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Abstract There is limited data regarding the added benefit of adjuvant systemic therapy in the management of small, node-negative, HER2+ breast cancer. In a multi-institutional retrospective analysis using the American Society of Clinical Oncology CancerLinQ database, we compared survival outcomes among T1a-c N0 HER2+ patients diagnosed between 2010 to 2021 who received locoregional therapy alone or in combination with adjuvant trastuzumab (+/− chemotherapy). Primary outcomes were invasive disease-free survival (iDFS) and overall survival (OS). Of the 1,184 patients, 436 received locoregional therapy alone. We found a statistically significant improvement in iDFS (HR 0.73, P = 0.003) and OS (HR 0.63, P = 0.023) on univariate analysis with adjuvant trastuzumab with or without chemotherapy which remained statistically significant on multivariate analysis. Three-arm univariate analysis found that iDFS was significantly improved with trastuzumab monotherapy (P = 0.003) and combination therapy (P = 0.027) compared to observation. Subgroup data suggests that T1b/c tumors derive the greatest benefit.

Background: The glenohumeral joint is characterized by its ball and socket configuration, offering the widest range of motion among major human joints. However, its shallow glenoid socket predisposes it to instability. This instability is mitigated by static and dynamic stabilizers. Glenoid bone loss, including Osseous Bankart and compression deformity, contributes to recurrent instability. Various imaging modalities, such as CT and MRI, are employed to assess glenoid bone loss, with methods like the Griffith Index and best-fit circle used for quantification. This study aims to evaluate MRI's accuracy in quantifying bone loss in glenoid compared to 3D CT in participants with anterior shoulder instability. Materials and Methods: The research was carried out at a specialized medical facility offering tertiary care services in south India. Approval was obtained from the ethical committee, and consent waiver was granted for PACS utilization. MRI and CT examinations were performed on participants to assess glenoid bone loss. MRI utilized a 1.5-T Ingenia system, while CT scans were conducted using multidetector CT scanners. Image analysis involved the best-fit circle method was employed to quantify bone loss. Results: Fifty-seven male participants with an average age of 30.72 ± 7.32 years participated. Bone loss measurements were comparable between CT and MRI. ICC and correlation coefficients indicated strong agreement between CT and MRI measurements. MRI detected Hill-Sachs lesions more frequently than CT (p

Introduction: Rotator cuff tears are common musculoskeletal injuries, often associated with fatty degeneration (FD) of the rotator cuff muscles. While MRI has been the gold standard for assessing FD, dual-energy CT (DECT) shows promise in providing quantitative measurements. This study aims to compare FD quantification using DECT and MRI fat fraction values in patients with rotator cuff tears. Materials and Methods: Thirty patients diagnosed with rotator cuff tears underwent DECT and MRI scans for FD assessment. Imaging parameters and techniques were standardized for both modalities. Fat fraction values were obtained using region-of-interest (ROI) analysis. Results: The mean age of participants was 55.73 ± 10.16 years, with a majority classified as Goutallier stage 1. Significant differences were observed between fat fraction values measured by DECT and MRI. The ICC revealed moderate reliability (0.549, p

Purpose This article studies the safety profile and role of intra-arterial (IA) tirofiban as a rescue therapy in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy.

Abstract Background The optimal adjuvant endocrine therapy (ET) in hormone receptor positive (HR+) and human epidermal growth factor receptor 2 positive (HER2+) premenopausal breast cancer (BC) remains unclear. Moreover, the benefit and clinical indications of ovarian suppression (OS) is poorly elucidated. We described real‐world patterns surrounding choice of ET and clinicopathologic features which predicted treatment with OS in a contemporary cohort of premenopausal women with HR+/HER2+ BC. Methods This retrospective analysis included premenopausal patients with nonmetastatic HR+/HER2+ BC from the CancerLinQ Discovery database from January 2010 to May 2020. Women were less than 50 years and received chemotherapy, anti‐HER2 therapy, and ET. They were categorized into 1 of 4 groups based on type of ET prescribed at initiation: aromatase inhibitor (AI) + OS, OS, tamoxifen + OS, or tamoxifen. Multivariable logistic regression assessed associations between clinicopathologic features and OS use. Results Out of 360,540 patients with BC, 937 were included. The majority (n = 818, 87%) were prescribed tamoxifen, whereas 4 (0.4%), 50 (5.3%), and 65 (6.9%) received OS, tamoxifen + OS and AI + OS, respectively. No clinicopathologic features predicted OS use apart from age; patients

Introduction Perianal fistula and its recurrence is a challenging entity for surgeons. It is a well-establi1shed fact that magnetic resonance imaging (MRI) findings influence surgical procedures and reduce the rate of recurrence. In this study, we assessed the contrast-enhanced (CE) three dimensional T1 sequences [sampling perfection with application optimized contrast using different flip angle evolution (SPACE) and volumetric interpolated breath-hold examination (VIBE)] in a 3T MRI system to evaluate perianal fistulas and compared them with two-dimensional (2D) sequences.

Background: India is facing triple epidemic of Non communicable diseases (NCDs) including high body mass index (BMI), high blood pressure and high blood glucose, contributing to more than half of deaths of all mortality, however, information in different demographics is limited, especially, in India. The aim of the study is to compare the prevalence of overweight, obesity, hypertension, and diabetes, along with the occurrence of multi-morbidity, across gender-specific populations in rural, suburban, and urban regions of India. Methods: This was a cross-sectional, population-based study including adults aged 20 and above in rural, suburban, and urban areas near Coimbatore, India. All participants were interviewed using a detailed questionnaire and had their anthropometric measurements, including height, weight, blood pressure, and blood samples collected. Gender specific and location specific prevalence of overweight, obesity, hypertension, diabetes, and multimorbidity were assessed. Results: This study included 2976 individuals, of which 865 were from rural areas, 1030 from sub-urban areas, and 1081 from metropolitan areas. The mean systolic and diastolic blood pressure were higher in rural participants than in sub-urban and urban participants, despite the fact that the prevalence of hypertension was higher in sub-urban (47.1%) than in rural (36.4%) and urban (39.7%, p < 0.001). In sub-group analysis, sub-urban areas had a greater prevalence of hypertension in both men and women (53.5% and 41.7%, p < 0.001) than rural areas (41.9% and 31.3%, p = 0.001) or urban areas (45.9% and 35.5%, p < 0.001). Compared to rural (16.1%) and urban (23%), sub-urban areas had a greater prevalence of diabetes (25.8%, p < 0.001). Urban residents (47.5%) had higher rates of overweight and obesity than rural (31.4%) and sub-urban (34.1%, p < 0.001) residents. The association between diabetes and hypertension was present in the unadjusted model and persisted even after age and BMI adjustments. Though not in men, higher levels of education were associated to a higher prevalence of diabetes in women. Diabetes was associated to being overweight or obese in women, however this association was significantly reduced once BMI was taken into account. The overall multimorbidity was 3.8%, however, women had a higher overlapping prevalence (2.8%) compared to men (1%, p < 0.001). Conclusions: Diabetes and hypertension were prevalent comorbidities across all demographics, with higher rates in suburban and urban areas. Women exhibited higher rates of multimorbidity than men, regardless of the demographic area.

