Search results for: malignant peripheral nerve sheath tumor

Authors: Ashwin Rai, Rajalakshmi Rai, Rajanigandha Vadgoankar

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Lingual artery is the chief artery of the tongue and the neighboring structures pertaining to the oral cavity. At the carotid triangle, this artery arises from the external carotid artery opposite to the tip of greater cornua of hyoid bone, undergoes a tortuous course with its first part being crossed by the hypoglossal nerve and runs beneath the digastric muscle. Then it continues to supply the tongue as the deep lingual artery. The aim of this study is to draw surgeon's attention to the course of lingual artery in this area since it can be accidentally lesioned causing an extensive hemorrhage in certain surgical or dental procedures. The study was conducted on 44 formalin fixed head and neck specimens focusing on the anatomic relations of lingual artery. In this study, we found that the lingual artery is located inferior to the digastric muscle and the hypoglossal nerve contradictory to the classical description. This data would be useful during ligation of lingual artery to avoid injury to the hypoglossal nerve in surgeries related to the anterior triangle of neck.

Keywords: anterior triangle, digastric muscle, hypoglossal nerve, lingual artery

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Authors: Laila Seada, Ashraf Ibrahim, Amjad Al Shammari

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Background and Objectives: Breast carcinoma is the most common cancer of females in Hail region, accounting for 31% of all diagnosed cancer cases followed by thyroid carcinoma (25%) and colorectal carcinoma (13%). Methods: In the present retrospective study, all cases of breast lesions received at the histopathology department in King Khalid Hospital, Hail, during the period from May 2011 to April 2016 have been retrieved from department files. For all cases, a trucut biopsy, lumpectomy, or modified radical mastectomy was available for histopathologic diagnosis, while 105/140 (75%) had, as well, preoperative fine needle aspirates (FNA). Results: 49 cases out of 140 (35%) breast lesions were carcinomas: 44/49 (89.75%) was invasive ductal, 2/49(4.1%) invasive lobular carcinomas, 1/49(2.05%) intracystic low grade papillary carcinoma and 2/49 (4.1%) ductal carcinoma in situ (DCIS). Mean age for malignant cases was 45.06 (+/-10.58): 32.6% were below the age of 40 and 30.6 below 50 years, 18.3% below 60 and 16.3% below 70 years. For the benign group, mean age was 32.52 (+/10.5) years. Benign lesions were in order of frequency: 34 fibroadenomas, 14 fibrocystic disease, 12 chronic mastitis, five granulomatous mastitis, three intraductal papillomas, and three benign phyllodes tumor. Tubular adenoma, lipoma, skin nevus, pilomatrixoma, and breast reduction specimens constituted the remaining specimens. Conclusion: Breast lesions are common in our series and invasive carcinoma accounts for more than 1/3^rd of the lumps, with 63.2% incidence in pre-menopausal ladies, below the age of 50 years. FNA as a non-invasive procedure, proved to be an effective tool in diagnosing both benign and malignant/suspicious breast lumps and should continue to be used as a first assessment line of palpable breast masses.

Keywords: age incidence, breast carcinoma, fine needle aspiration, hail region

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Authors: Ahmed Ashit

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Image fusion is a significant and efficient image processing method used for detecting different types of tumors. This method has been used as an effective combination technique for obtaining high quality images that combine anatomy and physiology of an organ. It is the main key in the huge biomedical machines for diagnosing cancer such as PET-CT machine. This thesis aims to develop an image analysis system for the detection of the eye tumor. Different image processing methods are used to extract the tumor and then mark it on the original image. The images are first smoothed using median filtering. The background of the image is subtracted, to be then added to the original, results in a brighter area of interest or tumor area. The images are adjusted in order to increase the intensity of their pixels which lead to clearer and brighter images. once the images are enhanced, the edges of the images are detected using canny operators results in a segmented image comprises only of the pupil and the tumor for the abnormal images, and the pupil only for the normal images that have no tumor. The images of normal and abnormal images are collected from two sources: “Miles Research” and “Eye Cancer”. The computerized experimental results show that the developed image fusion based eye tumor detection system is capable of detecting the eye tumor and segment it to be superimposed on the original image.

Keywords: image fusion, eye tumor, canny operators, superimposed

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Authors: J. Sagouis, A. Chamel, E. Carre, C. Casasreales, G. Rudnik, M. Cerdan

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Robotics provides answers to amputees. The most expensive solutions surgically connect the prosthesis to nerve endings. There are also several types of non-invasive technologies that recover nerve messages passing through the muscles. After analyzing these messages, myoelectric prostheses perform the desired movement. The main goal is to avoid all surgeries, which can be heavy and offer cheaper alternatives. For an amputee, we use valid muscles to recover the electrical signal involved in a muscle movement. EMG sensors placed on the muscle allows us to measure a potential difference, which our program transforms into control for a robotic arm with two degrees of freedom. We have shown the feasibility of non-invasive prostheses with two degrees of freedom. Signal analysis and an increase in degrees of freedom is still being improved.

Keywords: prosthesis, electromyography (EMG), robotic arm, nerve message

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Authors: Hanan Mohamed Abd Elmoneim, Rawan Saleh AlJawi, Razan Saleh AlJawi, Aseel Abdullah AlMasoudi , Zyad Adnan Turkistani, Anas Abdulkarim Alkhoutani , Ohood Musaed AlJuhani , Hanan Attiyah AlZahrani

