Outcomes of combined modality therapy for breast cancer with isolated ipsilateral supraclavicular nodal metastases at presentation.

BACKGROUND : The female breast has been an organ of fascination and so also the treatment of breast cancer. The treatment of breast cancer has remained an enigma from the ancient past to present day .Tremendous progress has been made in the management of carcinoma breast. Despite this, the treatment is still a complex issue. Breast cancer is a major public health problem for women throughout the world. In India, breast cancer remains the most common cancer in urban women. Since 1990, the death rate from breast cancer has decreased in the United States by 24% and similar reductions have been observed in other developed countries. AIMS OF THE STUDY : 1. To determine the incidence of isolated ipsilateral supraclavicular nodal metastases at presentation, in patients with carcinoma breast. 2. To study the outcomes in response rates, disease free survival, overall survival in patients with carcinoma breast who presented with ipsilateral supraclavicular nodal metastases. 3. To determine the factors affecting the disease free survival (DFS) and overall survival (OS). MATERIALS AND METHODS : A retrospective study of patients who presented with carcinoma breast, treated at Cancer Institute (WIA) from the year 2000 to 2008 was done. The total number of patients who were diagnosed to have invasive cancer of the breast, during the study period was 5587. Of the 5587 patients, we identified 60 patients who presented with ipsilateral supraclavicular lymph nodal metastases but no evidence of other distant metastases. Patients with distant metastases other than ipsilateral supraclavicular metastases were excluded. Patients with bilateral breast cancers were also excluded. All patients underwent biopsies of the breast tumor, to document invasive carcinoma. Pretreatment evaluation consisted of a thorough history, clinical examination, contralateral mammogram, staging workup that included a chest x-ray, nuclear bone scan, ultrasound of the abdomen and pelvis. All 60 patients had metastatic supraclavicular node, diagnosed either by a fine needle aspiration cytology or an excision biopsy of the lymph node. CONCLUSION : Patients with breast cancer who present with isolated ipsilateral supraclavicular nodal metastases, though previously thought to be a subset of patients with poor prognosis and a predecessor of distant metastases, need definitive treatment with multidisciplinary approach. In our Institute, we have been practising concurrent chemotherapy and radiotherapy followed by surgery if rendered operable. The 2003 revision of the AJCC breast cancer TNM staging system has appropriately reclassified patients presenting with supraclavicular metastases from M1 to a new category IIIC. In our study, the incidence of isolated supraclavicular nodal metastases at presentation in patients with carcinoma breast was 1.07%. In our study, the 5 year overall survival and disease free survival were 31.3% and 11.7% respectively. The overall response rate (complete plus partial response) to chemoradiotherapy was 88%. About 72% of patients relapsed after the completion of chemoradiotherapy. The median time to relapse was 12 months. The most common site of relapse was distant metastases constituting about 83%. The most common site of distant metastases was lungs (44%). The median follow up duration was 30 months (range 5 – 77 months). The T stage and the clinical response to concurrent chemoradiation had a significant impact on the overall survival in multivariate analysis. Patients with ipsilateral supraclavicular nodal metastases at presentation, but with no other evidence of distant metastases have outcomes more similar to stage IIIB, rather than stage IV. Therapeutic nihilism and sequential palliative interventions alone may well be insufficient unless the patient’s performance status indicates that radical treatment will not be tolerated. The intent of treatment in this subset of patients, therefore should be curative. The definitive multidisciplinary treatment which combines chemotherapy, radiotherapy and surgery has to be the standard of care and will go a long way in improving the treatment outcomes for these patients

In-Context Ability Transfer for Question Decomposition in Complex QA

Answering complex questions is a challenging task that requires question decomposition and multistep reasoning for arriving at the solution. While existing supervised and unsupervised approaches are specialized to a certain task and involve training, recently proposed prompt-based approaches offer generalizable solutions to tackle a wide variety of complex question-answering (QA) tasks. However, existing prompt-based approaches that are effective for complex QA tasks involve expensive hand annotations from experts in the form of rationales and are not generalizable to newer complex QA scenarios and tasks. We propose, icat (In-Context Ability Transfer) which induces reasoning capabilities in LLMs without any LLM fine-tuning or manual annotation of in-context samples. We transfer the ability to decompose complex questions to simpler questions or generate step-by-step rationales to LLMs, by careful selection from available data sources of related tasks. We also propose an automated uncertainty-aware exemplar selection approach for selecting examples from transfer data sources. Finally, we conduct large-scale experiments on a variety of complex QA tasks involving numerical reasoning, compositional complex QA, and heterogeneous complex QA which require decomposed reasoning. We show that ICAT convincingly outperforms existing prompt-based solutions without involving any model training, showcasing the benefits of re-using existing abilities.Comment: 10 page

A comprehensive study on malignant tumours of the maxillary sinus.

Malignant tumours of the maxillary sinus usually presents at an advanced stage due to the surrounding bony walls of maxilla. So by the time the patients reaches an oto-rhino-laryngologist, the condition is advanced making treatment difficult. The malignant tumours of maxillary sinus occurs in only one in 2,00,000 persons per year. This emphasizes the importance of clinical features, in detecting the disease at an earlier stage and to improve the prognosis of the patients. Hence this study was conducted to evaluate the importance of symptoms and signs in facilitating early diagnosis and in predicting the appropriate extent of disease. The aim of the study is to study the age and sex incidence of the tumours, to find the incidence of different symptoms, to correlate the clinical findings and stage of the disease, to compare the clinical staging and radiological staging with preoperative involvement and to determine the prognostic factors in malignant tumours of maxilla particularly in relation with staging of the lesion. Malignant tumours of maxillary sinus present in a quite advanced stage, even though the duration symptoms may be less. The tumour is usually more extensive than the symptomatology and clinical examination suggests. The low success rate may be due to advanced tumour at the time of diagnosis. Symptoms and signs have important role in detecting malignant tumours of maxillary sinus earlier and in improving the outcome of the treatment. Nasal symptoms are the commonest symptom and majority of the patients presenting with nasal symptoms belong to T3 and above even at initial presentation. Clinical staging tends to understage and radiological staging tends to over stage the tumour. Complete surgical removal of tumour with postoperative radiation therapy remains the gold standard for resectable lesions. Maintaining a high suspicion while treating patients with prolonged unexplained nasal problems could help in improving the success rate in malignant tumours of maxillary sinus

