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Background and purpose: Linac-based stereotactic radiosurgery (SRS) planning for multi-metastatic cases is a complex and intensive process. A manual planning strategy starts with a template-based set of beam angles and applies modifications though a trial and error process. Beam angle optimization uses patient specific geometric heuristics to determine beam angles that provide optimal target coverage and avoid treating through Organs-at-Risk (OARs). This study expands on a collision prediction application developed using an application programming interface, integrating beam angle optimization and collision prediction into a Stereotactic Optimized Automated Radiotherapy (SOAR) planning algorithm. Materials and methods: Twenty-five patient plans, previously treated with SRS for multi-metastatic intracranial tumors, were selected for a retrospective plan study comparing the manual planning strategy to SOAR. The SOAR algorithm was used to select isocenters, table, collimator, and gantry angles, and target groupings for the optimized plans. Dose-volume metrics for relevant OARs and PTVs were compared using double-sided Wilcoxon signed rank tests (α = 0.05). A subset of five patients were included in an efficiency study comparing manual planning times to SOAR automated times. Results: OAR dose metrics compared between planning strategies showed no statistical difference for the dataset of twenty-five plans. Differences in maximum PTV dose and the conformity index were improved for SOAR planning and statistically significant. The median SOAR planning time was 9.8 min compared to 55 min for the manual planning strategy. Conclusions: SOAR planning was comparable in plan quality to a manual planning strategy with the possibility for greatly improving planning efficiency through automation.

Objective This study was aimed to investigate machine learning (ML) and artificial neural networks (ANNs) in the prognostic modeling of lung cancer, utilizing high-dimensional data. Materials and Methods A computed tomography (CT) dataset of inoperable nonsmall cell lung carcinoma (NSCLC) patients with embedded tumor segmentation and survival status, comprising 422 patients, was selected. Radiomic data extraction was performed on Computation Environment for Radiation Research (CERR). The survival probability was first determined based on clinical features only and then unsupervised ML methods. Supervised ANN modeling was performed by direct and hybrid modeling which were subsequently compared. Statistical significance was set at

Introduction: Locally advanced Head and Neck Squamous Cell Carcinoma (HNSCC) is a diverse group of patients and the treatment needs to be individualised. Although Concurrent Chemoradiotherapy (CTRT) remains the standard of care, not all patients are suitable to receive the same. Accelerated Fractionated Radiotherapy (AFRT) is one of the treatment options in these patients and may achieve equivalent therapeutic ratio. Aim: To compare outcomes of patients of HNSCC treated with concurrent CTRT versus AFRT in a prospective randomised trial. Materials and Methods: A total of 322 patients of Stage IIIIV (AJCC, 6th Edition), HNSCC of oropharynx, larynx and hypopharynx were randomised to receive either definitive CTRT or AFRT. Radiotherapy (RT) dose was 70 Gray (2 Gray, 5 fractions per week over 7 weeks) to the primary and nodes and 46-60 Gray to the elective neck nodes. RT was delivered 5 fractions per week along with concurrent cisplatin 35-40 mg/m2 weekly in the CTRT arm. In the AFRT arm, RT was delivered as 6 fractions per week of 2 Gray each over 6 weeks. Acute and late toxicities were graded as per RTOG morbidity scoring. Kaplan Meier method was used for survival analysis. Results: Patients characteristics were balanced between CTRT arm and AFRT arm (161 patients each). Median overall treatment time for CTRT and AFRT arms were 43 and 49 days respectively. A 5-year actuarial locoregional control, diseasefree survival and overall survival was 32% vs. 42%; 28% vs. 35% and 30% vs. 35% respectively for CTRT vs. AFRT arm. Need of Ryle’s tube feeding (p=0.001), acute mucositis (p=0.015), late subcutaneous toxicity (p=0.05) and late xerostomia (p=0.042) rates were higher for CTRT arm. Conclusion: AFRT was associated with comparable clinical outcome as compared to CTRT in patients of HNSCC, albeit with reduced acute and late toxicities.