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Background Esophageal cancer is the eighth most common cancer worldwide. More than 90% of esophageal cancers are either squamous cell carcinoma or adenocarcinoma. Squamous dysplasia is a precancerous lesion for squamous cell carcinoma and Barrett's esophagus is the precancerous lesion for adenocarcinoma. Gastro-esophageal reflux disease (GERD) is the initiation factor for Barrett's esophagus. Cyclooxygenase-2 (COX-2) is a key enzyme in arachidonic metabolism. It appears to play an important role in gastrointestinal carcinogenesis. COX-2 activity may be a potential target for the prevention of cancer progression by selective COX-2 inhibitors, which decrease proliferation and increase apoptosis. Objectives To assess COX-2 expression in premalignant and malignant esophageal epitheliums changes and detect its roles in progression of these lesions. Materials and Methods We analyzed the expression of COX-2 immunohistochemically in 40 esophageal biopsies utilizing the streptavidin-biotin-peroxidase complex method on archival formalin fixed-paraffin embedded blocks. Histopathologically, 17 (42.5%) of cases were non-malignant cases which included GERD, Barrett's esophagus and squamous dysplasia. The malignant cases were 23 (57.5%) squamous cell carcinoma, adenocarcinoma and undifferentiated carcinoma. Results In non-malignant cases 7 (41.2%) out of 17 cases had high COX-2 expression. In squamous cell carcinoma 10 (83.3%) out of 12 cases had high COX-2 expression. The expression of COX-2 was high in all 9 (100%) cases of adenocarcinoma. COX-2 expression is significantly increased (P=0.005 and P=0.0001) in squamous cell carcinoma and adenocarcinoma respectively. There was a significant difference in COX-2 immunoreactivity between malignant and non-malignant lesions (P=0.0003). Conclusion COX-2 is responsible for the progression of esophageal diseases from benign to malignant. We recommend that COX-2 immunohistochemistry should be done routinely for premalignant and malignant esophageal lesions as selective COX-2 inhibitors will be helpful in the treatment. Further studies on molecular and genetic basis of COX-2 expression are needed to unmask its role and relation to progression of esophageal lesions.

Keywords: Cox-2, Esophageal adinocarcinoma, Esophageal squamous cell carcinoma, Immunohistochemistry.

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Authors: Sushila Jaiswal, Awadhesh Kumar Jaiswal

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Background: Primary melanocytic tumors of the central nervous system (CNS) are uncommon lesions and arise from the melanocytes located within the leptomeninges. Aim and objective: The aim of the study was to evaluate the clinical details, histomorphology of the primary melanocytic tumor of CNS. Method: The study was performed by the retrospective review of the case records of the primary melanocytic tumors of CNS diagnosed in our department. The formalin-fixed, paraffin embedded tissue blocks and tissue sections were retrieved and reviewed. Results: Seven cases (6 males, 1 female; age range- 16-40 years; mean age- 27 years) of primary melanocytic tumors of CNS were retrieved over last seven years. The tumor was intracranial (n=5; frontal – 1 case, parietal – 1 case, cerebello-pontine angle- 1 case, occipital -1 case, foramen magnum-1 case) and intra spinal (n=2; cervical – 2 cases). All patients presented with the neurological deficits related to the location of the tumor. Four cases were malignant melanoma; two were melanocytoma of intermediate grade and remaining one was melanocytoma. On histopathology, melanocytoma and melanoma both displayed sheets of well-differentiated melanocytes having round to oval nuclei with finely dispersed chromatin, occasional single eosinophilic nucleoli and a moderate amount of cytoplasm with abundant granular melanin pigment. The absence of mitosis and macronucleoli was noticed in melanocytoma while melanoma showed frequent mitosis and macronucleoli. On immunohistochemistry, both showed diffuse strong HMB45 and S-100 immunopositivity. Conclusion: Primary melanocytic tumors of CNS are rare and predominantly seen in males. It is important to differentiate melanoma from melanocytoma as prognosis of later is good.

Keywords: melanocytoma, melanoma, brain tumor, melanin

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Authors: Leila Anoosheh

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Aim: The aim of this study was to assess The effects of aerobic training on microRNA let-7a expression and levels of tumor tissue IL-6 in mice with breast cancer. Method: Twenty BALB/c c mice (4-5 weeks,17 gr mass) were cancerous by injection of estrogen-dependent receptor breast cancer cells MC4-L2 and divided into two groups: tumor-training(TT) and tumor-control(TC) group. Then TT group completed aerobic training for 6 weeks, 5 days per week (14-18 m/min). After tumor emersion, tumor width and length were measured by digital caliper every week. 48 hours after the last exercise subjects were killed. Tissue sampling were collected and stored in -70ᵒ. Tumor tissue was homogenized and let-7a expression and IL-6 levels were accounted with Real time-PCR and ELISA Kit respectively. Statistical analysis of let-7a was conducted by the REST software. Repeated measures and independent tests were used to assess tumor size and IL-6, respectively. Results: Tumor size and IL-6 levels were significantly decreased in TT group compare with TC group (p<0.05). microRNA let-7a was increased significantly in TT against control group respectively (p=0/000). Conclusion: Reduction in tumor size, followed by aerobic exercise can be attributed to the loss of inflammatory factors such as IL-6; It seems that regarding to up regulation effects of aerobic exercise training on let-7a and down regulation effects of that on IL-6 in mice with breast cancer, This type of training can be used as adjuvant therapy in conjunction with other therapies for breast cancer.

Keywords: breast cancer, aerobic training, microRNA let-7a, IL-6

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Authors: Alvarez Magañini, María Victoria-Rubbi, Lautaro Nahuel

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At present, we are facing an unstable international context, conditioned by a relative decline of the US power, primarily in the economic sphere and, to a lesser extent, in the military sphere. This scenario of multipolarity creates tension and uncertainty in the peripheral countries when the issue of their foreign policy arises. This paper presents an analysis of the bilateral relations that were maintained by the Argentine Republic, a peripheral country, along with the United States and China during the period of 2005-2015 in matters of defense in order to identify the empirical consequences resulted from the Argentine actions. Based on the conceptual framework of Peripheral Realism, we analyze indicators related to the weapon trade, defense loans, joint exercises, and personnel training, among others. There will also be a comparative analysis of the conventional military forces of the two powers in question, United States and China. As a conclusion, the cost of having closer relations with China instead of the United States in the defense agenda has been clearly higher than the benefits obtained. The conclusions drawn are empirically aligned with the theoretical paradigm of peripheral realism. Although there are certain conceptual and methodological digressions, these conclusions they could be useful to update and adapt the theory to the current complex international scenario.

