Infrared Photo Dissociation Spectroscopy and Infrared Correlation Table Spectroscopy Comparative Study on Malignant and Benign Human Cancer Cells and Tissues under Synchrotron Radiation with the Passage of Time

                            http://austinpublishinggroup.com/pharmacology-pharmaceutics/

In the currentstudy, we have experimentally and comparatively investigated and compared malignant human cancer cells and tissues before and after irradiating of synchrotron radiation using infrared photo dissociation spectroscopy and infrared correlation table spectroscopy.

It is clear that malignant human cancer cells and tissues have gradually transformed to benign human cancer cells and tissues under synchrotron radiation with the passage of time

It can be concluded that malignant human cancer cells and tissues have gradually transformed to benign human cancer cells and tissues under synchrotron radiation with the passage of time

Ameliorative Effect of Murraya Koenigii on Arsenic Induced Toxicity in Swiss Albino Mice

                              http://austinpublishinggroup.com/pharmacology-therapeutics/

Arsenic is a metalloid that can be toxic to humans and other living organisms, occurs naturally and anthropogenically throughout the world at varying concentrations, including concentrations of concern in soil or groundwater. Presently, in Bihar (India) 18 districts are affected with arsenic poisoning in ground water causing lots of health hazards among the population. This arsenic intoxication has caused lots of health related problems in the population. The present study has been designed, to study the ameliorative effect of Murraya Koenigii on sodium arsenite induced toxicity in Swiss albino mice. The treatment groups received sodium arseniteorally at the dose of 3mgkg-1 body weight daily for 4 weeks followed by administration of Murraya Koenigii 350mgkg-1 body weight daily by gavage method for 4& 6 weeks. Their biochemical levels like liver and kidney function tests were assayed and were observed with elevated levels. Furthermore, their free radical assessment like lipid peroxidation levels were assayed which was found to be many folds higher. But, after administration of aqueous extract of Murraya Koenigii, there was significant amelioration in the biochemical and lipid peroxidation levels. Therefore, it is evident from the present study that Murraya Koenigii possesses antidote effects and acts effectively against arsenic induced toxicity.

Arsenic is ametalloid that can be toxic to humans and other living organisms, occurs naturally and anthropogenically throughout the world at varying concentrations, including concentrations of concern in soil or groundwater. Acute arsenic exposure harms human health in many ways including the development of malignancies, severe gastrointestinal toxicities, diabetes, cardiac arrhythmias, cancer and death. Natural sources such as volcanic action, erosion of rocks, and forest fires introduce arsenic into the environment (EPA, 2001). Anthropogenic sources include arsenic added to the soil plant system as insecticides, herbicides, pesticides, livestock dips and wood preservatives. It is estimated that more than 200 million people worldwide are chronically exposed to dangerous levels of arsenic which leads to several diseases, including various types of cancer. Arsenical exposure through drinking water is common in many areas of the world. Metabolic disorders, hypertrophy of adrenal glands and anaemia inhibition of the activity of steroidogenic enzymes and reduction in the weight of the testis and accessory sex organs are associated with exposure to arsenicals. Presently, in Bihar, 18 districts are highly affected with arsenic poisoning. The groundwater contamination by arsenic is maximum 1928ppb in Buxar district of Bihar.

Urban Air Pollution and Type 1 Diabetes: There is Still a Long Way to Go

                                       http://austinpublishinggroup.com/pancreatic-disorders/

Immune-mediatedType 1 diabetes is characterized by permanent insulin deficiency and absolute requirement for insulin replacement therapy. Autoimmune destruction of beta cells has been related to multiple genetic predispositions and poorly defined environmental determinants. Exposure to air pollution (gaseous pollutants and/or particulate matter) has been associated with diabetes incidence, prevalence and mortality. Most human studies referred to diabetes mellitus, with no distinction between Type 1 and Type 2 diabetes. Few studies focused specifically on the role of air pollutants in the development of Type 1 diabetes with inconclusive results. Based on animal model studies, hypothesized mechanisms of air pollution-mediated metabolic disease included oxidative stress, adipose tissue inflammation, mitochondrial dysfunction, insulin resistance, and pancreas toxicity. Major difficulties in establishing a relationship between air pollution and Type 1 diabetes are: the retrospective design of epidemiological studies, unwatched pollution, and long-term exposure misclassification.

