Histopathological study of pancreatobiliary tumors in a tertiary care center: a 7 year study

Background: The aim of this study was to comprehensively analyse the histopathological spectrum of pancreatobiliary tumors with special reference to ampulla of Vater.Methods: The retrospective study was done for 5 years and a prospective study was carried out for 2 years in the Department of Pathology.Results: A total of 110 cases were included; 103 underwent a standard Whipple procedure and 7 underwent localised resection (partial pancreatectomy). The average age was 52.64 years (16-80 years) and males outnumbered females (3:2). Malignant (93.63%) lesions outweighed benign lesions (6.36%). Among malignant lesions, 71 (68.93%) were peri-ampullary, 15 (14.56%) were pancreatic, 11 (10.67%) were duodenal and only 6 (5.825%) were cholangiocarcinoma. The most common presenting feature was jaundice followed by pain in the abdomen. The mean tumor size was 2.38 cm (0.5-15cm). The pathological stage of most of the tumors was T2 (58.2%), followed by T3 (22.7%), T1 (11.8%) and T4 was only 1.8%. Proximal duodenal resection margin was free in 90.9%, distal duodenal resection margin was free in all cases, CBD resection margin was involved in only 2 cases (1.8%), while the pancreatic duct resection margin was involved in 2.7%. The nodal status was N0 in 61.8%, N1 in 23.6% and Nx in 9.1%.Conclusions: Adenocarcinoma (well differentiated-47.3%) is the most common histological variant of pancreatobiliary region

ASSESMENT OF CRITICAL SUCCESS FACTORS FOR SMART CITIES USING SIGNIFICANCE INDEX METHOD

ABSTRACT Smart development emphasis on a holistic development with combination of all key dimensions of urbanizatio

Promises and challenges of a decentralized CAR T-cell manufacturing model

Autologous chimeric antigen receptor-modified T-cell (CAR T) products have demonstrated un-precedent efficacy in treating many relapsed/refractory B-cell and plasma cell malignancies, leading to multiple commercial products now in routine clinical use. These positive responses to CAR T therapy have spurred biotech and big pharma companies to evaluate innovative production methods to increase patient access while maintaining adequate quality control and profitability. Autologous cellular therapies are, by definition, manufactured as single patient batches, and demand has soared for manufacturing facilities compliant with current Good Manufacturing Practice (cGMP) regulations. The use of a centralized production model is straining finite resources even in developed countries in North America and the European Union, and patient access is not feasible for most of the developing world. The idea of having a more uniform availability of these cell therapy products promoted the concept of point-of-care (POC) manufacturing or decentralized in-house production. While this strategy can potentially decrease the cost of manufacturing, the challenge comes in maintaining the same quality as currently available centrally manufactured products due to the lack of standardized manufacturing techniques amongst institutions. However, academic medical institutions and biotech companies alike have forged ahead innovating and adopting new technologies to launch clinical trials of CAR T products produced exclusively in-house. Here we discuss POC production of CAR T products

Serotonin-Norepinephrine Reuptake Inhibitors for Pain Control: Premise and Promise

The precise mechanisms of pain perception and transmission in the central nervous system have not been fully elucidated. However, extensive data support a role for the monoamine neurotransmitters, serotonin and norepinephrine, in the modulation of pain. Experiments with animal models of pain indicate that noradrenergic interventions, and to a lesser extent serotonergic interventions, reduce pain-related behavior. This is supported by data from clinical trials in humans in which antidepressants have been shown to reduce pain and functional impairment in central and neuropathic pain conditions. These effects are particularly well-studied in trials with serotonin-norepinephrine reuptake inhibitors (SNRIs), which have provided a useful tool in the clinician’s arsenal, particularly considering the limitations of other classes of pain medications such as opioids, anti-inflammatories, and anticonvulsants (i.e., limited efficacy, safety and tolerability issues). Moreover, painful physical symptoms are frequently comorbid with major psychiatric disorders such as major depressive disorder and anxiety disorders. This paper reviewed and summarized the rationale and potential role of SNRIs for the control of pain including clinical and preclinical background. Currently evidence does not definitely support a role of the SNRIs, while limited data propose a putative promise of SNRIs in the treatment of pain related disorders including fibromyalgia and depressed patients with multiple somatic complaints. More researches are warranted to generalize currently available preliminary evidences

Predicting breast tumor proliferation from whole-slide images : the TUPAC16 challenge