Abstract Background Incidence of malignancy in architectural distortion (AD) is variable, and as a standard of care, all the architectural distortions are biopsied. It is important to identify benign and malignant characteristics of ADs on imaging to predict the probability of malignancies as well as to establish radiological–pathological concordance. The aim of our study was to analyse the utility of contrast-enhanced mammography (CEM) in primary AD, to describe and evaluate the accuracy of CEM parameters and derive a novel scoring system to differentiate benign and malignant AD. Results Forty-six patients with 49 ADs were evaluated with a median age, 51 years (age range—34–72 years) and all were women. Of the 49 ADs, 65.3% (32/49) were benign, and 34.69% (17/49) were malignant. The CEM parameters which predicted malignancy were moderate or marked density, size > 0.95 cm, CT ratio > 1.31, mass morphology and washout kinetics. The absence of enhancement and enhancing AD with AD score of 0 had a 100% NPV for malignancy. Enhancing architectural distortion with a score of 3 or more had 100% PPV for malignancy. A score of 1 or 2 was indeterminate, and an individualised decision was recommended. Conclusions In primary AD, several CEM features have significantly predicted malignancy when the score is 3 and above. A biopsy may be avoided in non-enhancing AD and enhancing AD with a score of 0 due to high NPV.

Background: Heat shock protein 90 (HSP90) is a molecular chaperone required for stabilization of client proteins over-activated in triple-negative breast cancer (TNBC). Over-expression of HSP90 client proteins has been implicated in paclitaxel resistance. Onalespib (AT13387) is a potent inhibitor of HSP90 that could improve paclitaxel efficacy when administered in combination. Design: This phase Ib trial administered onalespib with paclitaxel in patients with advanced TNBC to assess safety and establish a recommended phase II dose (RP2D). Objectives: The primary objectives were determining the dose-limiting toxicities and maximum tolerated dose of combination therapy. Secondary objectives included pharmacokinetic (PK) analysis and determination of overall response rate (ORR), duration of response (DOR), and progression-free survival (PFS). Methods: Patients with advanced TNBC were treated with standard dose intravenous paclitaxel in combination with intravenous onalespib at doses ranging from 120 to 260 mg/m 2 administered on days 1, 8, and 15 of a 28-day cycle using a standard 3 + 3 design. A total of 15 patients were enrolled to dose expansion cohort at RP2D to confirm safety profile. Results: Thirty-one patients were enrolled in the study, of which over 90% had received prior taxane therapy. Paclitaxel was given for metastatic disease in 23% of patients. Adverse events (AEs) included anemia (grade 3: 20%), lymphopenia (grade 3: 17%), and neutropenia (grade 3: 33%, grade 4: 4%). The most frequent grade ⩾3 non-hematologic AE was diarrhea (7%). The established RP2D was 260 mg/m 2 onalespib when given with paclitaxel at 80 mg/m 2 . PK analysis revealed a modest drug interaction profile for onalespib in the combination regimen. ORR was 20%. Three patients achieved complete responses, all of whom had received prior taxane therapy. Median DOR was 5.6 months; median PFS was 2.9 months. Conclusion: Combination treatment with onalespib and paclitaxel had an acceptable toxicity profile and RP2D was determined to be 260 mg/m 2 of onalespib. Combination therapy showed antitumor activity in patients with advanced TNBC. Trial registration: Onalespib and paclitaxel in treating patients with advanced TNBC https://clinicaltrials.gov/ct2/show/NCT02474173 .

Background and Objectives The purpose of this study is to evaluate and establish the accuracy of noninvasive methods, including third-generation dual-source dual-energy computed tomography (DECT) and proton density fat (PDF) fraction on magnetic resonance imaging (MRI) using three-dimensional multiecho multipoint chemical shift-encoded spoiled gradient echo (q-Dixon) sequence in the quantification of hepatic steatosis; with H1-MR spectroscopy (MRS) as the reference standard. Materials and Methods A total of 47 patients were included in this prospective study. We studied the accuracy of fatty liver detection using third-generation DECT using mixed set images (MSIs), virtual monochromatic images (VMIs), and MRI q-Dixon. The results were compared with H1-MRS. Data were analyzed using linear regression for each technique compared with MRS. Results Our study's correlation and linear regression analysis showed a good correlation between PDF values obtained by H1-MRS and MR q-Dixon methods (r = 0.821, r 2 = 0.674, p

Catastrophic antiphospholipid syndrome (CAPS) is the rare but most severe form of antiphospholipid syndrome with multiple organ ischemia developing over a short period of time. CAPS should be considered when imaging suggests an acute and concurrent multiorgan ischemia, associated with positive antiphospholipid antibodies. As CAPS can have fulminant irreversible complications, its early recognition is important to initiate the treatment promptly. We present three patients of CAPS who were managed at our institution.

Purpose The purpose of this study is to evaluate the detection rate of pulmonary nodules in ultrashort echo time (UTE) lung magnetic resonance imaging (MRI) and to compare it with computed tomography (CT) in oncology patients. Materials and Methods All individuals undergoing radiotherapy/chemotherapy/regular follow-up or visiting the oncology department and referred to radiology department for nodule detection, during the period of 1 year, were subjected to UTE lung MRI using the sequence Flash 3d_spiralvibe coronal 1.25 mm iso and high-resolution CT lungs and the images were analyzed. Results Among the total number of nodules detected in both lungs of all patients, nodules detected by CT were 241, and nodules detected by MRI were 212. The nodule detection rate by MRI was 87.96%. The detection rate of nodules for size equal to or more than 5 mm was nearly 100%. For nodules less than 5 mm, and equal to or more than 4 mm, MRI showed a comparable detection rate of 75%, while for nodules less than 4 mm, the detection rate was only 25%. Conclusion Our study results indicate that lung MRI had a near-complete detection rate for nodules equal to or more than 5 mm in size. Hence, in oncology patients who are undergoing regular follow-up of the lung nodules, lung MRI using UTE can replace low-dose CT, which in turn reduces the radiation dose to the patient.