Keywords: China, United States, Argentine, peripheral country, peripheral realism

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Authors: Aniqa Jabeen

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The aim of this study was to evaluate the effectiveness of Tc-99m MIBI (Technetium 99-methoxy-iso-butyl-isonitrile) scintigraphy to differentiate malignancies from benign lesions, which were detected on planar bone scans. Materials and Methods: 59 patients with bone lesions were enrolled in the study. The scintigraphic findings were compared with the clinical, radiological and the histological findings. Each patient initially underwent a three-phase bone scan with Tc-99m MDP (Methylene Diphosphonate) and if evidence of lesion found, the patient then underwent a dynamic and static MIBI scintigraphy after three to four days. The MDP and MIBI scans were evaluated visually and quantitatively. For quantitative analysis count ratios of lesions and contralateral normal side (L/C) were taken by region of interests drawn on scans. The Student T test was applied to assess the significant difference between benign and malignant lesions p-value < 0.05 was considered significant. Result: The MDP scans showed the increase tracer uptake, but there was no significant difference between benign and malignant uptake of the radiotracer. However significant difference (p-value 0.015), in uptake was seen in malignant (L/C = 3.51 ± 1.02) and benign lesion (L/C = 2.50±0.42) on MIBI scan. Three of thirty benign lesions did not show significant MIBI uptake. Seven malignant appeared as false negatives. Specificity of the scan was 86.66%, and its Negative Predictive Value (NPV) was 81.25% whereas the sensitivity of scan was 79.31%. In excluding the axial metastasis from the lesions, the sensitivity of MIBI scan increased to 91.66% and the NPV also increased to 92.85%. Conclusion: MIBI scintigraphy provides its usefulness by distinguishing malignant from benign lesions. MIBI also correctly identifies metastatic lesions. The negative predictive value of the scan points towards its ability to accurately diagnose the normal (benign) cases. However, biopsy remains the gold standard and a definitive diagnostic modality in musculoskeletal tumors. MIBI scan provides useful information in preoperative assessment and in distinguishing between malignant and benign lesions.

Keywords: benign, malignancies, MDP bone scan, MIBI scintigraphy

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Authors: Khaled Alabduljabbar

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Background: Benign, isolated, recurrent sixth nerve palsy is very rare in children. Here we report a case of recurrent abducens nerve palsy with no obvious etiology. It is a diagnosis of exclusion. A recurrent benign form of 6th nerve palsy, a rarer still palsy, has been described in the literature, and it is of most likely secondary to inflammatory causes, e.g, following viral and bacterial infections. Purpose: To present a case of 14 months old girl with recurrent attacks of isolated left sixth cranial nerve palsy following upper respiratory tract infection. Observation: The patient presented to opthalmology clinic with sudden onset of inward deviation (esotropia) of the left eye with a compensatory left face turn one week following signs of upper respiratory tract infection. Ophthalmological examination revealed large angle esotropia of the left eye in primary position, with complete limitation of abduction of the left eye, no palpebral fissure changes, and abnormal position of the head (left face turn). Visual acuity was normal, and no significant refractive error on cycloplegic refraction for her age. Fundus examination was normal with no evidence of papilledema. There was no relative afferent pupillary defect (RAPD) and no anisocoria. Past medical history and family history were unremarkable, with no history of convulsion attacks or head trauma. Additional workout include CBC. Erythrocyte sedimentation rate, Urgent magnetic resonance imaging (MRI), and angiography of the brain were performed and demonstrated the absence of intracranial and orbital lesions. Referral to pediatric neurologist was also done and concluded no significant finding. The patient showed improvement of the left sixth cranial nerve palsy and left face turn over a period of two months. Seven months since the first attack, she experienced a recurrent attack of left eye esotropia with left face turn concurrent with URTI. The rest of eye examination was again unremarkable. CT scan and MRI scan of brain and orbit were performed and showed only signs of sinusitis with no intracranial pathology. The palsy resolved spontaneously within two months. A third episode of left 6th nerve palsy occurred 6 months later, whichrecovered over one month. Examination and neuroimagingwere unremarkable. A diagnosis of benign recurrent left 6th cranial nerve palsy was made. Conclusion: Benign sixth cranial nerve palsy is always a diagnosis of exclusion given the more serious and life-threatening alternative causes. It seems to have a good prognosis with only supportive measures. The likelihood of benign 6th cranial nerve palsy to resolve completely and spontaneously is high. Observation for at least 6 months without intervention is advisable.

Keywords: 6th nerve pasy, abducens nerve pasy, recurrent nerve palsy, cranial nerve palsy

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Authors: Mary-Ann N. Jallad, Dalal F. Jaber, Alexander M. Abdelnoor

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Introduction: Current evidence confirms that both innate and adaptive immune systems are capable of recognizing and abolishing malignant cells. The emergence of cancerous tumors in patients is, therefore, an indication that certain cancer cells can resist elimination by the immune system through a process known as “immune evasion”. In fact, cancer cells often exploit regulatory mechanisms to escape immunity. Such mechanisms normally exist to control the immune responses and prohibit exaggerated or autoimmune reactions. Recently, immunotherapies have shown promising yet limited results. Therefore this study investigates several immunotherapeutic combinations and devises a triple immunotherapy which harnesses the innate and acquired immune responses towards the annihilation of malignant cells through overcoming their ability of immune evasion, consequently hampering malignant progression and eliminating established tumors. The aims of the study are to rule out acute/chronic toxic effects of the proposed treatment combinations, to assess the effect of these combinations on tumor growth and survival rates, and to investigate potential mechanisms underlying the phenotypic results through analyzing serum levels of anti-tumor cytokines, angiogenic factors and tumor progression indicator, and the tumor-infiltrating immune-cells populations. Methodology: For toxicity analysis, cancer-free C57BL/6 mice are randomized into 9 groups: Group 1 untreated, group 2 treated with sterile saline (solvent of used treatments), group 3 treated with Monophosphoryl-lipid-A, group 4 with anti-CTLA4-antibodies, group 5 with 1-Methyl-Tryptophan (Indolamine-Dioxygenase-1 inhibitor), group 6 with both MPLA and anti-CTLA4-antibodies, group 7 with both MPLA and 1-MT, group 8 with both anti-CTLA4-antibodies and 1-MT, and group 9 with all three: MPLA, anti-CTLA4-antibodies and 1-MT. Mice are monitored throughout the treatment period and for three following months. At that point, histological sections from their main organs are assessed. For tumor progression and survival analysis, a murine melanoma model is generated by injecting analogous mice with B16F10 melanoma cells. These mice are segregated into the listed nine groups. Their tumor size and survival are monitored. For a depiction of underlying mechanisms, melanoma-bearing mice from each group are sacrificed at several time-points. Sera are tested to assess the levels of Interleukin-12 (IL-12), Vascular-Endothelial-Growth Factor (VEGF), and S100B. Furthermore, tumors are excised for analysis of infiltrated immune cell populations including T-cells, macrophages, natural killer cells and immune-regulatory cells. Results: Toxicity analysis shows that all treated groups present no signs of neither acute nor chronic toxicity. Their appearance and weights were comparable to those of control groups throughout the treatment period and for the following 3 months. Moreover, histological sections from their hearts, kidneys, lungs, and livers were normal. Work is ongoing for completion of the remaining study aims. Conclusion: Toxicity was the major concern for the success of the proposed comprehensive combinational therapy. Data generated so far ruled out any acute or chronic toxic effects. Consequently, ongoing work is quite promising and may significantly contribute to the development of more effective immunotherapeutic strategies for the treatment of cancer patients.