Context Aware Query Rewriting for Text Rankers using LLM

Query rewriting refers to an established family of approaches that are applied to underspecified and ambiguous queries to overcome the vocabulary mismatch problem in document ranking. Queries are typically rewritten during query processing time for better query modelling for the downstream ranker. With the advent of large-language models (LLMs), there have been initial investigations into using generative approaches to generate pseudo documents to tackle this inherent vocabulary gap. In this work, we analyze the utility of LLMs for improved query rewriting for text ranking tasks. We find that there are two inherent limitations of using LLMs as query re-writers -- concept drift when using only queries as prompts and large inference costs during query processing. We adopt a simple, yet surprisingly effective, approach called context aware query rewriting (CAR) to leverage the benefits of LLMs for query understanding. Firstly, we rewrite ambiguous training queries by context-aware prompting of LLMs, where we use only relevant documents as context.Unlike existing approaches, we use LLM-based query rewriting only during the training phase. Eventually, a ranker is fine-tuned on the rewritten queries instead of the original queries during training. In our extensive experiments, we find that fine-tuning a ranker using re-written queries offers a significant improvement of up to 33% on the passage ranking task and up to 28% on the document ranking task when compared to the baseline performance of using original queries

Query Understanding in the Age of Large Language Models

Querying, conversing, and controlling search and information-seeking interfaces using natural language are fast becoming ubiquitous with the rise and adoption of large-language models (LLM). In this position paper, we describe a generic framework for interactive query-rewriting using LLMs. Our proposal aims to unfold new opportunities for improved and transparent intent understanding while building high-performance retrieval systems using LLMs. A key aspect of our framework is the ability of the rewriter to fully specify the machine intent by the search engine in natural language that can be further refined, controlled, and edited before the final retrieval phase. The ability to present, interact, and reason over the underlying machine intent in natural language has profound implications on transparency, ranking performance, and a departure from the traditional way in which supervised signals were collected for understanding intents. We detail the concept, backed by initial experiments, along with open questions for this interactive query understanding framework.Comment: Accepted to GENIR(SIGIR'23

Enhancing Programming eTextbooks with ChatGPT Generated Counterfactual-Thinking-Inspired Questions

Digital textbooks have become an integral part of everyday learning tasks. In this work, we consider the use of digital textbooks for programming classes. Generally, students struggle with utilizing textbooks on programming to the maximum, with a possible reason being that the example programs provided as illustration of concepts in these textbooks don't offer sufficient interactivity for students, and thereby not sufficiently motivating to explore or understand these programming examples better. In our work, we explore the idea of enhancing the navigability of intelligent textbooks with the use of ``counterfactual'' questions, to make students think critically about these programs and enhance possible program comprehension. Inspired from previous works on nudging students on counter factual thinking, we present the possibility to enhance digital textbooks with questions generated using GPT.Comment: Paper Under Revie

Non-specific interstitial pneumonia as the initial presentation of biphenotypic acute leukemia: a case report

Nonspecific interstitial pneumonia has been linked to numerous etiologies including, most recently, haematologic malignancy. We present a 46-year-old woman with recent-onset rheumatologic illness who developed pulmonary symptoms as the presenting feature of biphenotypic acute leukaemia. Chest radiology demonstrated bilateral infiltrates, and lung biopsy revealed nonspecific interstitial pneumonia. Corticosteroid therapy resulted in resolution of both her pulmonary and rheumatologic symptoms, and her pulmonary symptoms did not recur following treatment of her leukemia. The case highlights the importance of searching for an underlying etiology when confronted with nonspecific interstitial pneumonia

Physics Potential of the ICAL detector at the India-based Neutrino Observatory (INO)

The upcoming 50 kt magnetized iron calorimeter (ICAL) detector at the India-based Neutrino Observatory (INO) is designed to study the atmospheric neutrinos and antineutrinos separately over a wide range of energies and path lengths. The primary focus of this experiment is to explore the Earth matter effects by observing the energy and zenith angle dependence of the atmospheric neutrinos in the multi-GeV range. This study will be crucial to address some of the outstanding issues in neutrino oscillation physics, including the fundamental issue of neutrino mass hierarchy. In this document, we present the physics potential of the detector as obtained from realistic detector simulations. We describe the simulation framework, the neutrino interactions in the detector, and the expected response of the detector to particles traversing it. The ICAL detector can determine the energy and direction of the muons to a high precision, and in addition, its sensitivity to multi-GeV hadrons increases its physics reach substantially. Its charge identification capability, and hence its ability to distinguish neutrinos from antineutrinos, makes it an efficient detector for determining the neutrino mass hierarchy. In this report, we outline the analyses carried out for the determination of neutrino mass hierarchy and precision measurements of atmospheric neutrino mixing parameters at ICAL, and give the expected physics reach of the detector with 10 years of runtime. We also explore the potential of ICAL for probing new physics scenarios like CPT violation and the presence of magnetic monopoles.Comment: 139 pages, Physics White Paper of the ICAL (INO) Collaboration, Contents identical with the version published in Pramana - J. Physic