Background Imaging of acute stroke patients in emergency settings is critical for treatment decisions. Most commonly, CT with CTA is used worldwide for acute stroke. However, MRI may be advantageous in certain settings. With advancements in endovascular clot retrieval techniques, there is a need to identify and use the best possible imaging for the diagnosis and outcome prediction of hyperacute stroke. Methods This mixed retrospective and prospective observational study was conducted over 2 years in patients who underwent reperfusion therapies. Patients were included in this study if they had a baseline as well as follow-up noncontrast CT and diffusion-weighted imaging (DWI) MRI. We compared them for estimating final infarct size and outcomes after reperfusion therapy. Results A total of 86 patients were included in the study. Baseline DWI found new infarcts in 33 patients compared to baseline CT. Sensitivity and specificity of CT and DWI in predicting the final infarct size was 75.3% and 76.9% and 97.2% and 92.3%, respectively. A positive correlation of 51.2% and 84.4% was noted between b-CT Alberta stroke programme early CT score (ASPECTS) and b-DWI with 72 hours DWI ASPECTS, respectively (p < 0.001). The positive predictive value of CT was 94.8% and DWI was 98.6%. None of the patients had reversible hyperintensities in the follow-up DWI. Conclusion MRI is more sensitive and specific than noncontrast CT in predicting final infarct volume. It predicts final outcomes better and could be an alternative if available in acute stroke settings.

Abstract Background The purpose of this study was to compare the Image Quality, Contrast Medium Volume, and Radiation dose in renal angiography performed using Turbo Flash mode and dual-energy (DE) mode in the third-generation dual-source dual-energy CT. This prospective observational study was performed on renal donors who underwent CTA imaging as a pre-transplant workup. The study population was divided into two groups. Group A underwent DECT renal angiography. Group B underwent Turbo Flash Mode CT renal angiography. For group A, a contrast volume of 1 ml/kg and for group B at 0.5 ml/kg was administered. Image Quality was evaluated objectively by calculating CNR and SNR and subjectively by a 5-point scale. Radiation Dose analysis was done by noting CTDIvol and DLP on the scanner system and calculating effective radiation dose (ED). Results The subjective image quality scores for the Turbo Flash group were comparable with the DE group in qualitative image analysis. Additionally, in the Turbo Flash group, there was a reduction in contrast media and effective radiation dose by 47.5% and 32.7%, respectively. Nevertheless, mean attenuation of the abdominal arteries, CNR, SNR, and Noise (S.D) showed statistical significance between the two groups (p value

Computed tomography (CT) has undergone a phenomenal evolution since its introduction in 1971 and has revolutionized diagnostic radiology. It is now the cornerstone of diagnostic imaging and has become an inevitable part of the management of patients. Among all the advancements and breakthroughs witnessed over the years, the most recent and most advanced is the dual-energy CT (DECT), also known as spectral CT, introduced in 2006. In DECT, two datasets are obtained by scanning with two different energy spectra (low and high energy). The difference in attenuation can differentiate materials with different elemental compositions but similar attenuation in single-energy CT. Therefore, it has widespread clinical applications based on its potential for material decomposition and virtual monoenergetic imaging. In this review, the principle and hardware of DECT will be presented with an overview of its clinical applications.

Objectives The purpose of our study was to evaluate the virtual monochromatic imaging in detecting hypervascular focal liver lesions in the late arterial phase with third-generation dual-source dual-energy computed tomography and to assess its image quality. Materials and Methods In our study, 80 patients were included. Contrast-enhanced images in the late arterial phase (in the dual-energy mode) were acquired and were post-processed in Syngo, via workstation, using Monoenergetic + software. Five sets of images, one polychromatic energy image (corresponding to 120 kVp single-energy image) and four virtual monoenergetic image (VMI) sets at 40, 50, 60, and 70 keV levels, were generated. All these images were analyzed both objectively and subjectively. The attenuation values were measured, and the contrast-to-noise ratio (CNR) of liver and tumor were measured and compared objectively in each dataset. Image noise, image contrast, and diagnostic confidence for liver lesion detection were analyzed subjectively using a five-point scale system. Statistical analysis was performed using Kolmogorov–Smirnov, analysis of variance, and Kruskal–Wallis tests. Results Among the VMI, maximum image noise was observed in the 40 keV image, with a gradual reduction in the image noise being noted with an increase in the VMI energy. The CNR of the hepatic parenchyma and the tumor gradually increased with a reduction in VMI energy from 70 to 40 keV. On subjective analysis, image contrast and image noise were observed to be more in low VMI datasets. In lesion detection, diagnostic confidence with an excellent confidence level was observed with a decrease in VMI energy. Conclusion VMI datasets of 40 to 70 keV from third-generation dual-source DECT provide superior diagnostic accuracy for detecting hypervascular liver lesions. Considering the image noise and lesion detection rate among the VMI datasets, 60 keV VMI is the most helpful dataset for increased liver lesion detection with good image quality.

Not applicable

The adoption of cocrystals into oral pharmaceutical formulations is expected to propel this, as yet, moribund field into clinical and monetary prominence. The increase in resources and research that will inevitably follow is expected to address long standing problems in crystal engineering. Ab initio predictions of heterosynthon structure, identification of molecular descriptors to enable bioavailability enhancing coformer selection and a priori prediction of the cocrystal lattice have thus far been insoluble. Solutions to the prediction of supersaturation levels and polymorphic transition of the cocrystal formulated API in GI fluids, and solvation barrier and solubilization free energies, remain empirical. Properties such as on-demand/environment, formulation enabled, proton transfer between API and coformer and the development of neural networks or AI, trained on empirical data to predict ideal API-coformer pairs without the need to explicitly understand mechanisms, remain obscure, and hence un-researched. It is ironic that failure mechanisms that result in the delayed appearance of a less- soluble polymorph in pharmaceutical formulations (disappearing polymorphs) could (and should) be gainfully utilized to facilitate the delayed appearance in vivo of less-soluble polymorph(s) in cocrystal formulations. The bioavailability increase afforded by cocrystal formulations has the potential to enable greater patient compliance due to favorable posology, introduce more efficacious drugs into the therapeutic armamentarium, enable line- extensions and expand intellectual property portfolios, reduce the cost-of-goods; and hence of medicines, and add one more valuable tool in the repertoire of the pharmaceutical formulation scientist.