Keywords: cancer immunotherapy, check-point blockade, combination therapy, melanoma

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Authors: Ghada E. Esheba, Ghufran Kheshaifaty, Kholoud Al-Harbi, Wafa'a Al-Harbi, Ala'a Al-Orabi, Moayad Turkistani

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Krukenberg tumor is a rare metastatic ovarian carcinoma that usually occurs in female between 30 - 40 year old and rarely seen after menopause. Stomach is the most common primary site. Histopathological features of krukenberg tumors appear as diffuse stromal proliferation, mucus-production, and numerous signet-cells and these tumors spread mostly by lymphatic route. Treatment and prognostic factors are not well established. This study describes a 34 year old female with a unilateral ovarian mass discovered accidentally during cesarean section delivery and it was misdiagnosed as luteoma of pregnancy, but histopathological examination showed a diffuse infiltration of the ovary and omentum by signet ring cells. These findings were not correlated with luteoma of pregnancy or any other types of primary ovarian tumors like surface epithelial tumor, sex cord stromal tumor or germ cell tumor. However, after the analysis of immunohistochemical results (negative CK7, positive CK20 and CDX-2), the finding was the diagnostic of metastatic krukenberg tumor. Two weeks later, the patient was evaluated and a large gastric tumor was found in her stomach and she underwent gastrectomy.

Keywords: CK7, CK20, CDX-2, Krukenburg tumor, metastatic ovarian tumor

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Authors: N. Ghatwary, A. Ahmed, H. Jalab

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In this paper, an approach for the liver tumor detection in computed tomography (CT) images is represented. The detection process is based on classifying the features of target liver cell to either tumor or non-tumor. Fractional differential (FD) is applied for enhancement of Liver CT images, with the aim of enhancing texture and edge features. Later on, a fusion method is applied to merge between the various enhanced images and produce a variety of feature improvement, which will increase the accuracy of classification. Each image is divided into NxN non-overlapping blocks, to extract the desired features. Support vector machines (SVM) classifier is trained later on a supplied dataset different from the tested one. Finally, the block cells are identified whether they are classified as tumor or not. Our approach is validated on a group of patients’ CT liver tumor datasets. The experiment results demonstrated the efficiency of detection in the proposed technique.

Keywords: fractional differential (FD), computed tomography (CT), fusion, aplha, texture features.

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Authors: Sadia Arshad, Yifa Tang, Dumitru Baleanu

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A fractional order mathematical model is proposed that incorporate CD8+ cells, natural killer cells, cytokines and tumor cells. The tumor cells growth in the absence of an immune response is modeled by logistic law as it was the simplest form for which predictions also agreed with the experimental data. Natural Killer Cells are our first line of defense. NK cells directly kill tumor cells through several mechanisms, including the release of cytoplasmic granules containing perforin and granzyme, expression of tumor necrosis factor (TNF) family members. The effect of the NK cells on the tumor cell population is expressed with the product term. Rational form is used to describe interaction between CD8+ cells and tumor cells. A number of cytokines are produced by NKs, including tumor necrosis factor TNF, IFN, and interleukin (IL-10). Source term for cytokines is modeled by Michaelis-Menten form to indicate the saturated effects of the immune response. Stability of the equilibrium points is discussed for biologically significant values of bifurcation parameters. We studied the treatment of fractional order system by investigating analytical conditions of tumor eradication. Numerical simulations are presented to illustrate the analytical results.

Keywords: cancer model, fractional calculus, numerical simulations, stability analysis

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Authors: Christopher Latella, Ashlee M. Hendy, Dan Vander Westhuizen, Wei-Peng Teo

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Introduction: Neural adaptations following resistance training interventions have been widely investigated, however the evidence regarding the mechanisms of early adaptation are less clear. Understanding neural responses from an acute resistance training session is pivotal in the prescription of frequency, intensity and volume in applied strength and conditioning practice. Therefore the primary aim of this study was to investigate the time course of neurophysiological mechanisms post training against current super compensation theory, and secondly, to examine whether these responses reflect neural adaptations observed with resistance training interventions. Methods: Participants (N=14) completed a randomised, counterbalanced crossover study comparing; control, strength and hypertrophy conditions. The strength condition involved 3 x 5RM leg extensions with 3min recovery, while the hypertrophy condition involved 3 x 12 RM with 60s recovery. Transcranial magnetic stimulation (TMS) and peripheral nerve stimulation were used to measure excitability of the central and peripheral neural pathways, and maximal voluntary contraction (MVC) to quantify strength changes. Measures were taken pre, immediately post, 10, 20 and 30 mins and 1, 2, 6, 24, 48, 72 and 96 hrs following training. Results: Significant decreases were observed at post, 10, 20, 30 min, 1 and 2 hrs for both training groups compared to control group for force, (p <.05), maximal compound wave; (p < .005), silent period; (p < .05). A significant increase in corticospinal excitability; (p < .005) was observed for both groups. Corticospinal excitability between strength and hypertrophy groups was near significance, with a large effect (η2= .202). All measures returned to baseline within 6 hrs post training. Discussion: Neurophysiological mechanisms appear to be significantly altered in the period 2 hrs post training, returning to homeostasis by 6 hrs. The evidence suggests that the time course of neural recovery post resistance training occurs 18-40 hours shorter than previous super compensation models. Strength and hypertrophy protocols showed similar response profiles with current findings suggesting greater post training corticospinal drive from hypertrophy training, despite previous evidence that strength training requires greater neural input. The increase in corticospinal drive and decrease inl inhibition appear to be a compensatory mechanism for decreases in peripheral nerve excitability and maximal voluntary force output. The changes in corticospinal excitability and inhibition are akin to adaptive processes observed with training interventions of 4 wks or longer. It appears that the 2 hr recovery period post training is the most influential for priming further neural adaptations with resistance training. Secondly, the frequency of prescribed resistance sessions can be scheduled closer than previous super compensation theory for optimal strength gains.

