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Head and neck cancers have become very prevalent all over the world and ranked 11th among all cancers worldwide. The mainstay for managing these oral cancers includes surgery, radiotherapy and chemotherapy or combination of these modalities. This article highlights the one of the type of radiotherapy which is mainly used in managing the head and neck cancers, that is brachytherapy. This review article enlights the dental surgeons about indications, types, mechanisms, limitations and advances about brachytherapy. Keywords: Brachytherapy, Head and neck cancer.

Retropharyngeal abscess is the formation of pus in retropharyngeal space, which occurs as a frequent complication of Upper Respiratory Tract Infection (URI). It is commonly seen in children less than 5 years old. The clinical manifestations includes neck mass, fever, cervical lymphadenopathy, neck stiffness, agitation, cough, drooling, torticollis, respiratory distress, stridor, and with signs of tonsillitis, pharyngitis, and otitis media. The first-line treatment includes drugs such as ampicillin-sulbactam and clindamycin. This case series highlights the complications of untreated upper respiratory tract infection leading to retropharyngeal abscess. Oral hygiene should be maintained to prevent future complications. Two patients were admitted in the paediatric inpatient unit and were diagnosed as a case of retropharyngeal abscess, following for which their management was done. After assessing, the clinical presentations and management scenario of the patients, age, and poor hygienic conditions are associated with the patients' risk factors for acquiring Retropharyngeal Abscess. In paediatrics, maintaining hygiene, especially oral hygiene and early diagnosis can prevent future complications of retropharyngeal abscess.

Background: Merkel cell carcinoma (MCC) is a rare neuroendocrine skin cancer. Prior to the advent of immunotherapy, treatment options were limited. In our study, we evaluate the impact of tumor cell PD-L1 expression and tumor immune microenvironment on survival in MCC patients who were not treated with immune checkpoint inhibitors. Methods: Clinical data and tissue samples were collected from 78 patients with confirmed MCC treated at Dana-Farber Cancer Institute. Specimens were analyzed for the distribution of PD-L1 by immunohistochemistry staining (IHC) and standardized analysis. Results were correlated with survival data. Results: In this study, membrane and cytoplasmic MCC tumor cell staining for PD-L1 was detected in 22.4% (15 of 67) of cases and PD-L1 staining of intratumoral microvessels and PD-L1 positive immune cells at the infiltrative margins of the tumor in 92.5% (62 of 67) of cases. In patients untreated with immune checkpoint inhibitors, median overall survival was not different for patients based on PD-L1 expression (PD-L1+ 64 months vs. PD-L1- not reached; HR = 1.26, 95% CI: 0.46–3.45; p = 0.60). Conclusion: PD-L1 expression is frequently detected in MCC tumor cells and tumor microenvironment. PD-L1 expression did not affect prognosis in this cohort that had not received PD-1/L1 blockade.

Hereditary sensory and autonomic neuropathy type IV or Congenital insensitivity to pain with anhydrosis is a rare autosomal recessive disorder. It is characterized by absence of small myelinated and unmyelinated sympathetic nerves resulting in pain and temperature insensitivity. We report a case of a 15 year old boy with hereditary sensory and autonomic neuropathy type IV associated with bifid tongue which is an extremely rare oral presentation and not often reported in literature. Keywords: Hereditary sensory and autonomic neuropathy type IV, Bifid tongue, Self mutilation.

Double lip is a rare deformity of the face, which can occur as congenital and acquired anomaly. It most often appears as syndromic variety along with systemic manifestations. It is a rare occurrence with slight male predilection. This article is a report of a 20-year-old female presented with the acquired double upper lip for 1 year developed after orthodontic treatment.

In this qualitative study, we report how Supervisors of Training, educational supervisors overseeing the learning of anaesthesia trainees, experience their role in practice. Using purposive sampling, we interviewed Supervisors of Training from across Australia and New Zealand. The interviews began by asking ‘what do you see as your role as a Supervisor of Training?’ then explored the response in detail. Following the technique of thematic analysis, inductive analysis occurred as data were collected until we generated a thematic structure sufficient to address our research question after 19 interviews. In the first three of the four identified themes, Supervisors of Training perceived themselves as the fulcrum of the learning environment, ‘the something in between’. These three themes were: guiding and assessing trainees; identifying, supporting, and adjudicating trainee underperformance; and mediating trainees’ relationship with the hospital. Participants perceived themselves as a broker between trainees, their colleagues, their hospital, the Australian and New Zealand College of Anaesthetists and the community to varying degrees at different times. Negotiating these competing responsibilities required Supervisors of Training to manage multiple different relationships and entailed significant emotional work. Our fourth theme, scarcity, described the imbalance between these demands and the time and resources available. The complexity of the Supervisor of Training role and the tensions between these competing demands is underappreciated. Our findings would support strategies to mitigate the administrative load and share the decision-making burden of the role and to enhance the capability of Supervisors of Training by requiring formal training for the role.

