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Breast cancer (Luminal and Triple-negative Breast Cancer (TNBC)) is the most common cancer among women in India and worldwide. Altered sphingolipid levels have emerged as a common phenomenon during cancer progression. However, these alterations are yet to be translated into robust diagnostic and prognostic markers for cancer. Here, we present the quantified sphingolipids of tumor and adjacent-normal tissues from patients of luminal (n = 70) and TNBC (n = 42) subtype from an Indian cohort using targeted liquid chromatography mass spectrometry. We recorded unique sphingolipid profiles that distinguished luminal and TNBC tumors in comparison to adjacent normal tissue by six-sphingolipid signatures. Moreover, systematic comparison of the profiles of luminal and TNBC tumors provided a unique five-sphingolipid signature distinguishing the two subtypes. We further identified key sphingolipids that can stratify grade II and grade III tumors of luminal and TNBC subtype as well as their lymphovascular invasion status. Therefore, we provide the right evidence to develop these candidate sphingolipids as widely acceptable marker/s capable of diagnosing luminal versus TNBC subtype of breast cancer, and predicting the disease severity by identifying the tumor grade.

Compensatory changes in cervical sagittal alignment after C1-C2 arthrodesis have been reported in a few studies. No studies have explored the differences in these compensatory changes between traumatic and non-traumatic pathologies. Conflicting reports exist on the correlation between cervical sagittal parameters and neck pain or function.Medical records of 81 consecutive patients [Jan 2010-Dec 2018] who underwent Harms arthrodesis were retrospectively reviewed. 53 patients were included in the final analysis. Radiological parameters [C0-C1, C1-C2, C2-C7 angles and T1 slope] and clinical parameters [VAS (Visual analogue scale) and NDI (Neck disability index)] were compared between the two groups, Group A (traumatic) and Group B (non-traumatic).The 53 patients [Group A (The sub-axial sagittal profile was strongly correlated with the ΔC1-C2 angle in both groups. Group B showed greater changes in sagittal parameters after Harms fixation and Group A showed greater improvement in long-term functional outcomes. The final functional outcomes were not related to the initial or final radiological sagittal profile in both groups.

BACKGROUND: The literature has not distinguished between LF “hypertrophy” and “buckling” when addressing cervical spondylotic myelopathy. The identification of buckling on dynamic magnetic resonance imaging can determine the levels for decompression more accurately and modify the surgical plan accordingly. No studies have been performed in the cervical spine to analyze the factors affecting LF buckling. PURPOSE: Our objective was to investigate the factors affecting static ligamentum flavum (LF) “hypertrophy” and dynamic LF “buckling.” STUDY DESIGN: Retrospective cohort study. METHODS: We conducted a retrospective study of hospital records and imaging database from January 2014 to January 2020. The relation of age, disc height, and intervertebral instability to LF hypertrophy and buckling were assessed. RESULTS: Measurements were performed from C2-3 to C7-T1 in 169 patients who satisfied the eligibility criteria, making a total of 1014 levels. The samples were divided into 2 groups: 798 levels with buckling 1 mm (group B). Of those, 161 levels satisfied the criteria for radiological instability (sagittal translation/rotation). No correlation was observed between age/disc height and buckling. Intervertebral instability showed significant association (P = 0.046) with buckling. No correlation was found between age/intervertebral instability and hypertrophy. CONCLUSION: LF buckling but not hypertrophy is related to intervertebral instability in the cervical spine. LF buckling in the cervical spine is not related to age or disc height in the cervical spine. CLINICAL RELEVANCE: Intervertebral instability on dynamic x-ray imaging of the cervical spine can be a predictor of ligamentum flavum buckling and can be utilized for surgical planning. LEVEL OF EVIDENCE: 3.

