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Radical cystectomy is long considered as the "gold standard" in the management of localized muscle-invasive bladder cancer (MIBC), and curative intent radiotherapy is relegated to those with either inoperable tumors or with multiple co-morbidities precluding surgery. This is despite a large volume of data showing equal survival between the two modalities of treatment in this setting. In this work we seek to dispel some common myths surrounding curative intent radiotherapy as part of a bladder preservation strategy in MIBC. Baseless claims of inferior outcomes and perceived contraindications for bladder preservation are debunked along with unfounded doubts relating to hypofractionation. Finally, we caution against using response to neoadjuvant chemotherapy as a predictive biomarker for treatment selection and conclude by recommending that trimodality bladder preservation be offered as a therapeutic option that is in clinical equipoise with radical cystectomy.

This pioneering study aims to identify the significant differences between males and females in their scale of measurements and thereby determine the sex using the humerus, the long bone between the shoulder and elbow joints of the Sri Lankan population. We analysed the dimensions of maximum length, intercondylar breadth, and the vertical and transverse diameter of left and right side humerus measured in millimetres (mm) of 86 humeri (46 males and 40 females) in Sri Lankan adults. To identify the significant mean differences between the male and female dimensions of humeri, paired sample t-test and Wilcoxon signed-rank test were used. Moreover, linear and quadratic discriminant functions for each univariate and multivariate variable were considered to determine the sex. All four humeral dimensions were significantly larger for males compared to females. The univariate quadratic linear discriminant function is better than the linear discriminant function for the sex estimation with higher accuracy. Both left and right transverse diameter provide 99% accuracy using univariate quadratic discriminant functions, while the maximum length of humerus showed the lowest accuracy in determining the sex. The multivariate discriminant function provided lower accuracy than the univariate quadratic discriminant function. Therefore, the study concludes that a univariate quadratic discriminant function with either the left or right transverse diameter of the humerus would be the best way to predict sex for the contemporary Sri Lankan population.

Highlights • The patient-reported outcomes are as vital as the physician documented toxicities. • The QOL scores return back to normal in most scales similar to baseline value by 3 months. • VMAT based SIB is a feasible and safe strategy in terms of toxicity profile., Objective To assess the change in the quality of life (QOL) in head and neck cancer patients treated with Simultaneous Integrated Boost (SIB) by Volumetric Modulated Arc Therapy (VMAT) technique. Methods Thirty patients with localised head and neck cancers (Stage II- IVa) were treated with VMAT and SIB technique. The three-dose levels prescribed were 68.2 Gy at 2.2 Gy/fraction, 62 Gy at 2 Gy/fraction and 55.8 Gy at 1.8 Gy/fraction to the high, intermediate and low-risk volumes respectively. Concurrent chemotherapy with cisplatin 100 mg/m2 was administered once in three weeks. Acute toxicities were evaluated and scored according to the RTOG grading system. Quality of life (QOL) was assessed using European Organization of Research and Treatment of Cancer (EORTC) QLQC30 and HN35 questionnaires at baseline and in three instances (immediately, one month and three months after the radiotherapy). Results Out of the total 30, 80% patients had a complete response (CR) at the median follow up of 12 months, while three patients died because of progression, and the remaining 3 had stable disease. All planning objectives were achieved for organs at risk and planning target volume(PTV). There was a statiscally significant(p value

Background: Pancreatic cancer is a devastating disease with a 5-year survival rate of 5–10%. Radiation is commonly used in neoadjuvant and adjuvant settings to improve local control. Studies have shown that circulating lymphocyte count depletion after radiation has been associated with poor tumor control and inferior overall survival (OS) outcomes. Method: To better understand the impact of radiation-associated lymphopenia in pancreatic cancer, the authors undertook this systematic review and meta-analysis of clinical studies that have reported radiation-related lymphopenia in pancreatic cancer. Results: A systematic methodology search of PubMed, Embase and the Cochrane Library resulted in 2969 abstracts. Nine studies fulfilled the inclusion criteria. Six studies reported on outcomes in patients undergoing definitive chemoradiation and three studies comparing outcomes in stereotactic body radiotherapy versus definitive chemoradiation. The patients with severe lymphopenia were at increased risk of death with a pooled hazard ratio of 2.33 (95% CI: 1.79, 3.03; I2: 36%; p 2: 95%; p 2: 99%; p