Arithmetic is the basic operation in everyday life which includes operations such as addition, subtraction and multiplication. To keep a check on the proper working on these arithmetic operations, Arithmetic logical unit (ALU) is used, and it is the most important element of a system. In this paper it is discussed about the Verification of DUT of Single precision Floating-point Arithmetic logical unit (ALU) in System Verilog language using Questa Sim software and the goal is to achieve maximum Functional Coverage.

Automotive industries are increasing day by day. The components of vehicle will be manufactured by different companies all around the world. The trimming process can be done through many ways. Trimming process aims at providing fine finishing to the products. The proper trimming technique should be selected for a particular application to obtain required results. The paper stresses on the automatic trimming machine for valve stem seals in automotive applications. The automatic machine in industries plays a major role to obtain more production. This paper includes the comparison of various trimming techniques proposed by different authors and the proposed work provides the most suitable trimming technique. Few trials with pick trimming and blade trimming unit is validated and results as shown improvement in the quality of a product compared to the previous system.

The main source of power in a Satellite is the Solar Array. Spacecraft which uses Photovoltaic cells is usually equipped with Rechargeable batteries that receive a charge from Main bus when Solar panels are in sunlit condition. During eclipse, the Shunt regulator remains off and Battery serves the Spacecraft load, which lowers the battery voltage. All these create a varying DC as the Spacecraft Bus Voltage. A Battery Charge and Discharge Control are required to maintain battery voltage within acceptable limits and extract maximum life out of the Battery. Typically, separate hardware circuits are used for the Battery Charge Regulator (BCR) and Battery Discharge Regulator (BDR). This paper discusses a Battery management scheme using a BCR/BDR Bidirectional converter.

Introduction: Previous murine studies have demonstrated that dietary Aquamin®, a calcium-rich, multi-mineral natural product, suppressed colon polyp formation and transition to invasive tumors more effectively than calcium alone when provided over the lifespan of the animals. Methods: In the present study, we compared Aquamin® to calcium for modulation of growth and differentiation in human colon adenomas in enteroid culture. Adenoma growth and differentiation were assessed at the light and electron microscopic levels and by immunostaining. Image quantitation of immunohistochemical markers was performed using Aperio Imagescope to compare these interventions. A proteomic assessment was done to compare protein expression patterns in treated cultures as compared to cultures maintained under control conditions (calcium 0.15 mM). Enteroids established from normal colonic tissue were examined in parallel. Results: Both calcium and Aquamin® provided at 1.5 mM calcium fostered differentiation in the adenoma enteroid cultures as compared to control, but Aquamin® was more effective. Even at a concentration providing only 0.15 mM calcium, Aquamin® induced differentiation in some individual enteroids. Aquamin® was more effective than calcium in inducing upregulation of proteins. There were 35 proteins upregulated with Aquamin as compared to 20 with calcium 1.5mM at 1.8-fold change or above (in 3 colonic adenomas) with less than 2% FDR. Both calcium and Aquamin® induced differences in the expression pattern of proteins known to be involved in differentiation (table). In addition, several keratins and histones, as well as merlin and Olfactomedin-4 were upregulated. Conclusion: These findings support that i) calcium (1.5 mM) has the capacity to modulate growth and differentiation in large human colon adenomas and ii) the additional trace elements provided along with calcium in Aquamin® can have effects on proliferation and differentiation at lower levels than observed with calcium at 1.5mM. Expression of Immunohistochemical Markers in enteroid cultures of Human Adenomas (Fold-Changes)IHC MarkersCalcium 0.15mMAquamin 0.15mMCalcium 1.5mMAquamin 1.5mMKi6710.750.59*0.49*CK2012.13*2.36*2.35*E-Cadherin11.051.57*1.57*NF2 (Merlin)12.44*#1.012.56*#Occludin11.23*1.25*1.29**reflects significance as compared to Ca 0.15mM. #reflects significance as compared to Ca 1.5mM Citation Format: Shannon D. McClintock, Justin A. Colacino, Durga Attili, Michael K. Dame, Areeba H. Rizvi, Aliah Richter, Anusha R. Reddy, Venkatesha Basrur, D. Kim Turgeon, James Varani, Muhammad N. Aslam. Differentiation of human colon adenomas in an enteroid culture: A treatment comparison [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1276.

