Clinicopathological study of surgical margins in squamous cell carcinoma of buccal mucosa

AbstractObjectiveTo evaluate the margins of resected specimen of oral squamous cell carcinoma (SCC) and to document the surgical margin (measured at the time of resection) and margins at the time of pathological examination (after immersion of the specimen in formalin).MethodsPatients who were diagnosed and confirmed with squamous carcinoma of buccal mucosa were included in the study. Patients underwent resection of the tumor with a margin of 1 cm. Soon after resection, the distance between outermost visible margin of the tumor and the margin of the specimen was measured and documented. Specimens were fixed in 10% formalin and submitted for gross and histopathological examination. The closest histopathologic margin was compared with the in situ margin (10 mm) to determine and document any shrinkage of the margin and the percentage of discrepancy if any.ResultsA total of 52 specimens were collected from patients between January 2014 and December 2014. All specimens were obtained from the oral cavity (n = 52) of which 43 (82.7%) were squamous cell carcinoma and 9 (17.3%) were verrucous variant of squamous cell carcinoma. The average decrease in tumor margins measured after fixation in formalin was found to be statistically significant (P < 0.05) in 65% of cases.ConclusionTumor margin shrinks significantly after formalin fixation by about 25%. The operating surgeon and pathologist should be well aware of such changes while planning for further management thereby ensuring adequate margin of resection and adjuvant treatment wherever required to prevent possible local recurrence of the disease

Longitudinal disease studies in small-holder black tiger shrimp (Penaeus monodon) farms in Andhra Pradesh, India. I. High prevalence of WSSV infection and low incidence of disease outbreaks in BMP ponds

A longitudinal study was conducted from January to August 2005 in small-holder black tiger shrimp (Penaeus monodon) ponds in the West Godavari District of Andhra Pradesh, India (16°25′ N, 81°19′ E). The study involved 457 ponds owned by low-income farmers participating in a better management practice (BMP) programme. Disease outbreaks occurred in 16.6% of ponds. There was significant spatial clustering of disease outbreaks with 31 (40.8%) of the 76 recorded disease outbreaks occurring in a single village block. Bivariate analysis indicated a 1.6-fold higher likelihood of disease outbreaks from nursery-stocked ponds but this was not significant in multivariate analysis due to the confounding effect of pond location. There was evidence of increasing prevalence of WSSV infection during grow-out. WSSV was detected in 5.9% of 119 batches of postlarvae tested at stocking, 38.2% of 34 juvenile batches collected at the time of transfer to grow-out ponds, and 47.0% of 336 pond stock tested at normal harvest or crop failure. WSSV was detected in 43 of 59 (72.9%) disease outbreak ponds tested and 115 of 277 (41.5%) non-outbreak ponds tested. Heavy WSSV infection was detected at harvest in 116 of the 336 (34.5%) of the ponds tested, including 78 ponds for which no outbreak was recorded. Duration of crop was recorded for 431 ponds with a mean of 117.0 days and a range of 20 to 176 days. Median duration was significantly shorter for disease outbreak ponds (68.5 days) compared to nonoutbreak ponds (119.0 days). Duration of crop also varied according to WSSV detection levels at harvest, with median duration for ponds classified as heavy WSSV infection (108.5 days) significantly shorter than for ponds classified as either light WSSV infection (116.0 days) or WSSV-negative (116.5 days). The study indicated a high risk of WSSV infection during grow-out but a relatively low incidence of disease despite a high prevalence of heavy WSSV infection in non-outbreak ponds

Traces of violence: Representing the atrocities of war

This article explores the relationships between war and representation through the use of visual images, and takes a cue from the French cultural theorist Paul Virilio, who has written extensively on the militarization of vision in ways that have yet to be fully recognized in criminology. It then outlines some of the disputes surrounding documentary photography, not least since one of the main factors driving the development of the medium was the desire to record warfare, before turning to recent efforts to reconfigure the violence of representation by focusing on what has been termed ‘aftermath photography’, where practitioners deliberately adopt an anti-reportage position, slowing down the image-making process and arriving well after the decisive moment. This more contemplative strategy challenges the oversimplification of much photojournalism and the article concludes by reflecting on how military-turned-consumer technologies are structuring our everyday lives in more and more pervasive ways

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all &gt;0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

Control and Simulation of Static Condenser

A static condenser is an advanced static VAR compensator (SVC) using voltage source power converters with capacitors connected on the DC side. It has several advantages over both rotating synchronous condensers and variable impedance type SVCs and is expected to make a major breakthrough in reactive power control in electric utility systems. This paper presents the mathematical modelling and analysis of a static condenser. The control parameters are based on eigenvalue analysis and the performance evaluated from digital simulation. The results from a case study show the benefits of static condensers in improving power system stability and thereby increasing the power transfer in the lin