Tumor proliferation is an important biomarker indicative of the prognosis of breast cancer patients. Assessment of tumor proliferation in a clinical setting is a highly subjective and labor-intensive task. Previous efforts to automate tumor proliferation assessment by image analysis only focused on mitosis detection in predefined tumor regions. However, in a real-world scenario, automatic mitosis detection should be performed in whole-slide images (WSIs) and an automatic method should be able to produce a tumor proliferation score given a WSI as input. To address this, we organized the TUmor Proliferation Assessment Challenge 2016 (TUPAC16) on prediction of tumor proliferation scores from WSIs. The challenge dataset consisted of 500 training and 321 testing breast cancer histopathology WSIs. In order to ensure fair and independent evaluation, only the ground truth for the training dataset was provided to the challenge participants. The first task of the challenge was to predict mitotic scores, i.e., to reproduce the manual method of assessing tumor proliferation by a pathologist. The second task was to predict the gene expression based PAM50 proliferation scores from the WSI. The best performing automatic method for the first task achieved a quadratic-weighted Cohen's kappa score of κ = 0.567, 95% CI [0.464, 0.671] between the predicted scores and the ground truth. For the second task, the predictions of the top method had a Spearman's correlation coefficient of r = 0.617, 95% CI [0.581 0.651] with the ground truth. This was the first comparison study that investigated tumor proliferation assessment from WSIs. The achieved results are promising given the difficulty of the tasks and weakly-labeled nature of the ground truth. However, further research is needed to improve the practical utility of image analysis methods for this task

Histopathological study of pancreatobiliary tumors in a tertiary care center: a 7 year study

Background: The aim of this study was to comprehensively analyse the histopathological spectrum of pancreatobiliary tumors with special reference to ampulla of Vater.Methods: The retrospective study was done for 5 years and a prospective study was carried out for 2 years in the Department of Pathology.Results: A total of 110 cases were included; 103 underwent a standard Whipple procedure and 7 underwent localised resection (partial pancreatectomy). The average age was 52.64 years (16-80 years) and males outnumbered females (3:2). Malignant (93.63%) lesions outweighed benign lesions (6.36%). Among malignant lesions, 71 (68.93%) were peri-ampullary, 15 (14.56%) were pancreatic, 11 (10.67%) were duodenal and only 6 (5.825%) were cholangiocarcinoma. The most common presenting feature was jaundice followed by pain in the abdomen. The mean tumor size was 2.38 cm (0.5-15cm). The pathological stage of most of the tumors was T2 (58.2%), followed by T3 (22.7%), T1 (11.8%) and T4 was only 1.8%. Proximal duodenal resection margin was free in 90.9%, distal duodenal resection margin was free in all cases, CBD resection margin was involved in only 2 cases (1.8%), while the pancreatic duct resection margin was involved in 2.7%. The nodal status was N0 in 61.8%, N1 in 23.6% and Nx in 9.1%.Conclusions: Adenocarcinoma (well differentiated-47.3%) is the most common histological variant of pancreatobiliary region

Comparative Study of Bupivacaine-Fentanyl versus Ropivacaine-Fentanyl for Epidural Analgesia in Labor.

Background Labor pain is one of the most intense pains that a woman experiences. Almost 60% of primiparous women described the pain of uterine contractions as unbearable extremely severe or excruciating. Aims Our study aimed to relieve pain suffering of mother and to decrease fetal acidosis to make the delivery process safer for mother and baby. Settings and Design Thus, epidural labor analgesia was designed comparing ropivacaine-fentanyl (RF) and bupivacaine-fentanyl (BF) as intermittent bolus technique. Materials and Methods Sixty women who requested epidural analgesia having ≥3 cm cervical dilatation were allocated in two groups, one group received RF and the other group received BF. Each group received study drug 16 mL with 50 μg fentanyl and top of 10 mL and 25 μg fentanyl when visual analog scale (VAS) ≥3. The efficacy of analgesia, adverse effects, and obstetric and neonatal outcomes were compared. Statistical Analysis For skewed data or ordered categorical data, nonparametric Mann-Whitney -test was used for statistical analysis of two groups. For categorical data, comparisons were made by Pearson's Chi-square test or Fisher's exact test as appropriate (%). Results Both groups were comparable in terms of demographic data and obstetric and neonatal parameters at the onset of labor Comparison of heart rate, systolic blood pressure (BP), diastolic BP, and saturation between Group RF and Group BF. It was found statistically not significant. VAS score before the epidural study drug was given, was 5 (4-5) in RF group, and was 5 (3-6) in BF group, and after 1 min, VAS score was 1 in both the groups thereafter. The score remained zero till at 100 min in both the groups till the time when the top-up dose was given. Bearing down reflex was present in all the patients as judged by the obstetrician. It was sluggish in 20% of patients in Group RF as compared to 10% in Group BF. Conclusions From clinical and safety perspective, both RF and BF were reasonable choice for labor analgesia