Immune-mediated Type 1 diabetes is characterized by permanent insulin deficiency and absolute requirement for insulin replacement therapy. Autoimmune destruction of beta cells has been related to multiple genetic predispositions and poorly defined environmental determinants. The incidence of Type 1 diabetes is increasing in many countries and the reasons for this remain unknown: changes in environmental risk factors and/or viral infections?.

Exposure to air pollution (gaseous pollutants and/or particulate matter) has been associated with diabetes incidence, prevalence and mortality. Most studies referred to diabetes mellitus, with no distinction between Type 1 and Type 2 diabetes. Few studies focused specifically on the role of air pollutants in the development of Type 1 diabetes with inconclusive results. As far back as 1970, Sultz et al. evaluated the effect of continued exposure to air pollution on the incidence of chronic allergic disease in children under 15 years of age from the Erie County Study of Long-Term Childhood Diseases. The average annual incidence rates for children hospitalized with diabetes mellitus by air pollution level (carbon monoxide, ozone, and particulate matter ≤2.5μm in diameter or PM2.5) and social class revealed no association.

Fish Hook Injuries in Children

                                           http://austinpublishinggroup.com/pediatrics/

Introduction: Fishing is a common recreational activity among the children and young adults all over the world. This study was done to determine the efficacy of various techniques used for fish hook removal, the anatomical areas involved in fish hook injuries, type of injuries, types of analgesia used, need for tetanus prophylaxis and complications associated with fish hook injuries.

Methodology: This was a single-center retrospective study based on data collected at the Children’s Emergency department at KK Women’s and Children’s Hospital (KKH) between 2006 and 2016.

Results: There were 37 fish hook injuries in the study period. Puncture wounds (81.1%) caused by fish hooks were the most common type of injuries seen followed by lacerations (18.9%). Advance and cut technique of fish hook removal was used in 70.3% of patients with retrograde removal technique being used in remaining patients. 13.5% patients developed features of wound infection requiring interventions like wound toileting, change in antibiotics and multiple follow up visits for wound care.

Conclusion: Our study demonstrated that the predominant types of injuries associated with fish hook are superficial injuries like puncture wounds and lacerations. Bystander use of fish hook resulted in majority of injuries in children. Advance and cut technique of fish hook removal was the most common type of method used for fish hooks removal and had the highest success rate. The commonest complication related to fish hook injury is infection and this occurred despite the use of prophylactic antibiotics in all the patients.

Keywords: Fish Hook Injuries; Children

Life Events Kept in Secret Destroy the Resilience Important for Successful Aging

                                  http://austinpublishinggroup.com/occupational-medicine/

For some decades the medical interview has been aimed not only at establishing a diagnosis, but also at determining the patient’s state of health and quality of life. In the field of geriatrics, conversation with the patient intends yet to assess the extent of physical fitness and mental performance impairment as well as to evaluate the risk factors which lead to a decrease in mental capacity and also the patient’s socalled psychological resilience, which determine the favorable course of aging. Researchers enumerate some kinds of factors determining mental resilience, e.g. pride in one’s personality, positive family relations, empowering relationships with professionals, the so-called ‘power of giving’, a balanced view on life and so on. There are, however, very few guidelines in geriatric literature on how to obtain this ‘balanced perception of one’s own life’. We do not find such tips either in the papers of authors who write about assessing the so-called ‘trajectory of life’.

We have presented recently an attempt to formulate a method of insight into the way we remember and even how we arrange the remembrance of own biography. As we emphasized, one should pay attention not only to biographical facts but also to important ‘psychological transformations’ concerning decisions on one’s own further anticipated actions and behavior.An example would be the decision that, “it is not worth striving for good grades in school or even to get a formal education because prosperity in life depends on other conditions” or for example, “that monogamy is not an advantageous pattern of behavior”.

Moreover, in our view, so far geriatric researchers have not paid enough attention to the kinds of extremely important facts which determine the course of life, resulting from dramatic, often hidden biographical events such as exclusion from family, broken family ties, sexual abuse like rape, incest, the suicide of someone close, the death of the mother in childhood, war or disaster experiences. They cause so-called entanglements, and sometimes incline one to acts of revenge or plans to take vengeance. As we mentioned, various literary works contain thrilling descriptions of such key mental changes. The content of the novel “Fates and furies” by Lauren Groff can exemplify such descriptions.