Locking compression plate technology needs perfect seating of the locking screw head in the corresponding recess in the plate hole for a stable construct. The purpose of this study is to quantify screw-plate angle. In this study, a total of 750 locking screws of different lengths were placed by six residents. The measured angles were compared with Repeated Measures ANOVA method. Significant differences were seen for 40mm, 50mm, 70mm and 80mm screw length (p < 0.05) to assess the deviation of angle in pre-training, post-training and final experiment. The placement of locking screws precisely can help avoid an easily preventable surgical risk factor for fixation failure. The evolution of Locking Compression Plate (LCP) technology has radically changed the practice of fracture fixation. This technology mandates meticulous detail in surgical technique in placing the locking screw. It demands perfect seating of the locking screw head in the corresponding recess in the plate hole. The purpose of this study is to quantify screw-plate angle i.e., off-axis screw trajectory and its change with an increase in the length of screw and strength of the surgeons.Six orthopaedic residents were selected. The surgeons were familiarized with the instrumentation. A total of 750 locking screws of different lengths were placed in a locking plate in osteoporotic saw bone models using a torque measuring screw driver. The deviation was assessed for 150 screws inserted in pre-training, post-training and the final test under the supervision of the senior author. Immediate feedback on the performance and objective proof of precision was given within an hour by measuring the angle of deviation on X-ray using InstaPACS.Collected data was entered in MS Excel sheet. Descriptive statistics were presented in mean ±SD for continuous variables and count with percentage for Categorical variables. Repeated Measures ANOVA was used to assess the difference in deviation of angle pre-training, post-training and final experiment with the length of the screw. IBM SPSS 25.0 software was used for data analysis. Surgeon grip strength and torque applied had no significant association with the angle of deviation. The surgeons exceeded 10 Newton meter torque in pretraining. This applied torque decreased after training in the post-training and final experiments. The length of the screw and angle of deviation were found to positively correlate in pre-training and final experiment. In this study, 40 out of 150 (26%) studied screw insertions were off-axis. Most of the deviations (29) were only one degree (19.33%). The remaining 11 were more than 2 degrees (6.67%). The maximum off-axis was 4.3 degrees. Significant differences were seen for 40mm, 50mm, 70mm and 80mm screw length (p < 0.05) in pre-training, post-training and the final experiment. : This study signifies that practice under supervision with immediate and objective feedback is a valuable learning tool. Real time feedback definitely improves the surgical confidence that will result in better patient outcome in placing locking screws. The placement of locking screws precisely can help avoid an easily preventable surgical risk factor for fixation failure.

Study design: Single-arm prospective phase I/II clinical trial Objective: Standing and walking are highly desirable goals forpersons with spinal cord injury (SCI). Spinal epidural electrical stimulation (sEES) has been utilized to produce rhythmic activity in animals and more recently, in a few human case reports. Our objective was to assess the safety and efficacy of sEES in the recovery of motor function after severe SCI. Setting: Indian Spinal Injuries Center, New Delhi Methods: Fiveparticipantssatisfying the eligibility criteria includingsevere and chronic SCIand an absence of useful power in the lower limbswere included in the study. The Institute Ethics Committee and the Research Review Committee approved the study and it was registered with Clinical Trials Registry of India. Results: No intraoperative or early postoperative complications were noted in any of the participants. Two participants had wound complicationsat 1 and 3 months respectively and were managed successfully.Improvement in the voluntary power of lower limbs, motor abilities, and functional recoverywas noted in the majority of the participants when the sEESwas turned on. Even with sEES turned off; there was improvement in motor abilities of a participant though there was no demonstrable neurological recovery. Conclusions: sEES is a safe intervention and improves the motor and functional abilities of persons with severe and chronic SCI. Neurological recovery could not be demonstrated. However, a larger,prospective,matched controlledstudy with more participants needs to be done to draw a definite conclusion.

Objectives Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are the major public health issues. Though the prevalence of the disease is high, there is no approved pharmacological treatment. Obeticholic acid (OCA) has not been well described in terms of its efficacy and safety in NAFLD/NASH patients. Hence, we investigated the efficacy and safety of OCA in NAFLD/NASH patients. Key findings PubMed, Cochrane CENTRAL and Google Scholar were searched from 2001 to date for identifying randomized controlled trials (RCTs) which examined the OCA effect on liver enzymes, lipoproteins and liver histology in NASH/NAFLD patients. Four relevant RCTs were identified and included for quantitative analysis. OCA exhibited significant reduction in ALT, AST and GGT levels, whereas in case of liver histology, significant improvement in steatosis, hepatocellular ballooning, lobular inflammation and fibrosis was observed in OCA treatment group [RR: 1.25, 95% CI: (1.03 to 1.52); P = 0.02; I2 = 53%], [RR: 1.39, 95% CI: (1.17 to 1.64); P = 0.0001; I2 = 0%], [RR: 1.23, 95% CI: (1.07 to 1.40); P = 0.002; I2 = 29%] and [RR: 1.85, 95% CI: (1.44 to 2.38); P < 0.00001; I2 = 0%], respectively. Summary Our results indicate that OCA might be used as a potential therapeutic drug candidate in NAFLD/NASH management.

COVID-19 made a huge impact on the world due to its rapid transmission and no treatments being available for it. The virus affected more people and spread to various countries than what was predicted when COVID-19 initially began spreading. There have been numerous pandemics and epidemics in the 21st century yet COVID-19 has affected more people and spread widely. The primary objective of the study was to explore history, spread and associated parameters of existing viruses especially COVID-19. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed for a systematic search to identify eligible published articles. Clinical data, regarding COVID-19 patients, was obtained from previously published articles. The main cause of COVID-19 spreading rapidly was noted to be due to a high percentage of asymptomatic patients, transmission being air-borne, and the lack of knowledge and preventative measures being implemented when the virus began spreading. The common co-morbidity that found in patients was Diabetes Mellitus, Hypertension, and Coronary Heart Disease. The common symptoms, found through the Meta-analysis, that the patients faced included cough (55.4%), fever (68.4%), fatigue (20.3%), and shortness of breath (18.1%). The proportion of asymptotic positive cases was measured 58.3% (95%CI: 24.7% – 87.9%) while mortality proportion was found to be 6.7% (fixed-effect model) and 13.4% (random-effect model). The Meta-analysis indicated that a higher percentage of males were affected by COVID-19 than females and more patients are found to be asymptomatic. Moreover, the mortality rate of patients that have had COVID-19 was found to be low.

