80 research outputs found
Evaluation of premetastatic changes in lymph nodes(pN0) of oral tongue tumour: A prospective observational Study [version 1; peer review: 2 approved]
Background: Tongue tumors show intra and inter-tumoral heterogenicity with high incidence, relapse and mortality rates necessitating further research. Recurrence/metastasis that occurs after surgical resection of primary cancer is often the reason for poor survival in these patients. Lymph nodes are the most common site of metastasis in tongue tumors. Therefore, premetastatic molecular changes can be best evaluated in lymph nodes which may epitomize the earliest events in the metastasis cascades. The presence of circulating tumor cells(CTCs) in the absence of nodal disease (N0) may represent tumor aggressiveness, suggesting an immune escape which may have high metastatic potential. This trial was developed to investigate the earliest pre-metastatic changes which may regulate tumor dormancy and predict metastasis. A better understanding of organotropism or pre-metastatic changes can help in theragnostic, thereby preventing the outbreak of overt metastasis. Methods: A single-institutional prospective observational cohort study. This trial will be conducted at a tertiary care Centre (Amrita Institute of Medical Sciences Kochi). Eligible patients will be enrolled after obtaining informed consent. The dissected lymph nodes will be subjected to histopathological and immunohistochemical analyses for premetastatic niche (PMN) formation. In addition, circulating tumor cells will be evaluated before treatment and 6 months after treatment. The patients will be followed up for a period of two years to correlate the findings with the recurrence-free survival. Expected results: The pre-metastatic changes, if detected will be a predictive biomarker. It may help to define future drug targets for metastasis chemoprevention . CTCs may define the tumor aggressiveness ,there by prognostication and helps in better disease management. Ethics and dissemination: The study has received the following approval: Ethics Committee of Amrita School of Medicine (ECASM-AIMS-2022-048).Trial Registered Prospectively( CTRI/2022/03/041256 ) on 22/03/2022 under Clinical Trial Registry of Indi
Recommended from our members
Equilibrium characterization for a class of dynamical neural networks with applications to learning and synthesis.
There has been a considerable amount of interest in the application of neural networks to information processing problems in the recent past. The computational capabilities of neural networks stem from a massively parallel, dense interconnection of simple nonlinear elements. In this dissertation, a class of dynamical neural networks which has received wide attention is investigated for its general computational capabilities. This is achieved by considering the design of the network in various application scenarios, viz. quadratic minimization, associative memory and nonlinear input-output mapping. The design of the network for each application is facilitated by a qualitative analysis of the properties of the equilibrium points of the neural network whose elements are appropriately tailored for the specific application. Two different design methodologies, learning and synthesis, are addressed. The equilibrium characterization studies conducted yield specific results regarding the equilibrium points: degree of exponential stability, estimation of regions of attraction and conditions for confining them in certain regions of the state-space. The synthesis procedure developed utilizing these results for the employment of the network to perform quadratic minimization guarantees a unique equilibrium point. It is shown that the speed of computation can be increased by adjusting certain parameters of the network and is independent of the problem size. The synthesis of the associative memory network is carried out by a proper tailoring of the neuronal activation functions to satisfy certain stability requirements and by using an interconnection structure that is not necessarily symmetric. Obtaining valuable insights from the results of the equilibrium characterization, a simple and efficient learning rule for the interconnection structure is also devised. Convergence properties of the learning rule are established, and guidelines for selecting the initial values and the adaptation step size parameters are provided. This learning rule is extended to a novel three layer neural network architecture that functions as a nonlinear input-output mapper. The feasibility of the developed learning rules and synthesis procedures are demonstrated through a number of applications, viz. parameter estimation and state estimation in linear systems, design of a class of pattern recognition filters, storage of specific pattern vectors, and nonlinear system identification
Vascularised composite allotransplants: Transplant of upper extremities and face
Transplantation of solid organs and bone marrow has become a highly acceptable and often the only available clinical solution in many situations. It has been practiced across the globe for quite a long time since the first kidney transplant in 1954. Transplantation of tissues other than these, which was termed composite tissue allotransplantation and currently as vascularised composite allotransplantation (VCA) is gaining acceptance as a solution for complex reconstructive problems. This involves the transfer of multiple types of tissue such as bone, muscle, nerve, skin and blood vessels. The advantage of these over the conventional reconstructive methods is its ability to give aesthetically and functionally superior equal composite substitute to the missing or deformed part. The composite tissues transplanted commonly include the upper extremities, face and abdominal wall. Among these, hand transplants were the first to be done and have been carried out more than any other VCA. This article reviews the current scenario of VCA especially of the hand and face, in the light of experience of the two bilateral hand transplants done recently in India
Maxillary reconstruction: Current concepts and controversies
Maxillary reconstruction is still an evolving art when compared to the reconstruction of the mandible. The defects of maxilla apart from affecting the functions of the speech, swallowing and mastication also cause cosmetic disfigurement. Rehabilitation of the form and function in patients with maxillary defects is either by using an obturator prosthesis or by a surgical reconstruction. Literature is abundant with a variety of reconstructive methods. The classification systems are also varied, with no universal acceptance of any one of them. The oncologic safety of these procedures is still debated, and conclusive evidence in this regard has not emerged yet. Management of the orbit is also not yet addressed properly. Tissue engineering, that has been hyped to be one of the possible solutions for this vexing reconstructive problem, has not come out with reliable and reproducible results so far. This review article discusses the rationale and oncological safety of the reconstructing the maxillary defects, critically analyzes the classification systems, offers the different reconstructive methods and touches upon the controversies in this subject. The management of the retained and exenterated orbit associated with maxillectomy is reviewed. The surgical morbidity, complications and the recent advances in this field are also looked into. An algorithm, based on our experience, is presented
- …