Changes in Peripapillar Retinal Nerve Fiber Layer Analized by Td-Oct in Patients with Diabetic Retinopathy that Receive Panretinal Photocoagulation

                            http://austinpublishinggroup.com/ophthalmology-visual-sciences/

Objective: Explain changes in peripapillar retinal nerve fiber layer in patients with diabetic retinopathy with criteria to receive panretinal photocoagulation, analyzed by td-oct (stratus) unit.

Material and Methods: A transversal retrospective and observational study was done to study peripapillar nerve fiber layers of 46 eyes from 33 patients using a td-oct (stratus) unit. according to laser application technique, time since application and day of the study, 4 groups of patients were set: the first with patients with less than 30 days since last laser application and day of study. The second with patients with 180 days since laser photocoagulation; the third and fourth groups received panretinal photocoagulation and macular selective laser with an Oct 30 and 180 days after administration of treatment.

Results: The clinically significant finding was in the comparation of the group that received panretinal photocoagulation with oct after 30 days, and the group that received panretinal photocoagulation and oct after 180 days. average thickness was less in the second group, with a statistical significant finding p=0.012 in inferior quadrant.

Conclusion: Administer laser photocoagulation makes changes in retina´s structure and function, there are many different results in accordance to equipment used to apply treatment and to take measurements. the patient must be informed about secondary and adverse effects after the treatment.

Keywords: Diabetic retinopathy; Panretinal photocoagulation; Macular laser; Time-Domain optic coherence tomography; Retinal nerve fiber layer

Retina Specialists: How we Think

                                http://austinpublishinggroup.com/austin-ophthalmology/currentissue.php

Purpose: Physicians frequently receive new information on the latest research from many different forms of media. It is interesting to see how they integrate this data and incorporate it into their own practices. This report focuses on physician opinions for the treatment of central serous chorioretinopathy and diabetic macular edema, as well as practice patterns associated with these treatments.

Methods: Retina specialists were surveyed during a lecture at the 2016 Ocular Imaging Conference in Vail, Colorado. Case studies were presented with questions integrated throughout the lecture that were designed to understand how physicians individually handle both specific cases and their specific treatment algorithms. When presented with multiple-choice questions, the audience texted their answers in to the Poll Everywhere application. Responses appeared on the screen in real time and were recorded for later use.

Results: The mean number of responses submitted per question was 30.15. Physicians answered 13 questions about management issues of central serous chorioretinopathy and diabetic macular edema, with some questions resulting in markedly varying answers.

Conclusion: The concept of using an text based polling app is a low cost, easy to use, efficient way to obtain greater audience input in case presentation conferences.

Maternal Obesity Increases the Risk of Primary as Well as Secondary Caesarean Section

                                    http://austinpublishinggroup.com/obesity/currentissue.php

Maternalobesity is not only associated with pregnancy outcome but also with the mode of delivery. In the present study the impact of maternal prepregnancy weight status on the mode of delivery, in particular on caesarean section rate was tested. The data of 3451 live births taking place at the Viennese University Hospital were analyzed. Maternal somatometrics (height, weight, weight gain) and newborn somatic characteristics (birth weight, birth length, head dimensions, APGAR scores) were documented. Prepregnancy weight status was classified using Body Mass Index (BMI) categories published by the WHO. The caesarean section rate was 15.6%. (6.8% primary CS, 8.8% secondary CS). 24.2% of the mothers were overweight, 9.6% obese and 0.8% morbidly obese before pregnancy. Maternal prepregnancy BMI was significantly associated with newborn size. The relative risk to give birth to a macrosome newborn was significantly increased among overweight (OR 1.46 CI 1.24- 1.72), obese (OR 1.76 CI 1.40-2.19) and morbidly obese mothers (OR 1.51 CI 0.57-3.99). The relative risk of caesarean section increased significantly with increasing prepregnancy weight status (p<0.04). Morbidly obese women showed the significantly highest rate of caesarean section (33.4%; primary CS 16.7%, secondary CS 16.7%). The relative risk of experiencing caesarean section was significantly higher among morbidly obese women than among underweight (OR 3.57 CI 1.85-6.86), normal weight (OR 2.89 CI 1.25-6.69), overweight (OR 2.27 CI 0.99-5-22) and even obese women (OR 2.11 CI 0.94- 4.72). Prepregnancy obesity is clearly a significant risk factor of newborn macrosomia and primary as well as secondary caesarean section.