Abstract Palbociclib 3-weeks-on/1-week-off, combined with hormonal therapy, is approved for hormone receptor positive (HR+)/HER2-negative (HER2−) advanced/metastatic breast cancer (MBC). Neutropenia is the most frequent adverse event (AE). We aim to determine whether an alternative 5-days-on/2-days-off weekly schedule reduces grade 3 and above neutropenia (G3 + ANC) incidence. In this single-arm phase II trial, patients with HR+/HER2− MBC received palbociclib 125 mg, 5-days-on/2-days-off, plus letrozole or fulvestrant per physician, on a 28-day cycle (C), as their first- or second-line treatment. The primary endpoint was G3 + ANC in the first 29 days (C1). Secondary endpoints included AEs, efficacy, and serum thymidine kinase 1 (sTK1) activity. At data-cutoff, fifty-four patients received a median of 13 cycles (range 2.6–43.5). The rate of G3 + ANC was 21.3% (95% CI: 11.2–36.1%) without G4 in C1, and 40.7% (95% CI: 27.9–54.9%), including 38.9% G3 and 1.8% G4, in all cycles. The clinical benefit rate was 80.4% (95% CI: 66.5–89.7%). The median progression-free survival (mPFS) (95% CI) was 19.75 (12.11–34.89), 33.5 (17.25–not reached [NR]), and 11.96 (10.43–NR) months, in the overall, endocrine sensitive or resistant population, respectively. High sTK1 at baseline, C1 day 15 (C1D15), and C2D1 were independently prognostic for shorter PFS (p = 9.91 × 10−4, 0.001, 0.007, respectively). sTK1 decreased on C1D15 (p = 4.03 × 10−7), indicating target inhibition. Rise in sTK1 predicted progression, with the median lead time of 59.5 (inter-quartile range: −206.25–0) days. Palbociclib, 5-days-on/2-days-off weekly, met its primary endpoint with reduced G3 + ANC, without compromising efficacy. sTK1 is prognostic and shows promise in monitoring the palbociclib response. ClinicalTrials.gov#: NCT3007979.

Although enteric fever is a relatively common disease in countries mainly belonging to South Asia (incidence of around 100/100,000 persons per year) where there is poor hygiene, its complications in the form of hemophagocytic lymphohistiocytosis (HLH) are rare but have been documented before. Here, we present the case of a 19-year-old boy diagnosed with enteric fever with secondary HLH possibly induced by the COVID-19 vaccine (COVISHIELD ChAdOx1 nCoV-19 coronavirus vaccine [Recombinant]). Although there is no proof that the vaccine could have induced secondary HLH, its possibility cannot be ruled out simultaneously. Early identification and diagnosis of HLH are of extreme importance. If not treated correctly, mortality can reach up to 40%. In this article, we would like to press upon the clinical presentation, diagnosis, and management of such a case and the possibility of this presentation being induced by the COVID-19 vaccine.

Purpose The treatment of aneurysms with characteristics such as complex morphology, fusiform, blister-like, wide neck, or large size has been revolutionized with the introduction of flow diverters. Though flow diverters have several advantages over coiling, they also have certain important disadvantages such as the lack of immediate protection against rupture, the risk of ischemic stroke, the need for antiplatelet therapy, and long latency for complete effect. The Derivo Embolization Device (DED) is a second-generation self-expanding device that is claimed to be less thrombogenic than conventional devices. We retrospectively evaluated the periprocedural safety and risks associated with the DED across 5 centers in India. Materials and Methods This is a multicentric, retrospective, observational study of DED, conducted at 5 high volume endovascular therapy centers in India from May 2018 to June 2020. Periprocedural demographic, clinical, and angiographic data were collected from a retrospective review of patient charts. Results A total of 96 patients, including 56 (58.3%) females, aged between 16–80 years (60±12.7 years) harboring 106 aneurysms were studied. Seven (7.3%) were noted to harbor multiple aneurysms: 6 had 3 aneurysms each, while 1 patient had 5 aneurysms. The following aneurysm characteristics were noted: average size, 9.8±8.2 mm; average neck size, 6.9±8.5 mm; wide-necked (>4 mm), 63 (59.4%); giant (>25 mm), 8 (7.5%); and anterior circulation location, 98 (92.5%). Eighteen (17%) of these were ruptured. Additional balloon angioplasty was performed in 5 (5.2%) patients. Intraprocedural problems were encountered in 3 (3.1%), of which only 1 had clinical implications, the device fish-mouthing with stent thrombosis resulting in a malignant middle cerebral artery territory infarction. The modified Rankin scale at 3 months was worse in 1 patient. Conclusion DED is a newer generation flow diverter stent with a low periprocedural complication rate.

Abstract In the BrighTNess trial, carboplatin added to neoadjuvant chemotherapy (NAC) was associated with increased pathologic complete response (pCR) rates in patients with stage II/III triple-negative breast cancer (TNBC). In this matched cohort study, cases with a germline BRCA1/2 mutation (gBRCA; n = 75) were matched 1:2 with non-gBRCA controls (n = 150) by treatment arm, lymph node status, and age to evaluate pCR rates and association of benefit from platinum/PARP inhibitors with validated RNA expression-based immune, proliferation, and genomic instability scores among gBRCA with the addition of carboplatin ± veliparib to NAC. Among the well-matched cohorts, odds of pCR were not higher in gBRCA cancers who received standard NAC with carboplatin (OR 0.24, 95% CI [0.04-1.24], p = 0.09) or with carboplatin/veliparib (OR 0.44, 95% CI [0.10-1.84], p = 0.26) compared to non-gBRCA cancers. Higher PAM50 proliferation, GeparSixto immune, and CIN70 genomic instability scores were each associated with higher pCR rate in the overall cohort, but not specifically in gBRCA cases. In this study, gBRCA carriers did not have higher odds of pCR than non-gBRCA controls when carboplatin ± veliparib was added to NAC, and showed no significant differences in molecular, immune, chromosomal instability, or proliferation gene expression metrics.