Background: Myxoid and round cell liposarcomas (RCL) are low and high-grade counterparts of a common subtype of liposarcomas (LPS), representing a histologic continuum. Aims: The aim was to study the cytomorphology of hypercellular RCL and to look for features that differentiate RCL from other sarcomas displaying round cells with myxoid change. Materials and Methods: Eight cases of hypercellular RCL were identified retrospectively in which round cell component constituted greater than 75% of the area. Cytomorphological features were studied in detail. Results: Four cases were predominantly composed of round cells, out of which 2 were entirely composed of round cells. Myxoid metachromatic stroma was absent in 2 cases, while it was present in ample amounts in the remaining 6 cases. Spindle cells were completely absent in 5 cases and lipoblasts were observed in a single case of RCL. Plexiform vascular capillaries were seen in 4 cases. Adherence of neoplastic round cells around thin capillaries (ANAC) was observed in 7 cases. Conclusions: Plexiform capillary plexus and ANAC should be separately evaluated. The latter feature is the most consistent one, and is an important clue to the adipocytic nature of the neoplasm when hypercellular round cell areas are aspirated. Confident diagnosis of hypercellular RCL can be made on the basis of this feature. Lipoblasts, although specific, are seen in few cases. The rest of the features are nonspecific and useful only in combination.

Diagnosis of a pneumothorax in the immediate post-operative area can be difficult. Traditional gold-standard modalities may not be available or feasible to institute. Ultrasound (US) guidance allows the anesthesia provider a method of quickly detecting this potentially life-threatening complication especially when it′s least expected. We encountered such a case when a 40 years male patient posted for video assisted thoracic surgery for drainage of empyema on left side of chest developed pneumothorax on right side post-operatively. Timely diagnosis with the help of US saved time and his life. We thus want to emphasize the importance of this simple but useful skill to the anesthesiologist.

Gorlin-Goltz syndrome is a rare autosomal-dominant syndrome related to mutation in " Patched" tumour suppressor gene on chromosome 9. Basocellular carcinomas, odontogenic keratocysts, palmar and/or plantar pits and ectopic calcifications of the falx cerebri are its major features, along with more than 100 minor features. Odontogenic cysts, notorious for recurrence, can make endotracheal intubation difficult, requiring modification of the standard intubation technique. We report such a case managed successfully by awake fibreoptic intubation. Direct laryngoscopy under anaesthesia later confirmed that it was a good decision.

Investigations of the In(III)porphyrin complexes with substituted salicylates(X) as axial ligands have been carried out using electronic and biological studies. Electronic spectra of the complexes are accompanied by shifting of wavelength towards hypsochromic/blue-shift or bathochromic/red-shift along with 'ƒ' values decided by the nature of the functional groups attached to the salicylate ligand. IR frequencies appear at 550cm-1-400cm-1 for In-N(Por) and at 650cm-1-700cm-1 for In-OSA. ¹HNMR spectra reveal the merging of the salicylate ring with that of the protons of the macrocyclic ring. The 13CNMR studies confirm the resonance of the meso-carbon tetraphenyl porphyrin ring between 130ppm to 160ppm and the salicylate ring carbons in the region of 110ppm to 165ppm. Thermal analysis confirms the presence of indium nitride (In-N) in an argon atmosphere from 0oC to 900oC. Cyclic voltammetry(CV) revealed the reduced or oxidized properties of these complexes lead to the generation of p-anion or cation radicals by two one-electron transfer reactions. In(III)porphyrin complexes with substituted salicylates were also screened for in-vitro antifungal activity(%inhibition) against the microbe "Acremonium fusidoides spp." using the PDA method, which shows that the percentage inhibition is inverse to the diameter of the colony. The freeradical scavenging or antiradical activity (%RSA) by the DPPH method reveals that these complexes were absorbance and concentration-dependent. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial resistance is a growing menace, claiming millions of lives all over the world. In this context, drug repurposing is one approach gaining interest as a suitable alternative to conventional drug discovery and development.Methods: Whole-cell assays were used to screen FDA-approved drugs to identify novel antimicrobial agents active against bacterial pathogens. Following identification of nitazoxanide, its various characteristics, such as antimicrobial activity against MDR isolates, time-kill kinetics, ability to synergize with approved drugs, antibiofilm activity and ability to generate resistance in Staphylococcus aureus, were determined, followed by determination of its in vivo potential against MDR S. aureus.Results: Nitazoxanide demonstrated a potent in vitro antistaphylococcal profile, including equipotent activity against clinical drug-resistant S. aureus and Enterococcus spp. Nitazoxanide exhibited concentration-dependent killing, significantly eradicated preformed S. aureus biofilm and S. aureus did not generate resistance to it. Nitazoxanide strongly synergized with linezolid both in vitro and in vivo against linezolid-susceptible and -resistant S. aureus, displaying superior activity to untreated control and drug-alone treatment groups.Conclusions: Nitazoxanide can be utilized in combination with linezolid against infections caused by linezolid-resistant S. aureus as it exhibits strong synergism in vitro and in vivo. [ABSTRACT FROM AUTHOR]