The prevalence of overweight and obesity as a worldwide epidemic has increased dramatically since the beginning of the 21rst century. In 2008 for the first time in the long history of Homo sapiens, the number of obese people on earth exceeded the number of people who suffer from starvation and malnutrition. Currently more than 1.9 billion adults, 18 years and older, were overweight. Of these over 600 million correspond to the definition of obesity. From the viewpoint of public health this high prevalence of overweight and obesity is a major concern because overweight and especially obesity increase rates of metabolic diseases such as diabetes type II, cardiovascular diseases such as heart disease, stroke, hypertension, but also pancreatitis, osteoarthritis and cancer. Obesity however, is also related to reproductive problems, such as increased infertility rates in women as well as in men. A special problem represents obesity among women of reproductive age. In the United States more than 50% of women ageing between 20 and 39 years are overweight or obese. Europe seems to follow a similar pattern, albeit with some delay. Currently one in five pregnant women can be classified as obese in Europe.

Noninvasive Methods for Treatment of Brain Metastases

                                  http://austinpublishinggroup.com/oncology/currentissue.php

Brainmetatases occur in 20-40% of patients with cancer. Median survival of patients who develop brain metastases is relatively short - 4 months. Treatment methods such as Whole Brain Radio Therapy (WBRT), Surgery (S) or Radiosurgery (SRS) prolong survival for 3 to 5 months. Treatment options in brain metastases are as follows: symptomatic tratment, surgery, radiotherapy, chemiotherapy and combination of those. Symptomatic treatment of edema and anticonvulsive therapy are used if necessery and depends on neurological patients status. Surgery has been used for single brain metstasis in patients with good performance status. WBRT alone is a treatment of choice for patients with multiple brain metastases, with single brain metastasis not sutable to surgery or radiosurgery, especially those with an active and disseminated systemic disease. SRS is an external irradiation technique to deliver a relatively large radiation dose in a single fraction to an intracranial small target volume.

Brain metastasis is a common manifestation of disseminated malignancy. In adults, lung, (36-40%), breast cancer (15-25%) and skin melanoma (5-20%) are the most common sources of brain metastases. Less frequent are colon, rectal, kidney, prostate, testicular, ovarian cancer and sarcoma. Cerebral lesion are mainly located in hemispheres (80%), in cerebellum (15%), in the brain stem (5%), being very rare in the basal ganglia, the pineal gland or hypophysis. Are more common than primary brain tumors. Frequency of disclosure is the result: a more effective treatment of the primary tumor, more effective systemic treatment of disseminated disease (clinical or subclinical), the existence of blood - brain barrier for the majority of cytostatic drugs and the introduction of new imaging techniques. Most patients who develop brain metastases have short time survival. The treatment is used: steroids, surgery, radiation therapy and symptomatic treatment. The choice of treatment depends on the age, general condition of the patient, the number and location of metastatic lesions and the severity of the underlying disease. The last decade has created new possibilities for the treatment of metastatic tumors such as radiosurgery and radiochemotherapy combination treatment with radiation.

Treatment options for brain metastases are: symptomatic and specific therapy directed at the area of the tumor or tumors. To the first treatment should antioedematous and anticonvulsants. Causal treatment includes: surgical resection with or without radiotherapy of the whole brain (WBRT), an independent method of WBRT, radiosurgery (SRS), SRS + WBRT, chemotherapy.