Objective:Leptomeningeal carcinomatosis (LMC), a common complication of advanced malignancies, is associated with high morbidity and mortality, yet diagnosis and treatment decisions remain challenging. This study describes the diagnostic and treatment modalities for LMC and identifies factors associated with overall survival (OS).Materials and Methods:We performed a single-institution retrospective study (registration #: OSU2016C0053) of 153 patients diagnosed with LMC treated at The Ohio State University, Comprehensive Cancer Center, (OSUCCC)-James between January 1, 2010 and December 31, 2015.Results:Median age at diagnosis was 55.7 years, and 61% had Eastern Cooperative Oncology Group baseline performance status ≤1. Most common primary tumors were breast (43%), lung (26%), and cutaneous melanoma (10%). At presentation, most patients were stage III-IV (71%) with higher grade tumors (grade III: 46%). Metastases to bone (36%), brain (33%), and lung (12%) were the most common sites with a median of 0.5 years (range, 0-14.9 years) between the diagnosis of first metastasis and of LMC. 153 (100%) patients had MRI evidence of LMC. Of the 67 (44%) who underwent lumbar puncture (LP), 33 (22%) had positive cerebrospinal fluid (CSF) cytology. Most patients received radiotherapy for LMC (60%) and chemotherapy (93%) for either the primary disease or LMC. 28 patients received intrathecal chemotherapy, 22 of whom had a primary diagnosis of breast cancer. 98% died with median OS of all patients was 1.9 months (95% CI: 1.3-2.5 months).Conclusion:Despite improved treatments and targeted therapies, outcomes of LMC remain extremely poor. Positive CSF cytology was associated with lower OS in patients who had cytology assessed and specifically in patients with breast cancer. CSF cytology serves as an important indicator for prognosis and helps aid in developing individualized therapeutic strategies for patients with LMC.

Objectives Our objective was to analyze the clinical presentation, imaging findings, and the management of segmental arterial mediolysis (SAM) in different case scenarios within our medical institution.

Objectives The aims of our study were to assess the comparability of conventional unenhanced images (CUIs) of hepatopancreaticobiliary system with virtual unenhanced images (VUIs) derived from arterial and portal venous phases acquired in a third-generation, dual-source, dual-energy CT (DECT), and also to assess the best dataset among these VUIs. We also calculated the radiation effective dose (ED) reduction by eliminating noncontrast acquisition. Materials and Methods 60 patients were included in our study. Unenhanced images in single energy and contrast-enhanced images in dual-energy mode were acquired. Arterial virtual unenhanced (AVU) and portal virtual unenhanced (PVU) images were generated and compared with CUI, using both objective and subjective methods. The ED was calculated separately for each phase. Statistical significance between difference in mean attenuation values were analyzed using ANOVA and unpaired student t-test. Results In our study, the difference in mean attenuation of liver, spleen, and pancreas between the three phases—CU, AVU, and PVU—were insignificant with p-value > 0.05. This indicates that the values were comparable. Among the VUI, AVU images were statistically superior in image quality. Elimination of noncontrast CT from triple phase abdominal imaging can achieve an average ED reduction of 39%. Conclusions We conclude that VUI generated in third-generation, dual-source DECT has diagnostic image quality and can replace the CUI in triple-phase studies, with a mean ED reduction by 39%. The VUI obtained from arterial phase is superior to those obtained from portal venous phase.

Abstract Background Triple-negative breast cancer (TNBC) is a heterogeneous disease and we have previously shown that rapid relapse of TNBC is associated with distinct sociodemographic features. We hypothesized that rapid versus late relapse in TNBC is also defined by distinct clinical and genomic features of primary tumors. Methods Using three publicly-available datasets, we identified 453 patients diagnosed with primary TNBC with adequate follow-up to be characterized as ‘rapid relapse’ (rrTNBC; distant relapse or death ≤2 years of diagnosis), ‘late relapse’ (lrTNBC; > 2 years) or ‘no relapse’ (nrTNBC: > 5 years no relapse/death). We explored basic clinical and primary tumor multi-omic data, including whole transcriptome (n = 453), and whole genome copy number and mutation data for 171 cancer-related genes (n = 317). Association of rapid relapse with clinical and genomic features were assessed using Pearson chi-squared tests, t-tests, ANOVA, and Fisher exact tests. We evaluated logistic regression models of clinical features with subtype versus two models that integrated significant genomic features. Results Relative to nrTNBC, both rrTNBC and lrTNBC had significantly lower immune signatures and immune signatures were highly correlated to anti-tumor CD8 T-cell, M1 macrophage, and gamma-delta T-cell CIBERSORT inferred immune subsets. Intriguingly, lrTNBCs were enriched for luminal signatures. There was no difference in tumor mutation burden or percent genome altered across groups. Logistic regression mModels that incorporate genomic features significantly outperformed standard clinical/subtype models in training (n = 63 patients), testing (n = 63) and independent validation (n = 34) cohorts, although performance of all models were overall modest. Conclusions We identify clinical and genomic features associated with rapid relapse TNBC for further study of this aggressive TNBC subset.

Background The COVID-19 pandemic has brought unprecedented challenges to health care services including interventional radiology (IR). Treating COVID-19 infected patients became a priority; furthermore, government policies of differing elective procedures and the public’s fear of contacting COVID-19 have impacted IR workload worldwide. The aim of this study was to evaluate the impact of the COVID-19 pandemic on the workflow in six vascular IR centers located across India. Methods The data were collected retrospectively from April 1 to June 30, 2020. All the six centers were staffed by the alumni of a single parent center located in India. Data was also collected from the same time period in 2019 for comparison. Results A total of 893 patients were treated from April 1 to June 30, 2019, and 419 were treated during the same period in 2020 during the pandemic, a 53% case volume reduction (95% CI:28. 56–129.44; p < 0.001). The month of April had the largest case volume reduction (66%, 95% CI: 13.57–50.43; p < 0.001). Elective procedures showed an 85% reduction (95% CI: 9.62–91.71; p < 0.001). Venous interventions showed the highest reduction of 76% (95% CI: 0.75–67.75; p < 0.001). Neurological emergencies, dialysis-related interventions, and nonvascular procedures did not show a significant change. No patient tested positive for COVID-19 prior to the procedure; however, one patient who was treated emergently was found to be positive later. Conclusion COVID-19 pandemic has severely impacted IR practice across India. Workload reduction was more profound at the beginning of the COVID-19 pandemic with a gradual improvement over time.