Keywords: neural responses, resistance training, super compensation, transcranial magnetic stimulation

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Authors: Syed Dawood M. Taimur

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Background: Peripheral arterial disease (PAD) is under diagnosed in primary care practices, yet the extent of unrecognized PAD in patients with coronary artery disease (CAD) is unknown. Objective: To assess the prevalence of previously unrecognized PAD in patients undergoing coronary angiogram and to determine the relationship between the presence of PAD and severity of CAD. Material & Methods: This five years retrospective study was conducted at an invasive lab of the department of Cardiology, Ibrahim Cardiac Hospital & Research Institute from January 2010 to December 2014. Total 77 patients were included in this study. Study variables were age, sex, risk factors like hypertension, diabetes mellitus, dyslipidaemia, smoking habit and positive family history for ischemic heart disease, coronary artery and peripheral artery profile. Results: Mean age was 56.83±13.64 years, Male mean age was 53.98±15.08 years and female mean age was 54.5±1.73years. Hypertension was detected in 55.8%, diabetes in 87%, dyslipidaemia in 81.8%, smoking habits in 79.2% and 58.4% had a positive family history. After catheterization 88.3% had peripheral arterial disease and 71.4% had coronary artery disease. Out of 77 patients, 52 had both coronary and peripheral arterial disease which was statistically significant (p < .014). Coronary angiogram revealed 28.6% (22) patients had triple vessel disease, 23.3% (18) had single vessel disease, 19.5% (15) had double vessel disease and 28.6% (22) were normal coronary arteries. The peripheral angiogram revealed 54.5% had superficial femoral artery disease, 26% had anterior tibial artery disease, 27.3% had posterior tibial artery disease, 20.8% had common iliac artery disease, 15.6% had common femoral artery disease and 2.6% had renal artery disease. Conclusion: There is a strong and definite correlation between coronary and peripheral arterial disease. We found that cardiovascular risk factors were in fact risk factors for both PAD and CAD.

Keywords: coronary artery disease (CAD), peripheral artery disease(PVD), risk, factors, correlation, cathetarization

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Authors: Yuan-Chung Tsai, Masao Kamimura, Kohei Soga, Hsin-Cheng Chiu

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In order to enhance the photodynamic/photothermal therapeutic efficacy on glioblastoma, the functionized upconversion nanoparticles with the capability of converting the deep tissue penetrating near-infrared light into visible wavelength for activating photochemical reaction were developed. The drug-loaded nanoparticles (NPs) were obtained from the self-assembly of oleic acid-coated upconversion nanoparticles along with maleimide-conjugated poly(ethylene glycol)-cholesterol (Mal-PEG-Chol), as the NP stabilizer, and hydrophobic photosensitizers, IR-780 (for photothermal therapy, PTT) and mTHPC (for photodynamic therapy, PDT), in aqueous phase. Both the IR-780 and mTHPC were loaded into the hydrophobic domains within NPs via hydrophobic association. The peptide targeting ligand, angiopep-2, was further conjugated with the maleimide groups at the end of PEG adducts on the NP surfaces, enabling the affinity coupling with the low-density lipoprotein receptor-related protein-1 of tumor endothelial cells and malignant astrocytes. The drug-loaded NPs with the size of ca 80 nm in diameter exhibit a good colloidal stability in physiological conditions. The in vitro data demonstrate the successful targeting delivery of drug-loaded NPs toward the ALTS1C1 cells (murine astrocytoma cells) and the pronounced cytotoxicity elicited by combinational effect of PDT and PTT. The in vivo results show the promising brain orthotopic tumor targeting of drug-loaded NPs and sound efficacy for brain tumor dual-modality treatment. This work shows great potential for improving photodynamic/photothermal therapeutic efficacy of brain cancer.

Keywords: drug delivery, orthotopic brain tumor, photodynamic/photothermal therapies, upconversion nanoparticles

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Authors: Lubomir Vecera, Tomas Gabrhelik, Benjamin Tolmaci, Josef Srovnal, Emil Berta, Petr Prasil, Petr Stourac

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Cancer is the second leading cause of death worldwide and colon cancer is the second most common type of cancer. Currently, there are only a few studies evaluating the effect of postoperative analgesia on the prognosis of patients undergoing radical colon cancer surgery. Postoperative analgesia in patients undergoing colon cancer surgery is usually managed in two ways, either with strong opioids (morphine, piritramide) or epidural analgesia. In our prospective study, we evaluated the effect of postoperative analgesia on the presence of circulating tumor cells or minimal residual disease after colon cancer surgery. A total of 60 patients who underwent radical colon cancer surgery were enrolled in this prospective, randomized, two-center study. Patients were randomized into three groups, namely piritramide, morphine and postoperative epidural analgesia. We evaluated the presence of carcinoembryonic antigen (CEA) and cytokeratin 20 (CK-20) mRNA positive circulating tumor cells in peripheral blood before surgery, immediately after surgery, on postoperative day two and one month after surgery. The presence of circulating tumor cells was assessed by quantitative real-time reverse transcriptase-polymerase chain reaction (qRT-PCR). In the priritramide postoperative analgesia group, the presence of CEA mRNA positive cells was significantly lower on a postoperative day two compared to the other groups (p=0.04). The value of CK-20 mRNA positive cells was the same in all groups on all days. In all groups, both types of circulating tumor cells returned to normal levels one month after surgery. Demographic and baseline clinical characteristics were similar in all groups. Compared with morphine and epidural analgesia, piritramide significantly reduces the amount of CEA mRNA positive circulating tumor cells after radical colon cancer surgery.