A Case Report of Uncommon Efficacy and Favorable Safety Profile of Gemcitabine Rechallenge in Metastatic Breast Cancer

                                        http://austinpublishinggroup.com/oncology-case-reports/

Breast cancer affects approximately 12% of women worldwide and results in 14% of all cancer-related deaths. Despite the diffusion of screening programs, about 6% of women still have metastatic disease at the onset presentation. Median Overall Survival (OS) of patients with Metastatic Breast Cancer (MBC) is extremely variable (8 months to 4 years). In the last decades, with the advent of new cytotoxic drugs and targeted therapies, a significant increase in OS of MBC patients has been achieved. Nevertheless, in the majority of cases, after an initial response to treatment, the development of highly aggressive and drug-resistant disease is commonly observed. For these reasons, the current goals are not only the prolongation of OS, but also the improvement of the Quality of Life (QoL) through disease control and drug-related toxicities management. Gemcitabine (2’,2’-difluorodeoxycytidine) is a nucleoside analog that makes its antiproliferative activity through two active metabolites, gemcitabine di- and triphosphate.

 The safety profile is good with a limited,mainly hematological, toxicity. This drug has been approved not only for the treatment of MBC but also for pancreatic lung bladder and ovarian tumors. Even if gemcitabine has been shown to be effective in combination with paclitaxel for the first-line treatment of MBC its use as single agent in pre-treated patients has given only a small benefit in several reports. Here we report the case of a MBC patient that, after several failing attempts with drugs commonly more effective than gemcitabine, achieved the complete remission of disease with this antimetabolite in more than one treatment-line. The overall benefit from the drug lasted more than 10 years. This case report highlights the existence of a small percentage of MBC patients that could obtain a terrific benefit from a low toxic and often underestimated drug for this pathology, in urgent need for new predictive biomarkers.

We describe the case of a 52-year old caucasian woman, in good clinical condition (ECOG performance status: 0), affected by essential hypertension, chronic hepatitis C infection and mild depressive syndrome. In January 1999, she underwent left upper quadrantectomy and ipsilateral axillary lymphadenectomy. The pathology report showed a bifocal invasive ductal carcinoma (stage pT2N3M0); by immunohistochemistry, neoplastic cells stained positive for Her2 (IHC: 3+) and negative for Hormone Receptors (HRs). Chemotherapy (4 cycles of doxorubicin plus paclitaxel q21, followed by CMF 1-8q28, for 4 cycles) and radiotherapy (50 Gy) were performed with adjuvant intent. 

Malignant External Otitis with Facial Nerve Paralysis

                                   http://austinpublishinggroup.com/otolaryngology/

A 62 years old man was referred to our department experiencing right otalgia, purulent otorrhea, ear loss and a grade III right facial nerve palsy according to the House Brackmann scale. He was affected by decompensated insulin-dependent type 2 Diabetes. The patient had a history of non cholesteatomatous ipsilateral chronic otitis treated with tympano-mastoid surgery 10 years before, without any sign of recurrence.

At the examination there was a purulent discharge from the right ear, the canal appeared red and swollen, the tympanic membrane was not visible and the retro auricular and preauricular areas showed redness and swelling. Meningeal signs were negative, without any cervical lymphadenopathy or any alteration of the blood exams. CT scan showed opacification of the right middle ear and mastoid cavity, with osteolysis of the facial canal and of the tegmen tympani, while MRI with contrast showed a mild enhancement in the meninx.

The scintigrafic evaluation with 99-Technetium confirmed the osteomyelitis with increased uptake of radio-marked Difosfonatein the temporomandibular joint, mastoid cells, semicircular canals, cochlea, middle and inner ear and in the greater wing of the sphenoid bone.

Wrist Arthroplasty Leads to Better Outcomes than Arthrodesis for Treatment of Patients with Advanced Rheumatoid Arthritis of the Wrist: A Review of Literature

                                         http://austinpublishinggroup.com/austin-orthopedics/

Rheumatoid arthritis is a chronic inflammatory condition of unknown a etiology, which can be disabling causing up to 35% of patients with 10 years of symptoms to early retire and carries a high mortality rate. It targets mainly the synovial membrane and articular cartilage of joints leading to joint deformity and instability. Genetic, immunological and environmental factors are thought to cause the disease in such a way that susceptible genes are triggered by infection or environmental factors leading to inappropriate immune response attacking the joints

Around 1% of general population is affected in the UK it is estimated to affect about 0.8% of the population and in some countries, where it is prevalent, it affects about 2% of population above 60 years. Though highest rates are in north Europe and America some studies are showing decrease of incidence in these regions. It is more common in white race affecting elderly in the 5th and 6th decade with women being affected 3 folds more than men.