The increasing pace in the wireless communication taking momentum in the market of commercial application where a significant trade-off between user-experience and security demands exists. The Near Field Communication or NFC is one such communication trend which is effectively adopted by the user worldwide to make touchless operation using their mobile device. Although, it is claimed that NFC incorporates some of the standard encryption but existing researchers fails to prove that their electromagnetic signals are not so difficult to compromise to result in collateral damage to user's resources. Thus, there exist research work towards strengthing security system, but there is yet to report on any standard security protocol or framework to ensure the highest resiliency. This paper provides a comprehensive visualization towards the effectiveness of existing research approaches to formulate the research trend and gap.

Prior studies of asthma in children with sickle cell disease (SCD) were based on reports of a doctor-diagnosis of asthma with limited description of asthma features. Doctor-diagnoses of asthma may represent asthma or wheezing unrelated to asthma. Objectives of this study were to determine if asthma characteristics are present in adults with a doctor-diagnosis of asthma and/or wheezing, and to examine the relationship between doctor-diagnosis of asthma, wheezing and SCD morbidity. This was an observational cohort study of 114 adults with SCD who completed respiratory symptom questionnaires and had serum IgE measurements. A subset of 79 participants completed pulmonary function testing. Survival analysis was based on a mean prospective follow-up of 28 months and data were censored at the time of death or loss to follow-up. Adults reporting a doctor-diagnosis of asthma (N = 34) were more likely to have features of asthma including wheeze, eczema, family history of asthma, and an elevated IgE level (all P < 0.05). However, there was no difference in pain or ACS rate, lung function, or risk of death between adults with and without a doctor-diagnosis of asthma. In contrast, adults who reported recurrent, severe episodes of wheezing (N = 34), regardless of asthma, had twice the rates of pain and ACS, decreased lung function and increased risk of death compared with adults without recurrent, severe wheezing. Asthma features were not associated with recurrent, severe wheezing. Our data suggest that wheezing in SCD may occur independently of asthma and is a marker of disease severity.

Business intelligence may be defined as a set of mathematical models and analysis methodologies that systematically exploit the available data to retrieve information and knowledge useful in supporting complex decision-making processes. A business intelligence environment offers decision makers information and knowledge derived from data processing, through the application of mathematical models and algorithms. In some instances, these may merely consist of the calculation of totals and percentages, while more fully developed analyses make use of advanced models for optimization, inductive learning and prediction.

An elevated tricuspid regurgitant jet (TRJ) velocity is present in more than 30% of adults with sickle cell anemia (SCA) and is associated with a risk of death [1-4]. The contribution of pulmonary thrombi to an elevated TRJ velocity is not well defined. To evaluate the relationship between an elevated TRJ velocity and pulmonary thrombi, we performed 3D, contrast-enhanced magnetic resonance angiography (3D MRA) in nine adults with SCA. Of the six participants with an elevated TRJ velocity, 5 (83%) did not have thrombi in their pulmonary arteries. No individuals with a normal TRJ velocity had pulmonary thrombi. Based on this pilot study using 3D MRA images, thrombi are not present in large vessels in most individuals with a TRJ > 2.5 m/sec, providing evidence thrombi may not significantly contribute to the pathogenesis of an elevated TRJ velocity in individuals with SCA.