Abstract Background Trastuzumab-induced cardiotoxicity (TIC) can lead to early discontinuation of adjuvant therapy, however there is limited evidence on long-term survival outcomes in patients with operable human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC) experiencing treatment interruption or discontinuation. Methods The primary objective of the study was to evaluate disease-free survival (DFS) in non-metastatic, HER2-positive, female BC patients who experienced treatment interruption or early discontinuation of trastuzumab therapy. Clinical and histopathological data were collected on 400 patients at The Ohio State University, an NCI-designated comprehensive cancer center between January 2005 and December 2015. Treatment interruption was defined as any delay of ≥2 weeks during trastuzumab therapy, including permanent cessation prior to completing planned therapy. TIC was defined as LVEF 15 points decline from baseline as evaluated by 2D echocardiogram after initiation of (neo) adjuvant therapy. DFS was defined as the time from diagnosis to first recurrence (loco-regional or distant recurrence) including second primary BC or death. Overall survival (OS) was defined as the time from diagnosis to death or last known follow up. OS/DFS estimates were generated using Kaplan-Meier methods and compared using Log-rank tests. Cox proportional hazard models were used to calculate adjusted hazard ratios (aHR) for OS/DFS. Results A total of 369 patients received trastuzumab therapy; 106 (29%) patients experienced treatment interruption at least once and 42 (11%) permanently discontinued trastuzumab prior to completing planned therapy. TIC was the most common reason for interruption (66 patients, 62%). The median duration of trastuzumab in patients with treatment interruption was 11.3 months (range: 0.5–16.9) with 24 (23%) patients receiving ≤6 months of therapy. This duration includes the time delay related to treatment interruption. Patients with any treatment interruption had worse DFS (aHR: 4.4, p = 0.001) and OS (aHR: 4.8, p

Abstract Background Breast conserving surgery (BCS) and adjuvant hormonal therapy (HT) without radiation therapy (RT) is an acceptable approach for older women with early stage, estrogen receptor (ER) positive breast cancer. Toxicity and compliance remain issues with HT. Adjuvant RT alone may have better compliance, but its efficacy in the absence of HT is unclear. We aim to assess patterns of adjuvant therapy and survival outcomes among older women with early stage, ER positive (ER+) breast cancer. Methods The National Cancer Data Base (NCDB) was used to identify 130,194 women age ≥65 years with invasive ER+, node negative breast cancer diagnosed between 2004 and 2015. All patients underwent BCS. Kaplan‐Meier survival curves were used to examine overall survival (OS). The association between adjuvant therapy and OS was assessed in multivariable Cox proportional hazards regression models. Results Unadjusted 5/10‐year OS rates were 90.0%/64.3% for HT and RT, 84.2%/54.9% for RT alone, 78.7%/44.5% for HT alone, and 71.6%/38.0% for no treatment; p

Objective: The primary objective of this study was to delineate differences in management, overall and distant disease-free survival in males diagnosed with breast cancer and treated at The Ohio State University Comprehensive Cancer Center as compared to comprehensively matched female subjects. Secondary objectives included assessment of clinical and histopathologic features and recurrence score, as measured by Oncotype DX and the modified Magee equation #2.Materials and Methods: This single institution retrospective study compared male and comprehensively matched female patients (1:2) with stage I-III breast cancer between 1994 and 2014. Recurrence risk was estimated using a modified Magee equation. Overall survival and distant disease-free survival were estimated and compared using Kaplan-Meier and Log-rank methods.Results: Forty-five male breast cancer patients were included (stage I: 26.7%; stage II: 53.3%; stage III: 20.0%; hormone receptor positive: 97.8%; human epidermal growth factor receptor 2 negative: 84.4%) with a median age of 63.8 (43.0-79.4) years at diagnosis. Intermediate and low recurrence scores were most common in male and female patients respectively; mean score was similar between groups (20.3 vs. 19.8). The proportion of male breast cancer patients treated with adjuvant chemotherapy and post-mastectomy radiation was lower compared to female patients (42.2% vs. 65.3%, p=0.013; 22.7% vs. 44.4%, p=0.030, respectively). Overall survival and distant disease-free survival between male and female patients were similar.Conclusion: Male breast cancer patient outcomes were similar compared to well-matched female patients suggesting that breast cancer specific factors are more prognostic than gender.

Abstract Background While combinations of immune checkpoint (ICP) inhibitors and neo-adjuvant chemotherapy (NAC) have begun testing in patients with breast cancer (BC), the effects of chemotherapy on ICP expression in circulating T cells and within the tumor microenvironment are still unclear. This information could help with the design of future clinical trials by permitting the selection of the most appropriate ICP inhibitors for incorporation into NAC. Methods Peripheral blood samples and/or tumor specimens before and after NAC were obtained from 24 women with operable BC. The expression of CTLA4, PD-1, Lag3, OX40, and Tim3 on circulating T lymphocytes before and at the end of NAC were measured using flow cytometry. Furthermore, using multi-color immunohistochemistry (IHC), the expression of immune checkpoint molecules by stromal tumor-infiltrating lymphocytes (TILs), CD8+ T cells, and tumor cells was determined before and after NAC. Differences in the percentage of CD4+ and CD8+ T cells expressing various checkpoint receptors were determined by a paired Student’s t-test. Results This analysis showed decreased ICP expression by circulating CD4+ T cells after NAC, including significant decreases in CTLA4, Lag3, OX40, and PD-1 (all p values

Priapism due to pseudoaneurysm of the cavernosal artery is very rare. Herein, we describe the magnetic resonance imaging and digital subtraction angiographic findings of pseudoaneurysm in the right corpus cavernosum in a 7-year-old boy who presented with pain in the penis and lower abdomen and priapism with an obscure history of trauma. This was managed by endovascular embolization of the aneurysm. One-year follow-up has shown him to be normal without any symptoms and normal erection.