Introduction: Locally advanced Head and Neck Squamous Cell Carcinoma (HNSCC) is a diverse group of patients and the treatment needs to be individualised. Although Concurrent Chemoradiotherapy (CTRT) remains the standard of care, not all patients are suitable to receive the same. Accelerated Fractionated Radiotherapy (AFRT) is one of the treatment options in these patients and may achieve equivalent therapeutic ratio. Aim: To compare outcomes of patients of HNSCC treated with concurrent CTRT versus AFRT in a prospective randomised trial. Materials and Methods: A total of 322 patients of Stage III-IV (AJCC, 6th Edition), HNSCC of oropharynx, larynx and hypopharynx were randomised to receive either definitive CTRT or AFRT. Radiotherapy (RT) dose was 70 Gray (2 Gray, 5 fractions per week over 7 weeks) to the primary and nodes and 46-60 Gray to the elective neck nodes. RT was delivered 5 fractions per week along with concurrent cisplatin 35-40 mg/m² weekly in the CTRT arm. In the AFRT arm, RT was delivered as 6 fractions per week of 2 Gray each over 6 weeks. Acute and late toxicities were graded as per RTOG morbidity scoring. Kaplan Meier method was used for survival analysis. results: Patients characteristics were balanced between CTRT arm and AFRT arm (161 patients each). Median overall treatment time for CTRT and AFRT arms were 43 and 49 days respectively. A 5-year actuarial locoregional control, disease-free survival and overall survival was 32% vs. 42%; 28% vs. 35% and 30% vs. 35% respectively for CTRT vs. AFRT arm. Need of Ryle's tube feeding (p=0.001), acute mucositis (p=0.015), late subcutaneous toxicity (p=0.05) and late xerostomia (p=0.042) rates were higher for CTRT arm. conclusion: AFRT was associated with comparable clinical outcome as compared to CTRT in patients of HNSCC, albeit with reduced acute and late toxicities. [ABSTRACT FROM AUTHOR]

Purpose: Increased use of Linac‐based stereotactic radiosurgery (SRS), which requires highly noncoplanar gantry trajectories, necessitates the development of efficient and accurate methods of collision detection during the treatment planning process. This work outlines the development and clinical implementation of a patient‐specific computed tomography (CT) contour‐based solution that utilizes Eclipse Scripting to ensure maximum integration with clinical workflow. Methods: The collision detection application uses triangle mesh structures of the gantry and couch, in addition to the body contour of the patient taken during CT simulation, to virtually simulate patient treatments. Collision detection is performed using Binary Tree Hierarchy detection methods. Algorithm accuracy was first validated for simple cuboidal geometry using a calibration phantom and then extended to an anthropomorphic phantom simulation by comparing the measured minimum distance between structures to the predicted minimum distance for all allowable orientations. The collision space was tested at couch angles every 15° from 90 to 270 with the gantry incremented by 5° through the maximum trajectory. Receiver operating characteristic curve analysis was used to assess algorithm sensitivity and accuracy for predicting collision events. Following extensive validation, the application was implemented clinically for all SRS patients. Results: The application was able to predict minimum distances between structures to within 3 cm. A safety margin of 1.5 cm was sufficient to achieve 100% sensitivity for all test cases. Accuracy obtained was 94.2% with the 5 cm clinical safety margin with 100% true positive collision detection. A total of 88 noncoplanar SRS patients have been currently tested using the application with one collision detected and no undetected collisions occurring. The average time for collision testing per patient was 2 min 58 s. Conclusions: A collision detection application utilizing patient CT contours was developed and successfully clinically implemented. This application allows collisions to be detected early during the planning process, avoiding patient delays and unnecessary resource utilization if detected during delivery. [ABSTRACT FROM AUTHOR]