Background: Spinal cord injury (SCI) is a debilitating disorder with dysfunction in daily activities and psychological consequences like anxiety as well as depression impacting the quality of life substantially. Existing treatments focus mainly on rehabilitation, symptom reduction, and secondary complications. However, psychological, social, and existential issues are least addressed in the prevailing models. Aims: To study the role of meditation in addressing psychological impairment and any resultant improvement in functional outcomes in SCI patients. Methods: Nonrandomized controlled study was conducted in a tertiary care center for SCI patients. Hospital inpatients were recruited into either experimental intervention group (add on easy raja yoga with conventional rehabilitation-ER n = 50) or control intervention group (conventional rehabilitation alone-CR n = 50). Patients in the ER group received easy raja yoga for 1 month, along with conventional rehabilitation and the CR group patients received only conventional rehabilitation. All the subjects were assessed for psychological (perceived stress scale [PSS], Hospital Anxiety and Depression Scale [HADS]) and functional impairment (spinal cord independence measure (SCIM), numeric pain rating (NPR) and WHO quality of life-BRIEF (WHOQOLBREF)] at baseline and after 1 month. Results: After 1 month of add-on easy raja yoga, there was significant decrease in the scores of HADS (F[1,88] = 272.92, P < 0.001), PSS (F[1,88] = 274.41, P < 0.001) and NPR (F[1,88] = 60.60, P < 0.001) and significant increase in the scores of WHOQOLBREF (F[1,88] = 349.94, P < 0.001) and SCIM (F[1,88] = 29.09, P < 0.001) in the ER group compared to CR group in analysis of covariance. Conclusion: One-month add-on easy raja yoga improves psychological and functional outcomes (HADS, PSS, NPR, WHOQOLBREF and SCIM) in patients with SCI. Future studies with robust designs are needed to validate the results.

BACKGROUND: Numerous publications of the late 20th century have presented the radiological outcome of open technique for distal metatarsal osteotomy for mild to moderate hallux valgus and the clinical outcomes by means of well-established scoring systems which have been published and make these open techniques today’s benchmark and gold standard. Minimally invasive procedures reduce surgical trauma because they are performed without large incisions, and injury to the soft tissues is limited. This has the theoretical advantages of improved recovery and decreased rehabilitation times. There is however limited literature to prove the same for minimally invasive surgery for hallux valgus. Our aim was thus to pool all available comparative literature on minimally invasive hallux valgus surgery done for mild to moderate hallux valgus versus open surgical approaches. METHODS: A PubMed, Embase and Scopus search was performed using the keywords (‘hallux valgus’ OR bunion) AND (‘minimally invasive’ OR percutaneous) AND osteotomy. A total of 473 records were identified and out of which nine studies were included in the final review. RESULTS: Most available studies are either randomized control trials, or prospective cohort studies providing good level of evidence. Radiological analysis showed similar correction with both MIS and open osteotomies. In functional analysis results were different with open techniques providing better results in terms of AOFAS score. (p

Air pollution is a global public health threat. Evidence suggests that increased air pollution leads to increased cardiovascular morbidity and mortality. The aim of this review was to systematically review and synthesize scientific evidence to understand the effect of performing outdoor physical activity (PA) in a polluted environment on cardiovascular outcomes. This review was developed and reported in accordance with the PRISMA guidelines. Electronic searches in Embase, Web of Science, and PubMed were undertaken through March 2021 initially, and later updated through to 31st January 2022, for observational studies published in peer-reviewed journals that report cardiovascular mortality or morbidity due to outdoor PA in air polluted environment. These searches yielded 10,840 citations. Two reviewers independently reviewed each citation for its eligibility. Seven studies were found to be eligible. Of these, five were cohort studies and two were cross-sectional studies. Pollutants measured in the selected studies were Particulate Matter (PM)—PM10, PM2.5, nitrogen oxides (NOx), and ozone (O3). The most common study outcome was myocardial infarction, followed by cardiovascular mortality, hypertension and heart rate variability. Six studies emphasized that the PA has beneficial effects on cardiovascular outcomes, though air pollutants attenuate this effect to an extent. Two studies showed that walking, even in the polluted environment, significantly reduced the heart rate and heart rate variability indices. The beneficial effects of outdoor PA outweigh the harmful effects of air pollution on cardiovascular health, though the benefits reduce to an extent when PA is carried out in a polluted environment. Because a limited number of studies (n = 7) were eligible for inclusion, the review further emphasizes the critical need for more primary studies that differentiate between outdoor and indoor PA and its effect on cardiovascular health.

