Diagnostic accuracy of intraoperative margin assessment techniques in surgery for head and neck squamous cell carcinoma: a meta-analysis

BACKGROUND: Positive margins following head and neck squamous cell carcinoma (HNSCC) surgery lead to significant morbidity and mortality. Existing Intraoperative Margin Assessment (IMA) techniques are not widely used due to limitations in sampling technique, time constraints and resource requirements. We performed a meta-analysis of the diagnostic performance of existing IMA techniques in HNSCC, providing a benchmark against which emerging techniques may be judged. METHODS: The study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Studies were included if they reported diagnostic metrics of techniques used during HNSCC surgery, compared with permanent histopathology. Screening, manuscript review and data extraction was performed by multiple independent observers. Pooled sensitivity and specificity were estimated using the bivariate random effects model. RESULTS: From an initial 2344 references, 35 studies were included for meta-analysis. Sensitivity (Sens), specificity (Spec), diagnostic odds ratio (DOR) and area under the receiver operating characteristic curve (AUROC) were calculated for each group (n, Sens, Spec, DOR, AUROC): frozen section = 13, 0.798, 0.991, 309.8, 0.976; tumour-targeted fluorescence (TTF) = 5, 0.957, 0.827, 66.4, 0.944; optical techniques = 10, 0.919, 0.855, 58.9, 0.925; touch imprint cytology = 3, 0.925, 0.988, 51.1, 0.919; topical staining = 4, 0.918, 0.759, 16.4, 0.833. CONCLUSIONS: Frozen section and TTF had the best diagnostic performance. Frozen section is limited by sampling error. TTF shows promise but involves administration of a systemic agent. Neither is currently in widespread clinical use. Emerging techniques must demonstrate competitive diagnostic accuracy whilst allowing rapid, reliable, cost-effective results

Infection does not increase long-term mortality in patients with acute severe alcoholic hepatitis treated with corticosteroids

AIM: To determine whether infection in patients with acute severe alcoholic hepatitis (AAH) treated with corticosteroids is associated with increased mortality. METHODS: Consecutive patients with AAH were treated with steroids and recruited to the study. Clinically relevant infections (body temperature > 38 °C or < 36 °C for more than 4 h, ascitic neutrophil count > 0.25 ×10(9)/L, consolidation on chest radiograph or clinically relevant positive microbiological culture of bodily fluid) were recorded prospectively. Clinical and laboratory parameters were recorded and survival at 90 d and 6 mo was determined. Univariate analysis of factors associated with 90-d mortality was performed and significant variables included in a multivariate analysis. RESULTS: Seventy-two patients were included in the final analysis (mean age 47.9 years, 26% female, mean discriminant function 53.0). Overall mortality in the group occurred in 15 (21%), 23 (32%) and 31 (43%) at day 28, day 90 and 1 year respectively. 36 (50%) had a clinically relevant infection during their hospitalisation (23 after initiation of steroids). The median time to development of incident infection after commencement of steroids was 10 d. The commonest site of infection was ascites (31%) and bacteraemia (31%) followed by urinary tract (19%) and respiratory tract (8%). Forty-one separate organisms were isolated in 33 patients; the most frequent genus was Escherichia (22%) and Enterococcus (20%). Infection was not associated with 90-d or 1 year mortality but was associated with higher creatinine, model for end-stage liver disease and Lille score. Baseline urea was the only independent predictor of 90-d mortality. CONCLUSION: Clinically relevant infections are common in patients with AAH but are not associated with increased 90-d or 1 year mortality

Fall-Planted Cover Crops for Weed Suppression in Western Kansas

The widespread evolution of herbicide-resistant (HR) kochia and Palmer amaranth warrants the use of alternative ecological-based strategies for weed management in no-tillage (NT) dryland cropping systems in western Kansas. A field study was established in the fall of 2020 at Kansas State University Agricultural Research Center near Hays, KS, to determine the impact of fall-planted cover crop (CC) mixture on 1) kochia and Palmer amaranth suppression (density and biomass reduction), and 2) Palmer amaranth emergence dynamics in subsequent grain sorghum. A CC mixture of winter triticale, winter pea, radish, and rapeseed was planted in wheat stubble in the fall of 2020. The CC mixture was terminated at triticale heading stage on May 26, 2021 by using 1) Roundup PowerMax (glyphosate) at 32 fl oz/a, and 2) Roundup PowerMax at 32 fl oz/a + Degree Xtra (premix of acetochlor + atrazine) at 2.2 quart/a. A chemical fallow treatment (without CC) was included for comparison. The study site was planted with grain sorghum hybrid ‘DKS 38-16’ on June 10, 2021. The CC mixture produced an average of 1360 lb/a aboveground biomass at the time of termination. The CC terminated with Roundup PowerMax + Degree Xtra had 98 and 95% less total weed density at 0 and 30 days after termination (DAT), respectively, compared to chemical fallow. No difference in weed density was observed at later evaluations. At grain sorghum harvest, CC terminated with Roundup PowerMax and Roundup PowerMax + Degree Xtra reduced total weed biomass by 61% and 73%, respectively, compared to chemical fallow. The time taken to reach 10, 50, and 90% cumulative emergence of Palmer amaranth was delayed by 9, 15, and 21 days, respectively, in CC terminated with Roundup PowerMax and 11, 39, and 128 days, respectively, in CC terminated with Roundup PowerMax + Degree Xtra when compared with chemical fallow. Grain sorghum yield did not differ between CC and chemical fallow treatments. These results suggest that a fall-planted CC mixture can play an important role for kochia and Palmer amaranth suppression in NT dryland crop production in western Kansas