Studies assessing dyspnoea and health-related quality of life (HRQoL) in chronic obstructive pulmonary disease (COPD) have focussed on patients in clinical settings, not the general population. The aim of this analysis was to compare the prevalence and severity of dyspnoea and impaired HRQoL in individuals with and without COPD from the general population, focussing on mild–moderate COPD. Analysis of the 3-year Canadian Cohort Obstructive Lung Disease (CanCOLD) study included four subgroups: mild COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1); moderate COPD (GOLD 2); non-COPD smokers; and non-COPD never-smokers. The primary outcome was dyspnoea (Medical Research Council (MRC) scale), and the secondary outcome was HRQoL (COPD Assessment Test (CAT) score; Saint George's Respiratory Questionnaire (SGRQ) score). Subgroups were analysed by sex, physician-diagnosed COPD status and exacerbations. 1443 participants (mild COPD (n=397); moderate COPD (n=262(; smokers (n=449) and never-smokers (n=335)) were studied. People with mild COPD were more likely to report more severe dyspnoea (MRC 2 versus 1) than those without COPD (OR (95% CI) 1.42 (1.05–1.91)), and non-COPD never-smokers (OR (95%CI) 1.64 (1.07–2.52)). Among people with mild COPD, more severe dyspnoea was reported in women versus men (MRC2 versus 1; OR (95% CI) 3.70 (2.23–6.14)); people with, versus without, physician-diagnosed COPD (MRC2 versus 1; OR (95% CI) 3.27 (1.71–6.23)), and people with versus without recent exacerbations (MRC2 versus 1; ≥2 versus 0 exacerbations: OR (95% CI) 3.62 (1.02–12.86); MRC ≥3 versus 1; 1 versus 0 exacerbation: OR (95% CI): 9.24 (2.01–42.42)). Similar between-group differences were obtained for CAT and SGRQ scores. Careful assessment of dyspnoea and HRQoL could help identify individuals for earlier diagnosis and treatment.

The intricate interplay between malignant cells and host cellular and non-cellular components play crucial role in different stages of tumor development, progression, and metastases. Tumor and stromal cells communicate to each other through receptors such as integrins and secretion of signaling molecules like growth factors, cytokines, chemokines and inflammatory mediators. Chemokines mediated signaling pathways have emerged as major mechanisms underlying multifaceted roles played by host cells during tumor progression. In response to tumor stimuli, host cells-derived chemokines further activates signaling cascades that support the ability of tumor cells to invade surrounding basement membrane and extra-cellular matrix. The host-derived chemokines act on endothelial cells to increase their permeability and facilitate tumor cells intravasation and extravasation. The tumor cells-host neutrophils interaction within the vasculature initiates chemokines driven recruitment of inflammatory cells that protects circulatory tumor cells from immune attack. Chemokines secreted by tumor cells and stromal immune and non-immune cells within the tumor microenvironment enter the circulation and are responsible for formation of a “pre-metastatic niche” like a “soil” in distant organs whereby circulating tumor cells “seed’ and colonize, leading to formation of metastatic foci. Given the importance of host derived chemokines in cancer progression and metastases several drugs like Mogamulizumab, Plerixafor, Repertaxin among others are part of ongoing clinical trial which target chemokines and their receptors against cancer pathogenesis. In this review, we focus on recent advances in understanding the complexity of chemokines network in tumor microenvironment, with an emphasis on chemokines secreted from host cells. We especially summarize the role of host-derived chemokines in different stages of metastases, including invasion, dissemination, migration into the vasculature, and seeding into the pre-metastatic niche. We finally provide a brief description of prospective drugs that target chemokines in different clinical trials against cancer.

Aim: The aim of this study was to describe the distribution and comparison of carotid intima thickness in two completely different demographics in South India. Materials and Methods: Data were obtained from 865 participants in rural Nallampatti and 1081 participants from urban Kalapatti in the state of Tamil Nadu. Local ethics committee approval and written and informed consent were obtained from all participants. Carotid intima thickness was measured on all participants using high-resolution B-mode ultrasound. Atherosclerosis was defined as a carotid intima-media thickness of ≥1 mm. Results: The prevalence of atherosclerosis was 10.3% in rural Nallampatti compared to 7.8% in urban Kalapatti. On binary logistic regression analysis, diabetes and hypertension were associated with atherosclerosis in rural areas, but this significance disappeared after adjustment for confounding factors. In urban areas, diabetes appeared to be significantly associated with atherosclerosis even after adjustment for confounding factors. Conclusion: Our data suggest a surprisingly increased prevalence of atherosclerosis in a rural farming population even though traditional risk factors for atherosclerosis such as diabetes and hypertension did not show a significant association after adjustment for confounding factors. If confirmed, this provides a rationale to do large-scale studies to explore the role of nontraditional risk factors in rural India that could have an impact on atherosclerosis and cardiovascular disease.

Blood blister aneurysms are extremely rare, and its treatment continues to be controversial. Although surgery was the only available treatment a decade ago, today newer endovascular devices such as flow diverters (FDs) appears to have very low complication rates with good long-term results. We analyzed our data of seven patients who angiographically had features of a blister aneurysm. All these patients presented with subarachnoid hemorrhage (SAH). Six of these were in anterior circulation, all of which were in internal carotid artery (ICA) and one was in a P1 segment of posterior cerebral artery (PCA). All of the patients except one in PCA were treated with FDs. One of the patients died (14.3%) following the procedure secondary to thrombosis of FD. Rest of the patients did well postprocedure with the good clinical outcome (modified Rankin Scale [mRS] of less than or equal to 2 at 1-month follow-up) in 85.7% patients. Five of the patients showed complete obliteration of an aneurysm (83.3%) on 6-month follow-up angiography. The only patient with an aneurysm in PCA showed persistence of an aneurysm and this particular lesion was instead treated by a single stent. Blister aneurysms pose diagnostic and therapeutic challenges and demand prompt treatment. Considering that all patients who were treated with FD had complete obliteration, it can be inferred that FD can be the treatment of choice in patients with blister aneurysms presenting with SAH. Further, with the introduction of small vessel FD, thrombotic complications may reduce, lowering the morbidity and mortality. Isolated stenting may not be an optimal treatment of a blister aneurysm.