Introduction The causal association between H. pylori and gastric MALT lymphoma has been well demonstrated and H. pylori eradication with antibiotics has emerged as the standard therapy for Stage I H. pylori positive (HPP) gastric MALT lymphoma. As per the NCCN Guidelines, radiation therapy is the preferred treatment option for early stage H. pylori negative (HPN) gastric MALT lymphoma and antibiotic therapy is not indicated. However, successful treatment of HPN early stage gastric MALT lymphoma with antibiotics was reported in small series of patients by Raderer et al, Gut, 2006 [(5/6 patients achieved complete remission (CR)] and Asano et al, Tohoku J Exp Med, 2012 (5/17 patients achieved CR). Here, we report the outcome of Stage I HPP and HPN gastric MALT lymphoma patients treated with antibiotics at MD Anderson Cancer Center, Houston, Texas, USA over a period of 20 years. Methods We reviewed medical records of all pathologically proven gastric MALT lymphoma patients (n=128) referred to MD Anderson Cancer Center at initial diagnosis between 1991 and 2011. Only patients with Stage IAE disease were considered for this analysis. Patients with large cell transformation were excluded. H. pylori status was determined by histopathology and serum antibody assay. Clinical staging was determined by upper GI endoscopy with biopsy, bone marrow biopsy, and CT scans of neck, chest, abdomen, and pelvis and/or PET-CT scan. Response was assessed by upper GI endoscopy every 3-6 months until complete resolution of lymphoma. Complete remission was defined as the absence of histopathologic evidence of lymphoma on endoscopic biopsies. Results Of the 128 patients reviewed, 81 patients had Stage IAE disease without histologic evidence of large cell transformation. The 81 Stage IAE patients were assigned to HPP (39/81, 48%) or HPN group (42/81, 52%) based on histopathologic evidence of H. pylori. The higher-than-expected proportion of HPN patients might be due to referral bias to a tertiary care cancer center. The results of H. pylori antibody serology are shown in Table 1. There was no significant difference in age, gender, and race between HPP and HPN groups. First-line antibiotic therapy was administered for all 39 (100%) HPP patients and 28/42 (67%) HPN patients. The CR rate after antibiotic therapy was significantly higher in HPP compared with HPN patients (22/39, 56% vs 7/28, 25%; p=0.019). The median time to achieve a CR was similar for the two groups (HPP: 7.8 mo, range 3-40 mo; HPN: 9.7 mo, range 3-35 mo; p=0.385). After a median follow-up of 110 mo for the HPP group and 91.5 mo for the HPN group, 3/22 (14%) and 2/7 (28%) responders relapsed, respectively (p=0.362). Patients who failed to achieve a CR with antibiotic therapy were mostly treated with radiation: 14/17 in the HPP group and 19/21 in the HPN group. All patients that received radiation achieved a CR. Of the patients in both groups who received upfront antibiotic therapy, there were no differences in time to progression (HPP, 90% vs HPN, 92% at 8 years; p=0.543) and overall survival (HPP, 93% vs HPN, 100% at 8 years; p=0.068). Conclusions Our results demonstrate that a substantial proportion of patients with Stage IAE HPN gastric MALT lymphoma achieve durable remission with antibiotic therapy alone. It is possible that such responses may be because of false-negative H. pylori test results or due to association of HPN gastric MALT lymphoma with other unidentified bacteria. We also observed that HPN gastric MALT lymphoma patients failing antibiotic therapy could be effectively salvaged with radiation therapy and their long-term outcome is not affected by delay from initial trial of antibiotic therapy. Thus, the results of this largest series-to-date of HPN patients treated with first-line antibiotic therapy, combined with results of smaller series reported previously, suggest that 1) antibiotic therapy should be considered as first-line therapy for Stage IAE HPN gastric MALT lymphoma patients, and 2) radiation therapy could be avoided in a subset of these patients. Table 1. H. pylori status in Stage IAE gastric MALT lymphoma as determined by histopathology and H. pylori antibody. H. pylori positive by histology (n=39) H. pylori negative by histology (n=28) CR (n=22) Non-CR(n=17) CR (n=7) Non-CR(n=21) H. pylori Ab Positive 4 4 0 3 H. pylori Ab Negative 8 2 1 7 Not available 10 11 6 11 Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Abstract 544 Background: In DLBCL, multiple extranodal sites of involvement and MYC/BCL2 translocations (double hit lymphoma) are associated with a poor clinical outcome. The association between the pattern of extranodal involvement and MYC and BCL2 protein expression, as well as the prognostic significance of expression, are unknown. Methods: We analyzed the clinical data of 487 DLBCL patients treated with R-CHOP. Immunohistochemical (IHC) studies were performed on paraffin-embedded tissue samples for MYC and BCL2. A double-hit score (DHS) of 0, 1, or 2 was assigned to all patients based on protein expression of MYC and BCL2. Those with both MYC and BCL2 expression were DHS 2, with MYC or BCL2 was DHS 1, and neither was DHS 0. Cell-of-origin classification was achieved by combining gene expression profiling (GEP) and IHC data with GEP as the gold standard. Patient characteristics were compared using Fisher's exact test. Survival analyses were performed using Kaplan-Meier curves and compared using log-rank test. The Cox proportional regression model was used for multivariate analysis. Results: Approximately half of the patients (n = 251; 51.5%) had at least 1 extranodal site of involvement. In this group, the clinical features were: median age of 63 years (range, 12–88), male (58.6%), stage III/IV (63.2%), elevated serum LDH (66.8%), and International Prognostic Index (IPI) of 3–5 (48.5%). IHC features were: non-germinal center B-cell like (non-GCB) (53%), MYC+ (64.9%), BCL2+ (49.8%), MYC-/BCL2- (DHS 0; 20.3%), MYC+/BCL2- or MYC-/BCL2+ (DHS 1; 44.6%) and MYC+/BCL2+ (DHS 2; 35.1%). The common extranodal sites of involvement were genitourinary tract (18.3%), gastrointestinal tract (15.1%), sinonasal (14.3%), bones (13.9 %), lung (11.6 %), skin/soft tissues (9.9%), liver (9.1%), and bone marrow (8.4%). MYC+ was associated with bone marrow (odds ratio [OR]: 5.67; P = 0.009) and skin (OR: 3.11; P = 0.045) involvement, BCL2+ with sinonasal (OR: 2.26; P = 0.032) involvement, and MYC+/BCL2+ with skin/soft tissue (OR: 2.38; P = 0.049) and lung (OR: 2.37; P = 0.04) involvement. Non-GCB subtype was associated with genitourinary tract (OR: 1.47; P = 0.005) and bone marrow involvement (OR: 1.5; P = 0.038). The DHS 2 subgroup was significantly associated with lower complete response rate (62.5% vs 76.1%; P = 0.023), shorter progression-free-survival (PFS) (median 23.1 months vs 80.7 months; P < 0.001), and shorter overall survival (OS) (median 25.0 months vs 94.5 months; P < 0.001) compared with the DHS 0–1 subgroups. Using multivariate analysis, DHS 2 remained significantly associated with a worse outcome. Conclusions: In DLBCL with extranodal disease, MYC and BCL2 protein expressions and cell-of-origin are associated with distinct patterns of organ involvement. Patients with DLBCL expressing both MYC and BCL2 (score DHS 2; double hit biology) have a poor outcome independent of IPI and cell-of-origin. Disclosures: No relevant conflicts of interest to declare.