Keywords: cancer progression, colon cancer, minimal residual disease, perioperative analgesia.

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Authors: P. K. Purohit, Azad A. Mansoori, Parvaiz A. Khan, Purushottam Bhawre, Sharad C. Tripathi, A. M. Aslam, Malik A. Waheed, Shivangi Bhardwaj, A. K. Gwal

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The geomagnetic storm represents the most outstanding example of solar wind-magnetospheric interaction, which causes global disturbances in the geomagnetic field as well as the trigger ionospheric disturbances. We study the behaviour of ionospheric Total Electron Content (TEC) during the geomagnetic storms. For the present investigation we have selected 47 intense geomagnetic storms (Dst ≤ -100nT) that were observed during the solar cycle 23 i.e. during 1998-2006. We then categorized these storms into four categories depending upon their solar sources like Magnetic Cloud (MC), Co-rotating Interaction Region (CIR), SH+ICME and SH+MC. We then studied the behaviour of ionospheric TEC at a mid latitude station Usuda (36.13N, 138.36E), Japan during these storm events produced by four different solar sources. During our study we found that the smooth variations in TEC are replaced by rapid fluctuations and the value of TEC is strongly enhanced during the time of these storms belonging to all the four categories. However, the greatest enhancements in TEC are produced during those geomagnetic storms which are either caused by sheath driven magnetic cloud (SH+MC) or sheath driven ICME (SH+ICME). We also derived the correlation between the TEC enhancements produced during storms of each category with the minimum Dst. We found the strongest correlation exists for the SH+ICME category followed by SH+MC, MC and finally CIR. Since the most intense storms were either caused by SH+ICME or SH+MC while the least intense storms were caused by CIR, consequently the correlation was the strongest with SH+ICME and SH+MC and least with CIR.

Keywords: GPS, TEC, geomagnetic storm, sheath driven magnetic cloud

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Authors: Fakhrosadat Sajjadian, Ramin Ghasemi Shayan

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The tumor microenvironment plays an fundamental part in tumor start, movement, metastasis, and treatment resistance. It varies from ordinary tissue in terms of its extracellular network, vascular and lymphatic arrange, as well as physiological conditions. The clinical application of atomic cancer imaging is regularly prevented by the tall commercialization costs of focused on imaging operators as well as the constrained clinical applications and little showcase measure of a few operators. . Since numerous cancer types share comparable characteristics of the tumor microenvironment, the capacity to target these biomarkers has the potential to supply clinically translatable atomic imaging advances for numerous types encompassing cancer and broad clinical applications. Noteworthy advance has been made in focusing on the tumor microenvironment for atomic cancer imaging. In this survey, we summarize the standards and methodologies of later progresses in atomic imaging of the tumor microenvironment, utilizing distinctive imaging modalities for early discovery and conclusion of cancer. To conclude, The tumor microenvironment (TME) encompassing tumor cells could be a profoundly energetic and heterogeneous composition of safe cells, fibroblasts, forerunner cells, endothelial cells, flagging atoms and extracellular network (ECM) components.

Keywords: molecular, imaging, TME, medicine

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Authors: Manik Sharma

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Understanding the anatomy and normal anatomical variations of the lower limb arterial system is undeniably important not only to understand the pathology involving the vessels of the lower limb but also as a part of endovascular intervention and surgical planning in cases that demand them as a part of treatment. There have been very few cases of duplication of SFA cited in the literature, close to six worldwide and this being the seventh case in the world and first to be reported in the Indian population. We incidentally came across this normal variant during US lower limb (US-LL) duplex scan in a patient with claudicating pain in bilateral lower limbs hence suspected of having peripheral vascular disease. It was confirmed on CT-Peripheral Angiography (CT-PA), which was done successively.

Keywords: peripheral vascular disease, claudicating pain, normal anatomical variants, endovascular intervention, duplication, CT-peripheral angiography, duplex scan, Iohexol

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Authors: Amdy Moustapha Drame, Ilya V. Germashev, E. A. Markushevskaya

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Among the main problems of medicine is breast cancer, from which a significant number of women around the world are constantly dying. Therefore, the detection of malignant breast tumors is an urgent task. For many years, various technologies for detecting these tumors have been used, in particular, in thermal imaging in order to determine different levels of breast cancer development. These periodic screening methods are a diagnostic tool for women and may have become an alternative to older methods such as mammography. This article proposes a model for the identification of malignant neoplasms of the mammary glands by the asymmetry of internal and external thermal imaging fields.

Keywords: asymmetry, breast cancer, tumors, deep learning, thermogram, convolutional transformation, classification

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Authors: Mostafa Sarabzadeh, Masoumeh Helalizadeh, Seyyed Mahmoud Hejazi

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Multiple Sclerosis is considered as diseases related to central nerve system, the chronic and progressive disease impress on sensory and motor function of people. Due to equilibrium problems in this patients that related to disorder of nerve conduction transmission from central nerve system to organs and the nature of elastic bands that can make changes in neuromuscular junctions and momentary actions, the aim of this research is evaluate elastic training effect by reactionary ropes on nerve conduction velocity (in lower and upper limb) and functional balance in female patients with Multiple Sclerosis. The study was a semi-experimental study that was performed based on pre and post-test method, The statistical community consisted of 16 women with MS in the age mean 25-40yrs, at low and intermediate levels of disease EDSS 1-4 (Expanded Disability Status Scale) that were divided randomly into elastic and control groups, so the training program of experimental group lasted six weeks, 3 sessions per week of elastic exercises with reactionary ropes. Electroneurography parameters (nerve conduction velocity- latency) of Upper and lower nerves (Median, Tibial, Sural, Peroneal) along with balance were investigated respectively by the Electroneurography system (ENG) and Timed up and go (TUG) functional test two times in before and after the training period. After that, To analyze the data were used of Dependent and Independent T-test (with sig level p<0.05). The results showed significant increase in nerve conduction velocity of Sural (p=0.001), Peroneal (p=0.01), Median (p=0.03) except Tibial and also development Latency Time of Tibial (p= 0), Peroneal (p=0), Median (p=0) except Sural. The TUG test showed significant decreases in execution time too (p=0.001). Generally, based on what the obtained data can indicate, modern training with elastic bands can contribute to enhanced nerve conduction velocity and balance in neurosis patients (MS) so lead to reduce problems, promotion of mobility and finally more life expectancy in these patients.