A new dual responsive "turn‐on" and "ratiometric" aggregation‐induced emission luminogen (AIEgen) 3‐formyl‐5‐(piperidin‐1‐yl)biphenyl‐4‐carbonitrile 6 a (FPBC 6 a) for selective detection of hydrazine in solution as well as in vapour phase is described. At a low concentration of 2.5 μm, the probe FPBC 6 a is non‐fluorescent (turn‐off) but remarkably lights up (turn‐on with blue emission) in the presence of hydrazine solution (0.25–25 μm). Interestingly, at higher concentrations, the nanoaggregates of FPBC 6 a (>25 μm, 99 % HEPES in DMSO) displayed ratiometric response in the presence of hydrazine with a remarkable hypsochromic shift from the green (500–550 nm) to blue regions (440–480 nm). Furthermore, a real application of FPBC 6 a was successfully demonstrated through the detection and visualization of hydrazine in live cervical cancer cells as well as using portable test strips. Got any rocket fuel? A new dual‐acting "turn‐on" and "ratiometric" aggregation‐induced emission luminogen (AIEgen) 3‐formyl‐5‐(piperidin‐1‐yl)biphenyl‐4‐carbonitrile 6 a for selective detection of hydrazine in solution as well as in the vapour phase is described. [ABSTRACT FROM AUTHOR]

Luminescent carbon quantum dots (CQDs) prepared from aqueous beetroot extract were developed as unique fluorescent nanomaterials for in vivo live animal imaging applications. Blue (B) and green (G) emitting environmentally benign CQDs (particle size of 5 nm and 8 nm, respectively) exhibited bright fluorescence in aqueous medium and were found to be biocompatible, photostable and non-toxic in animal models. The in vivo imaging and toxicity evaluation of both CQDs were performed for the first time in the Caenorhabditis elegans (C. elegans) model, which revealed consistent fluorescence in the gut tissues of the worms without exerting any sign of toxic effects on the nematodes. The in vivo bio-distribution of G-CQDs given by tail vein injection in live BALB/c mice showed optical signals in the lower abdominal regions, mainly in the intestine, and cleared from the body through faeces. The tremendous potential shown by these eco-friendly CQDs in the C. elegans and mice models advocates new hopes for greener CQD nanomaterials as diagnostic tools in the biomedical field. [ABSTRACT FROM AUTHOR]

Objectives: To compare the efficacy and tolerability of losartan, telmisartan, and olmesartan as antihypertensive agents and evaluate and compare their effects on lipid profile and blood glucose. Materials and Methods: This was a randomized, open-label, parallel-group, comparative study conducted in sixty patients of Stage I hypertension. The eligible patients were randomly allocated into three treatment groups: (1) Tablet olmesartan (20 mg), (2) Tablet telmisartan (40 mg), and (3) Tablet losartan (50 mg). Blood pressure (BP) was assessed at an interval of 2 weeks for 3 months. Fasting blood glucose (FBG) and lipid profile were estimated at baseline and then at 12 weeks. Results: Olmesartan and telmisartan were more efficacious than losartan in reducing diastolic BP (DBP). There was a statistically significant decrease in mean blood glucose level (P < 0.02) after 12 weeks of treatment in telmisartan group when compared to baseline. Serum total cholesterol, triglycerides, and low-density lipoproteins decreased significantly after 12-week treatment with olmesartan and telmisartan. Conclusions: The most efficacious drug in reducing BP is Olmesartan whereas telmisartan and losartan show equal efficacy. Telmisartan shows the most favorable effects on FBG and lipid profile. [ABSTRACT FROM AUTHOR]