Wrist and hands are the most common joints affected in rheumatoid arthritis such that by 4 years of the onset of the disease more than 90% of patients would show symptoms of involvement of at least one of these joints. Affection of carpal ligaments and tendons around the wrist would lead to radial deviation of radio carpal joint with ulnar deviation of the fingers at the MCP joint, subluxation of distal ulna and dropped fingers resulting in a zigzag deformity or what is known as caput ulnae syndrome. Half of the patients might have systemic or extra articular manifestations (ExRA). Nodules are the most common ExRA with the cardiovascular system being the most affected and this might be the reason why these patients show a higher mortality rate than the non-ExRA subgroup.

Effectiveness and Safety of a Combination of Intra- Articular Corticosteroid and Local Anesthetic in Indian Patients with Knee Osteoarthritis: A Pilot Study

                            http://austinpublishinggroup.com/orthopedics-rheumatology/

Background: Osteoarthritis is a chronic degenerative disorder of multifactorial etiology characterized by the loss of articular cartilage, resulting in joint pain, stiffness, swelling, and disability without any clear answer to its treatment and cure. Studies from intra-articular steroid with local anesthetic uses in osteoarthritis are rare from India.

Objective: To determine the effectiveness and safety of administering a combination of intra-articular corticosteroid and local anesthetic in Indian patients with knee osteoarthritis.

Methods: This, prospective, open-label, observational single-center pilot study was conducted at the Rheumatology Clinic of a tertiary care centre, from December 2015 to December 2016. This, prospective, open-label, observational single-center pilot study included patients (n=20) between 35-70 years of age, suffering from chronic knee pain for at least three months prior to inclusion, with a clinical or radiological diagnosis of knee osteoarthritis, dissatisfied with previous non-surgical management. Patients were administered injection methylprednisolone 80 mg (2 ml) plus lignocaine 1% (0.5 ml) intra-articularly which were followed with five scheduled visits i.e. baseline (visit 1), day 1 (visit 2), 6 weeks (visit 3), 12 weeks (visit 4), and 24 weeks (visit 5). Patients were evaluated on a Visual Analogue Scale [VAS] for pain and patient reported self-assessment questionnaire to evaluate other clinical effectiveness parameters.

Results: Mean age of the study population was 52.55+7.91 years. Majority (85%) were females. After administration of the injection, pain (as measured by the VAS scale) improved within a day and there was complete (100%) pain relief in all patients (as per subjective assessment) at week 1. The VAS score reduced from 8.90+0.968 at baseline to 6.35+1.387 on day 1 (mean reduction of 2.55+1.191) and 5.30+0.923 at week 1 (mean reduction of -3.60+1.273). For each of the clinical effectiveness parameters, a significantly greater proportion of patients showed ‘improved’ status than those who ‘worsened’ or remained the same. Seventy percent (14/20) patients reported ‘decreased’ frequency of Non- Steroidal Anti-Inflammatory Drug (NSAID) usage (p=0.0368).

Conclusion: Combination injection of intra-articular corticosteroid and local anesthetic is safe and effective in Indian patients with osteoarthritis. It achieves immediate pain relief, with effects lasting for at least 6 months and helps decrease NSAID usage in most patients.

Keywords: Osteoarthritis; Injections; Intra-articular; Anesthetics; Local; Visual Analog Scale; Anti-inflammatory agents; Non-steroidal

Unenhanced Chest Computerized Tomography Assisted Sentinel Lymph Node Biopsy Could be a Highly Reliable Option for Only Methylene Blue Available Breast Cancer Patients

                      http://austinpublishinggroup.com/obstetrics-gynecology/onlinefirst.php

Chinese incidence of breast cancer has increased remarkably with the socioeconomic development, particularly in eastern coastal areas, and it has been expected to approach more than 100 cases per 100000 women aged 55~69 years by 2021. Whereas, benefitting from systemic therapy, the invasiveness of surgical treatment has been largely controlled. Clinical trials have revolutionized the pattern of clinical practice. Mastectomy and Axillary Lymph Node Dissection (ALND) were both profoundly proven not to improve survival and Quality of Life (QOL) when comparing with Breast-Conserving Therapy (BCT) and Sentinel Lymph Node Biopsy (SLNB) [3,4]. National Surgical Adjuvant Breast and Bowel Project (NSABP) B-32 and other trials identified that SLNB could not only reduce the surgical morbidities, but could also be reliable for axillary staging of clinically lymph node negative (cN0) breast cancer.