Keywords: balance, elastic bands, multiple sclerosis, nerve conduction, velocity

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Authors: Zohra Salim

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Objective: To access the relationship of primary tumor thickness with cervical lymphadenopathy in squamous cell carcinoma of buccal mucosa. Methodology: A cross-sectional observational study was carried out on 80 Patients with biopsy-proven oral squamous cell carcinoma of buccal mucosa at Dow University of Health Sciences. All the study participants were treated with wide local excision of the primary tumor with elective neck dissection. Patients with prior head and neck malignancy or those with prior radiotherapy or chemotherapy were excluded from the study. Data was entered and analyzed on SPSS 21. Chi-squared test with 95% C.I and 80% power of the test was used to evaluate the relationship of tumor depth with cervical lymph nodes. Results: 50 participants were male, and 30 patients were female. 30 patients were in the age range of 20-40 years, 36 patients in the range of 40-60 years, while 14 patients were beyond age 60 years. Tumor size ranged from 0.3cm to 5cm with a mean of 2.03cm. Tumor depth ranged from 0.2cm to 5cm. 20% of the participants reported with tumor depth greater than 2.5cm, while 80% of patients reported with tumor depth less than 2.5cm. Out of 80 patients, 27 reported with negative lymph nodes, while 53 patients reported with positive lymph nodes. Conclusion: Our study concludes that relationship exists between the depth of primary tumor and cervical lymphadenopathy in squamous cell carcinoma of buccal mucosa.

Keywords: squamous cell carcinoma, tumor depth, cervical lymphadenopathy, buccal mucosa

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Authors: Conor Mccartney, Mark Lee

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Background: An essential component in ambulatory breast augmentation surgery is good analgesia. The demographic undergoing this operation is usually fit, low risk with few comorbidities. These patients do not require long-term hospitalization and do not want to spend excessive time in the hospital for financial reasons. Opiate analgesia can have significant side effects such as nausea, vomiting and sedation. Reducing volumes of postoperative opiates allows faster ambulation and discharge from day surgery. We have developed two targeted nerve blocks that can be applied by the operating surgeon in a matter of seconds under direct vision, not requiring imaging. Anecdotally we found that these targeted nerve blocks reduced opiate requirements and allowed accelerated discharge and faster return to normal activities. This was then tested in a prospective randomized, double-blind trial. Methods: 20 patients were randomized into saline (n = 10) or Ropivicaine adrenaline solution (n = 10). The operating surgeon and anesthetist were blinded to the solution. All patients were closely followed up and morphine equivalents were accurately recorded. Follow-up pain scores were recorded using the Overall Benefit of Analgesia pain questionnaire. Findings: The Ropivicaine nerve blocks significantly reduced opiate requirements postoperatively (p<0.05). Pain scores were significantly decreased in the study group (p<0.05). There were no side effects attributable to the nerve blocks. Conclusions: Intraoperative targeted nerve blocks significantly reduce postoperative opiate requirements in breast augmentation surgery. This results in faster recovery and higher patient satisfaction.

Keywords: breast augmentation, nerve block, postoperative recovery, opiate analgesia, inter pectoral block, sub serratus block

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Authors: Namita Mittal, Himakshi Shekhawat, Ankit Vidyarthi

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In medical research study, doctors and radiologists face lot of complexities in analysing the brain tumors in Magnetic Resonance (MR) images. Brain tumor detection is difficult due to amorphous tumor shape and overlapping of similar tissues in nearby region. So, radiologists require one such clinically viable solution which helps in automatic segmentation of tumor inside brain MR image. Initially, segmentation methods were used to detect tumor, by dividing the image into segments but causes loss of information. In this paper, a hybrid method is proposed which detect Region of Interest (ROI) on the basis of difference in intensity values and texture values of tumor region using nearby tissues with Gradient Vector Flow (GVF) technique in the identification of ROI. Proposed approach uses both intensity and texture values for identification of abnormal section of the brain MR images. Experimental results show that proposed method outperforms GVF method without any loss of information.

Keywords: brain tumor, GVF, intensity, MR images, segmentation, texture

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Authors: Kun Hua O., Dong Woon Kim, Won Hyung Lee

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Introduction: Neuropathic pain induced by spinal or peripheral nerve injury is highly resistant to common painkillers, nerve blocks, and other pain management approaches. Recently, several new therapeutic drug candidates have been developed to control neuropathic pain. In this study, we used the spinal nerve L5 ligation (SNL) model to investigate the ability of intrathecal or intravenous Evans blue to decrease pain behavior and to study the relationship between Evans blue and the neural structure of pain transmission. Method: Neuropathic pain (allodynia) of the left hind paw was induced by unilateral SNL in Sprague-Dawley rats(n=10) in each group. Evans blue (5, 15, 50μg/10μl) or phosphate buffer saline(PBS,10μl) was injected intrathecally at 3days post-ligation or intravenously(1mg/200 μl) 3days and 5days post-ligation . Mechanical sensitivity was assessed using Von Frey filaments at 3 days post-ligation and at 2 hours, days 1, 2, 3, 5,7 after intrathecal Evans blue injection, and on days 2, 4, 7, and 11 at 14 days after intravenous injection. In the intrathecal group, microglia and glutaminergic neurons in the dorsal horn and VNUT(vesicular nucleotide transporter) in the dorsal root ganglia were tested to evaluate co-staining with Evans blue. The experimental procedures were performed in accordance with the animal care guideline of the Korean Academy of Medical Science(Animal ethic committee of Chungnam National University Hospital: CNUH-014-A0005-1). Results: Tight ligation of the L5 spinal nerve induced allodynia in the left hind paw 3 days post-ligation. Intrathecal Evans blue most significantly(P＜0.001) alleviated allodynia at 2 days after intrathecal, but not an intravenous injection. Glutaminergic neurons in the dorsal horn and VNUT in the dorsal root ganglia were co-stained with Evans blue. On the other hand, microglia in the dorsal horn were partially co-stained with Evans blue. Conclusion: We confirmed that Evans blue might have an analgesic effect through the central nervous system, not another system in neuropathic pain of the SNL animal model. These results suggest Evans blue may be a potential new drug for the treatment of chronic pain. This research was supported by the National Research Foundation of Korea (NRF-2020R1A2C100757512), funded by the Ministry of Education.