Abstract 2647 Rationale: Among children with sickle cell disease (SCD), a physician diagnosis of asthma has been associated with increased rates of acute chest syndrome (ACS), pain and mortality. Respiratory symptoms, including wheezing, occur in individuals with SCD independent of an asthma diagnosis. Few studies have evaluated the significance of asthma or respiratory symptoms in adults with SCD. Objective: The primary objective of this study was to determine whether adults with SCD and a physician-diagnosis of asthma have more ACS and pain episodes compared to adults with SCD but without asthma. A secondary objective was to evaluate the relationship between asthma-like symptoms and ACS and pain among adults with SCD. Methods: This was an observational cohort study of adults (≥ 19 years) with SCD who received care exclusively in the Washington University/Barnes Jewish Hospital system and completed baseline questionnaires including the ATS-DLD respiratory symptom survey. The questionnaires documented the frequency, severity and precipitants of symptoms such as wheezing, cough and shortness of breath. Enrollment into the study began August 2006. Hospitalizations for ACS and pain were determined from retrospective and prospective review of electronic medical records from January 1, 2004 to March 1, 2010 and analyzed using adjusted negative binomial regression models. Cox proportional hazards models were used to determine survival rates from date of consent through March 1, 2010. Spirometry was obtained from 69% of the study cohort. Results: Of 114 adults with SCD, those with a physician diagnosis of asthma (n=34) were more likely to have classic features of asthma including cough and wheeze, history of eczema, parental history of asthma, and an IgE level >150 kU/L (all p Conclusions: While a physician diagnosis of asthma was not associated with an increased risk of morbidity/mortality or decreased lung function in this cohort of adults with SCD, a history of recurrent, severe wheezing was associated with an increased rate of ACS, pain and decreased lung function. These findings may represent a misclassification of asthma diagnoses or SCD-associated wheezing, a clinical observation that is not well-defined. This study highlights the need for careful assessment of respiratory symptoms by physicians caring for adults with SCD. Disclosures: Blinder: Novartis: Honoraria, Research Funding, Speakers Bureau. Field:Novartis: Honoraria.