ≥ 11 days). Multivariate analysis revealed that significant variables independently associated with eLOS were instrumentation >9 spinal segmental levels (OR 2.89, 95% CI 1.1-7.5, p = 0.032) and presence of postoperative complications (OR 3.68, 95% CI 1.85-7.30, p < 0.001). Metastatic tumours other than breast, prostate and lung have lesser risk of eLOS (OR 0.31, 95% CI 0.14-0.70, p = 0.004). Survival estimates show that patients with eLOS have shorter survival than patients with nLOS (Crude HR 1.81, 95% CI 1.13-2.89, p = 0.003).