Abstract Purpose Acute ischemic stroke was not long ago the territory of the neurologist, where the endovascular surgeon had only started baby steps. The scenario has completely changed post-2015 and now mechanical thrombectomy holds centerstage of the treatment guidelines. The two basic techniques for clot retrieval are the stent retriever thrombectomy and a direct aspiration first-pass technique. Use of one device as an adjunct to the other also has a passing mention in the trials. Tandem occlusions pose issues in accessing the target vessel for clot retrieval, and emergency stenting of the carotid pathway opens further avenues in stroke care. Cases The authors present four cases of acute ischemic stroke, three of them involving the anterior circulation and one involving the basilar artery. All the cases underwent endovascular therapy, albeit with different techniques. Through the cases, they present the current technology, and its implementation and challenges faced by the interventional radiologist. Conclusion The availability of a diverse technical repertoire helps in tackling specific scenarios facing the stroke interventionist. The levels of evidence vary for the different weapons at hand, but it is not long before endovascular intervention becomes the panacea for stroke.

Abstract Aims To evaluate the safety and effectiveness of transarterial embolization for blunt abdominal trauma in patients without the imaging signs of peritonitis or bowel injury. Materials and Methods A total of 45 patients (41 males and 4 females; mean age: 32.15) were studied, of which 48% were hemodynamically unstable. All patients underwent multidetector computed tomography prior to selective angiography and embolization. Outcomes were considered as favorable if embolization was successful in achieving hemostasis. The frequency of complications, mortality rates, and duration of hospital stay were calculated. Results Embolization was successful in achieving hemostasis in all patients. None of the patients required surgery to achieve hemostasis after embolization. The overall mortality rate was 13.3% and none related to persistent bleeding. The mean intensive care unit stay was 5.6 days and the median was 3.5 days. Only one patient required continued blood transfusion of more than 10 units after embolization. No major complications were encountered except for one patient who required hemodialysis for acute renal injury related to embolization procedure. Conclusion Transarterial embolization is very effective in treating bleeding related to blunt abdominal trauma even in hemodynamically unstable patients and is associated with minimal complications. Embolization should be considered as an integral part of resuscitative measures for bleeding related to trauma.

The incidence of varicose veins in lower limbs is increasing in the Indian subcontinent. With the advent of radiofrequency ablation (RFA), an effective minimally invasive technique is now available to treat varicose veins. RFA can be performed with either unipolar or bipolar probes. We present a simple technique for bipolar radiofrequency-induced thermotherapy of the great saphenous vein. This can be a safe and effective alternative to surgical procedures.

Background: Dental implants in the recent past have become indispensable in restoring loss of space and support as well as aiding the aesthetics. Although in practice for a few years there is no consensus on the protocols for placement and usage of dental implants in growing jaws. Objective: The present study aims to evaluate evidence-based literature on single or multiple dental implant placements in children(up to 17 years) and to identify areas lacking and gaps in knowledge. The quality assessment tool,namely AMSTAR-2, will also aim to evaluate the quality of said research around paediatric dental implants. Design: The study was prospectively registered on the Open Science Framework https://osf.io/e59bt/?view_only=ec8fb69455c240ecbfc7379734784bf7.For source selection, electronic searches were performed on MEDLINE, EMBASE, Scopus databases as well as Google Scholar for all English language systematic reviews and meta analysis on dental implants placed on children up to 17yrs of age by 2 reviewers, wherein the publications until December 2020 were included. A final dataset of 4 systematic reviews were incorporated and analysed using the AMSTAR-2 grading tool. Results: It was seen that only one study showed moderate overall confidence while one low overall confidence as per the AMSTAR-2. The other 2 systematic reviews were of critically low confidence levels. Hence, the existing systematic reviews on the subject are not of high quality. Most of the reviews have no consensus regarding use and placement of implants in growing patients. Conclusion: More research and stricter adherence to the quality assessment guidelines is recommended for all future systematic reviews regarding dental implant in children.

Introduction Pulmonary embolism is the third most common cause of cardiovascular death worldwide and imaging plays a pivotal role in establishing the diagnosis. Computed tomography pulmonary angiography (CTPA) scores over other modalities and is the current diagnostic investigation of choice. In this study, we assessed the main pulmonary artery and its corresponding segmental artery attenuation in reconstructed virtual monoenergetic (mono plus) images (VMI-MP) and linear blended images (spectral post processing, SPP) obtained from dual-energy CTPA. The values were compared using contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR).

Background: Multifaceted etiology of cardiovascular diseases (CVD), especially coronary heart disease, has been recognized for a long time. The Metabolic syndrome (METS) is a specific clustering of cardiovascular risk factors in the same person (abdominal obesity, atherogenic dyslipidemia, elevated blood pressure (BP), insulin resistance (IR), a prothrombotic and a proinflammatory state. Aims and Objectives: To evaluate the prognosis of Myocardial Infarction (STEMI & N-STEMI) in patients with Metabolic Syndrome in our tertiary care hospital. Materials And Methods: Total of 154 Patients have been reported for diagnosis in our hospital. A final diagnosis of Myocardial Infarction (MI) was made in the presence of serial increases in serum biochemical markers of cardiac necrosis, associated with typical electrocardiographic changes and/or typical symptoms as defined by the joint committee of the European society of cardiology and the American college of cardiology. A detailed case history was taken including the symptoms, history of diabetes mellitus, hypertension (HT), smoking and alcohol consumption. A careful physical examination was done with special reference to resting blood pressure (BP), waist circumference (WC), height and weight. Results and Observations: As we sampled a total of 154 Patients, 77 patients with MI and METS and 77 Patients without MI and METS into two groups 1 & 2. There were 39 (50.66%) cases of heart failure among patients of MI with METS compared to 18 (24.00%) cases of heart failure among patients of MI without METS, and the difference was statistically significant. Postoperative analgesic requirement was seen in 64 % of the patients of group 1 while it was seen in 16 % of the patients in group 2. Conclusion: The main finding of present study was that the Metabolic Syndrome was a meaningful predictor of in-hospital death in patients with STEMI. During one week of hospital stay there were significantly more deaths and heart failure among patients of MI with METS compared to patients of MI without METS (50.66% and 25.33% vs. 24% and 14.66%). Though the number of patients who developed other complications like recurrent MI, VT (Ventricular Tachycardia), VF (Ventricular Fibrillation) and Stroke were more in patients of MI with METS when compared to patients of MI without METS, The difference was not statistically significant. [ABSTRACT FROM AUTHOR]