Keywords: neuropathic pain, Evas blue, intrathecal, intravenous

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Authors: Musatafa Abbas Abbood Albadr, Masri Ayob, Sabrina Tiun, Fahad Taha Al-Dhief, Mohammad Kamrul Hasan

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Breast Cancer (BC) is considered one of the most frequent reasons of cancer death in women between 40 to 55 ages. The BC is diagnosed by using digital images of the FNA (Fine Needle Aspirate) for both benign and malignant tumors of the breast mass. Therefore, this work proposes the Online Sequential Extreme Learning Machine (OSELM) algorithm for diagnosing BC by using the tumor features of the breast mass. The current work has used the Wisconsin Diagnosis Breast Cancer (WDBC) dataset, which contains 569 samples (i.e., 357 samples for benign class and 212 samples for malignant class). Further, numerous measurements of assessment were used in order to evaluate the proposed OSELM algorithm, such as specificity, precision, F-measure, accuracy, G-mean, MCC, and recall. According to the outcomes of the experiment, the highest performance of the proposed OSELM was accomplished with 97.66% accuracy, 98.39% recall, 95.31% precision, 97.25% specificity, 96.83% F-measure, 95.00% MCC, and 96.84% G-Mean. The proposed OSELM algorithm demonstrates promising results in diagnosing BC. Besides, the performance of the proposed OSELM algorithm was superior to all its comparatives with respect to the rate of classification.

Keywords: breast cancer, machine learning, online sequential extreme learning machine, artificial intelligence

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Authors: Aamna Tufail, Catherine Anyanwu

Abstract:

Introduction/Aims: Neurosensory deficits following third molar removal affect the quality of life markedly. The purpose of this audit was to evaluate the incidence of IDN and LN damage and to compare departmental rates to an established standard. A secondary objective was to provide a descriptive summary of identified cases for clinical learning. Materials and Methods: A retrospective audit was conducted by a telephone survey of 101 patients who had third molar extractions performed under LA, IVS, or GA from January 2019 to June 2020 at a District General Hospital. The results were compared to a clinical standard identified as Cheng et al1. Data collection included mode of surgery, mode of anaesthesia, grade of clinician, assessment of difficulty, severity, and duration of symptoms. Results/Statistics: A total of 101 patients had 136 third molars extracted. Age range was 18-84 years. 44% extractions were under LA, 52% under GA, and 4% under IV sedation. 30% were simple extractions, 68% were surgical removals, 2% were unspecified. 89% extractions were performed by an Associate Specialist, 5% by a consultant, and 6% by unspecified grade of clinician. The rate of IDN injuries was 2.9% (n=4), higher than standard (0.3%). The rate of LN injuries was 0.7% (n=1), same as standard (0.7%). The 5 cases of neurosensory deficits are discussed in detail. Conclusions/Clinical Relevance: The rate of ID nerve injuries was higher than the standard. The rate of LN complications was lower than the standard.

Keywords: inferior dental nerve, lingual nerve, nerve injuries, third molars

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Authors: Anis Al-Yakhiri

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Introduction: The World Health Organization (WHO) classifies malignant epithelial thyroid tumors into four major groups (papillary, follicular, medullar and undifferentiated) . Papillary thyroid carcinoma (PTC) is the most common type, for about eight out of ten thyroid cancers belong to this histological type. Radioactive iodine (RAI) is considered effective for patients with total or nearly total thyroidectomy, but the beneficial effects of RAI are still controversial. War conditions forced us to study alternative methods of using radioactive iodine in the treatment of patients with PTC. Material and methods: Between January 2014 and June 2021, in Al-Yakhiri hospital, 57 Total Thyroidectomy with Radical BilateralNeckDissection (RBND) were performed, 50 for malignant disease,7 for false positive cytology.RBND involves surgical clearance of Levels II-VI. Mean age was 40.7 years old and 92% of the patients were female. 7(14%) patients had hypothyroidism which required preoperative thyroid hormone treatment. The Thyroid Stimulating Hormone- Suppression Therapy (TSH-ST) immediately started after RBND for mostpatients on the first day. It consisted in reducing the level of TSH< 0.1 mIU/L. Results: The Apron flap was used on most operations (40)80% and with lateral extensions had 10(20%). RBND involves surgical clearance of Levels II-VI performed in all operated patients, besides that, 4(8%) of them had resection of sternocleidomastoid muscle (SCM) and accessory nerve (XIn) and internal jugular vein (IJV) withclearance of Levels IB. The PTC was the most common 80.9% (38 patients from 47)by histopathological report. and 4(8%) patients of 50 had resection of sternocleidomastoid muscle (SCM) and accessory nerve (XIn) and internal jugular vein (IJV). The postoperative mortality rate not observed (0%). The postoperative morbidity rate was 22.8% (n =13).Seroma(8.7%),Hypocalcimia(7%), Wound infection(5.3%), Bleeding(1.8%). To suppress TSH and growth of any residual thyroid theTSH-ST (levothyroxine150 – 600mcg)was performed in all patients 57(100%) on the first day afterRBND. We tracked the results of treatment for two years in 30 patients with PTC, only 3 of them received radioactive iodine abroad. Biennial Recurrence rate for PTC appeared in one woman (2%), who had RAI postoperatively in the form of neck lymph nodes metastasis. Conclusion: For patients with PTC, thyroidectomy plus prophylacticRBND is a safe and efficient procedure and it results in lower recurrence rate. Postoperative treatment with exogenous thyroid hormone in doses sufficient to suppress TSH (not less than 150mcg), decreases incidence of recurrence. Total Thyroidectomy with RBND followed by TSH-ST, in our opinion, applicable optimal treatment scheme care for this patient population.

Keywords: thyroid cancer, Yemen war, absence of radioactive iodine, neck dissection, surgery results

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