SNB has become the standard of care in patients with cN0 disease. Although blue dye and radioisotope (RI) combined lymphatic mapping was well established as a standard procedure to limit FNR  but the optimal protocol for SLNB is still under investigation. In many Japanese hospitals, due to the lack of RI, contrast enhanced CT Lymphography (CT-LG) has been routinely used to stage the axilla accurately with dye-only SLNB. It was concluded that using the only size criterion by CT-LGor MRI alone to diagnose SLNs was not sufficient. No matter what contrast regimen used, the cost and procedure of the technique they used were not practical in China.

Based on previous studies on ultrasonography and CT-LG, metastatic nodes have several abnormal signs. In our daily wok, US-guided Core Needle Biopsy (CNB) and unenhanced chest CT have routinely been preoperatively adopted to evaluate node status and triage the patients. Because of unavailable RI and limited financial support in our country, most of patients, especially who live in remote rural areas, must receive more unnecessary ALND. In this context, we conduct this research to evaluate an unenhanced chest CT assisted method for SLNB and provide an alternative option for the given population.

Maternal Obesity Increases the Risk of Primary as Well as Secondary Caesarean Section

                                           http://austinpublishinggroup.com/obesity/currentissue.php

Maternal obesity is not only associated with pregnancy outcome but also with the mode of delivery. In the present study the impact of maternal prepregnancy weight status on the mode of delivery, in particular on caesarean section rate was tested. The data of 3451 live births taking place at the Viennese University Hospital were analyzed. Maternal somatometrics (height, weight, weight gain) and newborn somatic characteristics (birth weight, birth length, head dimensions, APGAR scores) were documented. Prepregnancy weight status was classified using Body Mass Index (BMI) categories published by the WHO. The caesarean section rate was 15.6%. (6.8% primary CS, 8.8% secondary CS). 24.2% of the mothers were overweight, 9.6% obese and 0.8% morbidly obese before pregnancy. Maternal prepregnancy BMI was significantly associated with newborn size. The relative risk to give birth to a macrosome newborn was significantly increased among overweight (OR 1.46 CI 1.24-1.72), obese (OR 1.76 CI 1.40-2.19) and morbidly obese mothers (OR 1.51 CI 0.57-3.99). The relative risk of caesarean section increased significantly with increasing prepregnancy weight status (p<0.04). Morbidly obese women showed the significantly highest rate of caesarean section (33.4%; primary CS 16.7%, secondary CS 16.7%). The relative risk of experiencing caesarean section was significantly higher among morbidly obese women than among underweight (OR 3.57 CI 1.85-6.86), normal weight (OR 2.89 CI 1.25-6.69), overweight (OR 2.27 CI 0.99-5-22) and even obese women (OR 2.11 CI 0.94-4.72). Prepregnancy obesity is clearly a significant risk factor of newborn macrosomia and primary as well as secondary caesarean section.

The prevalence of overweight and obesity as a worldwide epidemic has increased dramatically since the beginning of the 21rst century. In 2008 for the first time in the long history of Homo sapiens, the number of obese people on earth exceeded the number of people who suffer from starvation and malnutrition. Currently more than 1.9 billion adults, 18 years and older, were overweight. Of these over 600 million correspond to the definition of obesity. From the viewpoint of public health this high prevalence of overweight and obesity is a major concern because overweight and especially obesity increase rates of metabolic diseases such as diabetes type II, cardiovascular diseases such as heart disease, stroke, hypertension, but also pancreatitis, osteoarthritis and cancer. Obesity however, is also related to reproductive problems, such as increased infertility rates in women as well as in men. A special problem represents obesity among women of reproductive age. In the United States more than 50% of women ageing between 20 and 39 years are overweight or obese. Europe seems to follow a similar pattern, albeit with some delay. Currently one in five pregnant women can be classified as obese in Europe.