Background: Myxoid and round cell liposarcomas (RCL) are low and high-grade counterparts of a common subtype of liposarcomas (LPS), representing a histologic continuum. Aims: The aim was to study the cytomorphology of hypercellular RCL and to look for features that differentiate RCL from other sarcomas displaying round cells with myxoid change. Materials and Methods: Eight cases of hypercellular RCL were identified retrospectively in which round cell component constituted greater than 75% of the area. Cytomorphological features were studied in detail. Results: Four cases were predominantly composed of round cells, out of which 2 were entirely composed of round cells. Myxoid metachromatic stroma was absent in 2 cases, while it was present in ample amounts in the remaining 6 cases. Spindle cells were completely absent in 5 cases and lipoblasts were observed in a single case of RCL. Plexiform vascular capillaries were seen in 4 cases. Adherence of neoplastic round cells around thin capillaries (ANAC) was observed in 7 cases. Conclusions: Plexiform capillary plexus and ANAC should be separately evaluated. The latter feature is the most consistent one, and is an important clue to the adipocytic nature of the neoplasm when hypercellular round cell areas are aspirated. Confident diagnosis of hypercellular RCL can be made on the basis of this feature. Lipoblasts, although specific, are seen in few cases. The rest of the features are nonspecific and useful only in combination. [ABSTRACT FROM AUTHOR]

Diagnosis of a pneumothorax in the immediate post-operative area can be difficult. Traditional gold-standard modalities may not be available or feasible to institute. Ultrasound (US) guidance allows the anesthesia provider a method of quickly detecting this potentially life-threatening complication especially when it's least expected. We encountered such a case when a 40 years male patient posted for video assisted thoracic surgery for drainage of empyema on left side of chest developed pneumothorax on right side post-operatively. Timely diagnosis with the help of US saved time and his life. We thus want to emphasize the importance of this simple but useful skill to the anesthesiologist. [ABSTRACT FROM AUTHOR]

Whether or not to put a thoracostomy tube in an 'asymptomatic pneumomediastinum' patient is still an un-answered question due to lack of proper definition of the condition and guidelines for surgical intervention. We managed a 2 years old child with an unusual foreign body who presented with occult pneumomediastinum in postoperative period. The conservative strategy worked well and the child was sent home without any morbidity. [ABSTRACT FROM AUTHOR]

Background: To study the long term results of two phase II concurrent chemoradiotherapy protocols and conduct pooled data analysis with special emphasis on nodal density. Materials and Methods: In the period from April 2001 to May 2003, phase II Mitomycin C (MMC) and late chemo-intensification (LCI) protocols were started in the same institute, enrolling 69 and 74 patients respectively. Long term results for these individual trials are reported along with pooled data analysis. Results: Median follow-up time for whole group, MMC protocol and LCI protocol was 43.8 months (SD±19.8), 55 months (SD ±18.5) and 47.5 months (SD ±20.9) respectively. LRFS, DFS and OS at five years for whole group was 59.4, 43.5 and 47.1% respectively, for MMC protocol was 59.9, 45.5 and 49.5% respectively and for LCI, protocol was 53.6%, 41.5% and 44.4% respectively. Subgroup analysis revealed that MMC protocol was more effective than LCI protocol in terms of DFS and OS in patients with hypo dense nodes while opposite was true for Isodense nodes. Multivariate analysis revealed nodal density as an independent variable that had an impact on treatment outcome. Risk of death in patients with hypo dense nodes was 2.91 times that of Isodense nodes. Conclusions: Innovative and pragmatic approach is required to address locally advanced head neck cancer. Long term results for MMC and LCI protocols are encouraging. Integrating the basic concepts of these protocols may help develop new protocols, which will facilitate the search for the optimal solution. [ABSTRACT FROM AUTHOR]