Background The impact of radiation-related lymphopenia on clinical outcomes has been reported in various solid malignancies such as high grade gliomas, head and neck cancers, thoracic malignancies and gastro-intestinal malignancies but its impact is not clearly known in the context of common genito-urinary (GU) malignancies. Methodology To better understand the effect of radiation-associated lymphopenia in prostate and bladder cancer, we undertook this systematic review of clinical studies that have studied radiation-related lymphopenia in GU malignancies. A systematic methodology search of PubMed, Embase, and Cochrane library resulted in 2125 abstracts. Ten studies fulfilled the inclusion criteria which included any prospective, retrospective study or cohort study of prostate, urinary bladder, kidney, ureter, urethra, penile cancer in humans, and radiation should be part of treatment and intent has to be in definitive or adjuvant settings. Finally the study should have data on radiation-related lymphopenia. Results Four studies reported on the cancer-specific outcomes related to the lymphopenia. The incidence of low lymphocyte counts were documented in all the studies. Three studies analyzed the factors associated with the Lymphocyte depletion. Pooled incidence of severe lymphopenia was 29.25% and mild to moderate lymphopenia was 60.75%. Bone marrow volume receiving 40 Gy was associated with the incidence of lymphopenia. Conclusion One-third of the patients suffer from severe lymphopenia after radiation in prostate and bladder cancer. There are no clear data to support the correlation between severe lymphopenia and disease outcomes. Bone marrow dosimetry can affect the incidence and severity of lymphopenia. There is need of prospective datasets to identify the impact of radiation-related lymphopenia in GU malignancies focusing on long-term side effects, recurrence rates, and overall survival.

Senile cataract is the most common cause of severe visual impairment and blindness. Lenticular epithelial cells apoptosis induced by oxidative stress is a major factor in senile cataract pathogenesis, but there are still many blind nodes in this progress. The aim of the present experiment was to investigate the possibility that nanoeugenol prevents selenite-induced cataractogenesis by regulating the reactive oxygen species (ROS) generation, expressions of apoptotic genes and corresponding proteins. Nanoeugenol found to be inhibited oxidative stress-induced downregulation cytochrome c oxidase subunit I (COX-1), B-cell lymphoma 2 (Bcl-2) genes and upregulation of early growth response protein- 1 (EGR-1), Bcl-2-associated X (Bax), caspase-3, caspase-8 and caspase-9 genes in cultured lenses from Wistar rats. Nanoeugenol significantly reduced oxidative stress-induced cell apoptosis and generation of ROS in human lenticular epithelial cells (HLE-B3 cells). These findings suggested that, nanoeugenol can regulate cataract progression by influencing cell vitality and apoptosis, which could provide new ideas for the clinical treatment of senile cataract.

Despite the modern advances in treatment techniques, the survival of locally advanced lung cancer patients continues to remain poor. Circulating lymphocytes have an important role to play in local immune response to RT as well as immune checkpoint inhibitors, and radiation related lymphopenia has been associated with inferior survival in various tumors.We undertook this systematic review and meta-analysis to evaluate the literature on risk and impact of lymphopenia in thoracic tumors. A systematic methodology search of the PubMed, Embase and Cochrane library was performed and eligible studies selected based on pre-defined inclusion and exclusion criteria. Review Manager Version 5.4.1 was used for the meta-analysis.Fourteen studies were included in the final systematic review and 10 in the quantitative analysis. Overall mean incidence of severe lymphopenia (absolute lymphocyte count 500) was 64.24%. The patients with severe lymphopenia were at increased risk of death with a pooled HR of 1.59 (95% CI: 1.40, 1.81, IRadiation related lymphopenia is associated with increased hazard of progression and death in lung cancer. Minimizing the lung and heart dose, especially in patients with concurrent other risk factors can reduce lymphopenia and potentially improve treatment outcomes in these patients.