Noninvasive Methods for Treatment of Brain Metastases

                             http://austinpublishinggroup.com/oncology/currentissue.php

Brain metatases occur in 20-40% of patients with cancer. Median survival of patients who develop brain metastases is relatively short - 4 months. Treatment methods such as Whole Brain Radio Therapy (WBRT), Surgery (S) or Radiosurgery (SRS) prolong survival for 3 to 5 months. Treatment options in brain metastases are as follows: symptomatic tratment, surgery, radiotherapy, chemiotherapy and combination of those. Symptomatic treatment of edema and anticonvulsive therapy are used if necessery and depends on neurological patients status. Surgery has been used for single brain metstasis in patients with good performance status. WBRT alone is a treatment of choice for patients with multiple brain metastases, with single brain metastasis not sutable to surgery or radiosurgery, especially those with an active and disseminated systemic disease. SRS is an external irradiation technique to deliver a relatively large radiation dose in a single fraction to an intracranial small target volume.

Chemotherapy alone (CT) is not used unless in clinical trials. Which method to use depends on profile of prognosis factors such as:performance status, patients age,number and volume of metastases. Brain metastasis is a common manifestation of disseminated malignancy. In adults, lung, (36-40%), breast cancer (15-25%) and skin melanoma (5-20%) are the most common sources of brain metastases. Less frequent are colon, rectal, kidney, prostate, testicular, ovarian cancer and sarcoma. Cerebral lesion are mainly located in hemispheres (80%), in cerebellum (15%), in the brain stem (5%), being very rare in the basal ganglia, the pineal gland or hypophysis. 

Are more common than primary brain tumors. Frequency of disclosure is the result: a more effective treatment of the primary tumor, more effective systemic treatment of disseminated disease (clinical or subclinical), the existence of blood - brain barrier for the majority of cytostatic drugs and the introduction of new imaging techniques. Most patients who develop brain metastases have short time survival. The treatment is used: steroids, surgery, radiation therapy and symptomatic treatment. The choice of treatment depends on the age, general condition of the patient, the number and location of metastatic lesions and the severity of the underlying disease. The last decade has created new possibilities for the treatment of metastatic tumors such as radiosurgery and radiochemotherapy combination treatment with radiation

Bladder Lymphoepithelioma-Like Carcinoma: Case Report and Literature Review

                    http://austinpublishinggroup.com/oncology-case-reports/currentissue.php

UrinaryLymphoepithelioma-like carcinoma are rare tumours classified according to Lymphoepithelioma component as pure (100%), predominant (≥50%) or focal (<50%), that is correlated with prognosis.We present here an original case of a 54 year-old man who was diagnosed with a high-grade T2 transitional cell carcinoma associated with LELC >50%. Four cycles of neoadjuvant gemcitabine and platinum-based chemotherapy were carried out with a good tolerance. After completed chemotherapy, the patient underwent a radical cyst prostatectomy with lymph nodes dissection and orthotropic urinary diversion. One year after surgery the patient remains free from relapse.

It’s difficult to define the optimal strategy, literature reporting only small series. Nevertheless, the benefit of chemotherapy is certain. The outcome is good in the pure and predominant forms and poorer in focal subtypes.Lymphoepithelioma-Like Carcinoma (LELC) is a rare tumour, which has a close link to Epstein-Barr virus. (EBV) It’s commonly found in nasal pharyngea, stomach, cervix, lung, hepatobiliary tract and ovary. Its occurrence in the urinary system is very rare. LELC of the urinary bladder was first described by Zuckerberg in 1991. It represents between 0,4 and 1,3% of all bladder cancers. These tumours are classified according to Lymphoepithelioma component as pure (100%), predominant (≥50%) or focal (<50%).

We present here an original case of a 54 year-old man who was diagnosed with a LELC of the urinary bladder and discuss its management regarding the lake of data in the literature. A 54 year-old Caucasian man presented few weeks history of haematuria associated with urinary frequency and dysuria. He had no medical history. He underwent surgery for discal hernia and appendicectomy a long time ago. He was a smoker since he was 15 year-old and stopped for fifteen years. He underwent transurethral resection for its bladder tumour. The results of histological examination confirmed a high-grade T2 transitional cell carcinoma with LELC >50%. On immunohistochemical staining the CKAE1/AE3, p53, was positive and CK7 and CD20 were negative.