Genetic characterization of Yug Bogdanovac virus

We present pyrosequencing data and phylogenetic analysis for the full genome of Yug Bogdanovac virus (YBV), a member of the Vesicular stomatitis virus serogroup of the Rhabdoviridae isolated from a pool of Phlebotomus perfiliewi sandflies collected in Serbia in 1976. YBV shows very low nucleotide identities to other members of the Vesicular stomatitis virus serogroup and does not contain a reading frame for C&prime;/C proteins

Women candidates and party nomination trends in India: evidence from the 2009 general election

More women MPs than ever before were elected to the lower house of the national parliament of India in the 2009 General Election. Yet, the increase in women’s presence in the Lok Sabha cannot necessarily be attributed to the increased willingness of political parties to field more women candidates, despite rhetorical party political support for increasing women’s participation in political institutions. This article analyses party political nomination of women as candidates in the 2009 election, and finds significant variations in levels of nomination across parties and across India’s states. The article also examines in detail the nomination of female candidates by the two largest political parties, the Indian National Congress party and the Bharatiya Janata Party, both of which support proposals for introducing reserved seats for women in national and state legislatures. The findings reject the proposition that parties only nominate women in unwinnable seats, but finds support for the proposition that parties are risk averse when it comes to nominating women, and that this can restrict the number of women nominated for election. The article concludes with some further questions for future research on gender and political recruitment in India

Mental Imagery to Reduce Alcohol-related harm in patients with alcohol use disorder and alcohol-related liver damaGE: the MIRAGE randomised pilot trial results

Objective The healthcare burden of alcohol-related liver disease (ARLD) is increasing. ARLD and alcohol use disorder (AUD) is best managed by reduction or cessation of alcohol use, but effective treatments are lacking. We tested whether people with ARLD and AUD admitted to hospital could be recruited to and retained in a trial of Functional Imagery Training (FIT), a psychological therapy that uses mental imagery to reduce alcohol craving. We conducted a multicentre randomised pilot trial of treatment as usual (TAU) versus FIT+TAU in people admitted to hospital with ARLD and AUD. Design Participants were randomised to TAU (a single session of brief intervention) or FIT+TAU (TAU with one hospital-based FIT session then eight telephone sessions over 6 months). Pilot outcomes included recruitment rate and retention at day 180. Secondary outcomes included fidelity of FIT delivery, alcohol use, and severity of alcohol dependence. Results Fifty-four participants (mean age 49; 63% male) were recruited and randomised, 28 to TAU and 26 to FIT+TAU. The retention rate at day 180 was 43%. FIT was delivered adequately by most alcohol nurses. 50% of intervention participants completed FIT sessions 1 and 2. There were no differences in alcohol use or severity of alcohol dependence between treatment groups at day 180. Conclusion Participants with ARLD and AUD could be recruited to a trial of FIT versus FIT+TAU. However, retention at day 180 was suboptimal. Before conducting a definitive trial of FIT in this patient group, modifications in the intervention and recruitment/retention strategy must be tested. Trial registration number ISRCTN41353774

Whole Genomes of Chandipura Virus Isolates and Comparative Analysis with Other Rhabdoviruses

The Chandipura virus (CHPV) belonging to the Vesiculovirus genus and Rhabdoviridae family, has recently been associated with a number of encephalitis epidemics, with high mortality in children, in different parts of India. No full length genome sequences of CHPV isolates were available in GenBank and little is known about the molecular markers for pathogenesis. In the present study, we provide the complete genomic sequences of four isolates from epidemics during 2003–2007. These sequences along with the deduced sequence of the prototype isolate of 1965 were analysed using phylogeny, motif search, homology modeling and epitope prediction methods. Comparison with other rhaboviruses was also done for functional extrapolations. All CHPV isolates clustered with the Isfahan virus and maintained several functional motifs of other rhabdoviruses. A notable difference with the prototype vesiculovirus, Vesicular Stomatitis Virus was in the L-domain flanking sequences of the M protein that are known to be crucial for interaction with host proteins. With respect to the prototype isolate, significant additional mutations were acquired in the 2003–2007 isolates. Several mutations in G mapped onto probable antigenic sites. A mutation in N mapped onto regions crucial for N-N interaction and a putative T-cell epitope. A mutation in the Casein kinase II phosphorylation site in P may attribute to increased rates of phosphorylation. Gene junction comparison revealed changes in the M-G junction of all the epidemic isolates that may have implications on read-through and gene transcription levels. The study can form the basis for further experimental verification and provide additional insights into the virulence determinants of the CHPV