Background: Aim of the study was to assess prostate motion on daily basis with respect to setup and to compare the shifts based on bony anatomy and gold fiducial markers. Materials and Methods: Gold fiducial markers were inserted in prostate under U/S guidance and daily portal images were taken and compared with digitally reconstructed images, both using bony landmarks and fiducial markers as reference. A dose of 2 MU was given for two orthogonal images daily. The mean and standard deviation of displacement using gold seeds and bone were calculated. Systematic and random errors were generated. The planning target volume (PTV) was calculated using the Van Herk formula. Results: A total of 180 portal images from 10 patients were studied. The mean displacement along x, y and z axes was 1.67 mm, 3.58 mm, and 1.76 mm using fiducial markers and 2.12 mm, 3.47 mm, and 2.09 mm using bony landmarks, respectively. The mean internal organ motion was 1.23 mm (+1.45), 3.11 mm (+2.69 mm); and 1.87 mm (+1.67 mm) along x, y and z axes, respectively. The PTV to account for prostate motion if daily matching was not done was 4.64 mm, 10.41 mm and 4.40 mm along lateral, superoinferior, and anteroposterior directions, respectively. If bony landmarks were used for daily matching, margins of 3.61 mm, 7.31 mm, and 4.72 mm in lateral, superoinferior, and anteroposterior directions should be added to the clinical target volume. Conclusion: Daily alignment using gold fiducial markers is an effective method of localizing prostate displacement. It provides the option of reducing margins, thus limiting normal tissue toxicity and allowing the possibility of dose escalation for better long-term control. [ABSTRACT FROM AUTHOR]

Purpose: We have been using intensity-modulated radiotherapy (IMRT) for selective neck irradiation. This article presents an analysis of patterns of failure and their dosimetric correlation. Methods and Materials: Between October 2003 and January 2008, 83 patients with head-and-neck cancer were treated with IMRT. Nodal levels were contoured as per the Radiation Therapy Oncology Group (RTOG) consensus guidelines. Results: There were 32 relapses with 23 local relapses (21 local relapses alone and 2 local and regional relapses, simultaneously), 9 regional relapses (including 2 simultaneous local and regional relapses), and 5 distant relapses, of which 2 patients had local relapses. At 2 and 3 years, the locoregional relapse-free survival rates were was 68.3% and 60.8%, respectively, while the overall survival rates were 84.1% and 81.7%, respectively. Subgroup analyses revealed significant differences in locoregional relapse-free survival rates for total treatment times of <53 days vs. >53 days, a volume of CTV1PTV (i.e., the volume prescribed 70 Gy) <177 cc vs. >177 cc, a V100 for CTV1PTV of <91% vs. >91%, and a minimum dose to CTV1PTV of <54 Gy vs. >54 Gy. There were no failures in the elective nodal volume, substantiating both the nodal selection criteria and the RTOG consensus guidelines for delineation of neck node levels. Conclusions: IMRT for head–neck cancer is feasible, using elective nodal selection criteria along with RTOG consensus guidelines for the radiological boundaries of levels of neck nodes. [Copyright &y& Elsevier]

The hazards of hydrogen peroxide have been known for long time, but it is still widely used in our country for irrigation of wounds. We report a case of oxygen embolism when hydrogen peroxide was accidently infiltrated subcutaneously along with local anesthetic during spine surgery and was successfully managed. We discuss the possible mechanism for embolism and its management. We also want to emphasize on the importance of being vigilant and avoiding such mistakes. [ABSTRACT FROM AUTHOR]

Gorlin-Goltz syndrome is a rare autosomal-dominant syndrome related to mutation in "Patched" tumour suppressor gene on chromosome 9. Basocellular carcinomas, odontogenic keratocysts, palmar and/or plantar pits and ectopic calcifications of the falx cerebri are its major features, along with more than 100 minor features. Odontogenic cysts, notorious for recurrence, can make endotracheal intubation difficult, requiring modification of the standard intubation technique. We report such a case managed successfully by awake fibreoptic intubation. Direct laryngoscopy under anaesthesia later confirmed that it was a good decision. [ABSTRACT FROM AUTHOR]

The article presents a case report of a 27-year-old male patient who suffered from severe kyphoscoliosis and cerebral palsy. Topics discussed include diagnosis of the patient which included chest X-ray, medication and injections given to the patient such as midazolam, paracetamol injection, and dexmedetomidine (DEX) injection. Other topic discussed includes agitation management in intensive care unit (ICU) patients using benzodiazepines (BZP).

The article presents a case study of a 32-year-old male with Hypertrophic obstructive cardiomyopathy (HOCM) with atrial fibrillation posted for spine surgery. He had a history of syncope, blood pressure and systolic murmur but no signs of congestive cardiac failure. The patient was receiving Propranolol, aspirin and warfarin, which were replaced by low-molecularweight heparin. He was induced with thiopentone and measures to prevent tachycardia were taken.