Background Cancer patients with COVID-19 disease have been reported to have double the case fatality rate of the general population. Materials and methods A systematic search of PubMed/MEDLINE, Embase, Cochrane Central, Google Scholar, and MedRxiv was done for studies on cancer patients with COVID-19. Pooled proportions were calculated for categorical variables. Odds ratio and forest plots were constructed for both primary and secondary outcomes. The random-effects model was used to account for heterogeneity between studies. Results This systematic review of 31 studies and meta-analysis of 181,323 patients from 26 studies involving 23,736 cancer patients is the largest meta-analysis to the best of our knowledge assessing outcomes in cancer patients affected by COVID-19. Our meta-analysis shows that cancer patients with COVID-19 have a higher likelihood of death (odds ratio, OR 2.54), which was largely driven by mortality among patients in China. Cancer patients were more likely to be intubated, although ICU admission rates were not statistically significant. Among cancer subtypes, the mortality was highest in hematological malignancies (OR 2.43) followed by lung cancer (OR 1.8). There was no association between receipt of a particular type of oncologic therapy and mortality. Our study showed that cancer patients affected by COVID-19 are a decade older than the normal population and have a higher proportion of co-morbidities. There was insufficient data to assess the association of COVID-directed therapy and survival outcomes in cancer patients. Despite the heterogeneity of studies and inconsistencies in reported variables and outcomes, these data could guide clinical practice and oncologic care during this unprecedented global health pandemic. Conclusion Cancer patients with COVID-19 disease are at increased risk of mortality and morbidity. A more nuanced understanding of the interaction between cancer-directed therapies and COVID-19-directed therapies is needed. This will require uniform prospective recording of data, possibly in multi-institutional registry databases.

Building an analytical thermal model to simulate actual working conditions of a jet engine is quite challenging. Many approximations creep into thermal analysis in the process of simulating real-time working environment. Therefore, it is mandatory to validate analytical temperature predictions against test engine data (thermal couple measured temperatures). Thermal boundary conditions (BCs), i.e., convective heat transfer coefficients (HTC), are estimated using empirical correlations which are derived from experiments conducted in controlled environments. Traditionally, BCs are varied within permissible limits to account the inability of empirical correlations in capturing physics. This approach requires large number of iterations to match analytical model against engine data. This requires manual efforts and consumes huge cycle time. Fine tuning BCs for the validation of analytical model varies from engine to engine based on its architecture and flow system. Rule-based algorithms would not help in data matching analytical models with less number of iterations. Machine learning (ML) algorithms would be an appropriate choice as it can use lessons from the legacy data matched models. A methodology is developed using regression-based ML algorithm which uses data from legacy thermal data matched models to identify the influence of convective HTCs on component temperatures. 70% of available data is used to train the ML model and the remaining 30% of data is used for validation. Further to improve the results, hyperparameters were tuned along with the k-fold cross validation. Several attempts have been made to improve prediction accuracy by employing various algorithms like Lasso, Ridge, Elastic Net, and XGBoost. Among all, multiple linear regression has yielded lowest mean squared error. An ensembling approach has also been applied with the best resulting algorithms among above. Though the results seem to be interesting, the objective of identifying weights could not be achieved with ensembling technique. Thus, the objective function is constructed with the results obtained from multiple linear regression and solved using simplex method to identify optimal scale factors to convective heat transfer coefficients. With this approach, user intervention is mostly eliminated. 50% of cycle time reduction is achieved.

The purpose of this work was to improve the antioxidant and anticataractogenic potential of eugenol by encapsulating it within chitosan nanoparticles via an emulsion–ionic gelation crosslinking method. Various ratios of chitosan to eugenol (1:0.75, 1:1 and 1:1.25) were optimized by encapsulation efficiency, loading capacity, drug-releasing profile, and in-vitro antioxidant potential. Synthesized eugenol-loaded chitosan nanoparticles (ECNP 1:1) and plain chitosan nanoparticles (CNPs) were characterized by UV–visible spectrometry, dynamic light scattering (DLS), X-ray powder diffraction, Fourier-transform infrared spectroscopy, scanning electron microscopy, transmission electron microscopy and atomic force microscopy (AFM). The range of sizes of ECNPs, as determined by the AFM and DLS methods, was approximately 200–600 nm. 3–4,5-(dimethyl-thyazol-2-yl)-2,5-diphenyltetrazolium (MTT) analysis revealed that ≥ 50% of cultured human lenticular epithelial (HLE-B3) cells remained viable when exposed to an ECNP concentration of 150 μM or less. These ECNPs were evaluated for efficacy in preventing experimental in-vitro selenite-induced cataractogenesis. Encapsulation of eugenol within chitosan nanoparticles appeared to improve the antioxidant capacity of plain eugenol; this could conceivably improve the anticataractogenic potential of eugenol.