An utmost increase of breast cancer burden during the last several decades was reported in Asian countries. Findings from literature confirm that risk factors of breast cancers can be modifiable and non-modifiable in nature.The present study is designed to identify specific modifiable and non-modifiable risk factors associated with breast cancer.A matched case-control study was conducted considering 187 cases as women diagnosed with breast cancer and 187 hospital-controls as women without having breast cancer visiting the hospital. Other than standard risk factors, stress is measured using Perceived Stress Scale (PSS) and stress is measured using Pittsburgh Sleep Quality Index (PSQI). Several modifiable and non-modifiable risk factors were assessed using conditional logistic regression to find out significant association with breast cancer.Regular multi-vitamin uptake (OR = 3.38; 95%CI = 1.69 - 6.77; p-value = 0.001), poor sleep (OR = 11.29; 95%CI = 4.36 - 29.25; p-value0.001), irregular sleep (OR = 34.11; 95%CI = 10.03 - 115.92; p-value0.001) and severe stress (OR = 6.74; 95%CI = 3.06 - 14.81; p-value0.001) were found to be the highest odds ratio among all modifiable risk factor of breast cancer. Also, age at first childbirth less than 30 years (OR = 0.44; 95%CI = 0.25 - 0.78; p-value = 0.005) was found protective against breast cancer.In our study, stress, sleeping pattern, and regular multi-vitamin uptake were found to be significant modifiable risk factors of breast cancer. None of the non-modifiable risk factors were found to be significantly associated with the risk of breast cancer.

Online education approach provides innovative opportunities for engaging youths. Web-based, multimedia smoking prevention programs have been tested in high-income countries; however, efficacy of such programs is not well-investigated in low- and middle-income countries. The aim of this study was to evaluate the impact of A Smoking Prevention Interactive Experience (ASPIRE), an interactive tobacco prevention curriculum, among university students in India.A single-subject cohort study where each subject serves as their own control was conducted among university student participants engaged in ASPIRE, 60 minutes per week for five consecutive weeks during July to August of 2019. Assessments were conducted at baseline and immediately after exposure to ASPIRE. To evaluate the program, a structured instrument was specifically designed to measure the outcomes.A total of 103 university students participated voluntarily. Average age of the participants was 18.3±0.9 ranging from 17 to 20 years. Eighteen percent of students were curious to know about the various smoking products. More males were more susceptible to cigarette smoking as compared to females. The majority of participants felt that ASPIRE was culturally appropriate for young adults in India, but a modified version targeted toward Indian youth would be more acceptable. Pre- to postintervention knowledge of tobacco-related hazards increased from 70 to 97% (p < 0.001).ASPIRE, a multimedia interactive program, demonstrated its considerable potential to discourage smoking initiation among Indian youth.

Background: A biosimilar product is expected to exhibit similar safety, efficacy, and quality as that of the approved reference product. Only a few reports of thorough evaluation of the quality of insulin glargine biosimilars are available in literature. Here, we examine the structural and functional similarity of biosimilars of insulin glargine, the first basal long-acting insulin analogue with respect to its innovator product (Lantus® from Sanofi Aventis). Methods: Structural similarity was established using mass spectrometry, chromatographic, and spectroscopic techniques. Stability was compared by performing accelerated thermal stress studies. Functional similarity was established via in vitro assay. Results: Biosimilar 4 exhibited greater content of high molecular weight species (HMWs) (0.80%) and related substances (RS) (0.45±0.06%) vs others (HMWs of 0.04% and RS of 0.17%). Biosimilars 1 and 3 exhibited higher rate of impurity generation (0.78% and 0.73% per week, respectively), as compared with other drug products (0.02% to 0.43% per week). Furthermore, %aggregation at 14 days was found to statistically correlate ( R2= 0.99, root mean square error (RMSE) = 0.095) with %aggregation at 0 day (linearly) and the number of months from expiry (nonlinearly), highlighting the overpowering impact of the latter. Conclusions: While an overall structural and functional similarity was observed across insulin glargine biosimilars with respect to the innovator product, low amounts of product-related variants were seen in some biosimilars and these impact product stability. The %aggregation at 14 days exhibits statistical correlation with %aggregation at 0 day and the number of months from expiry. The order of biosimilarity was denoted as Lantus®>Biosimilar 2>Biosimilar 4>Biosimilar 1>Biosimilar 3.

Background Pulmonary and pleural involvement is fairly common in patients with lymphoma, especially in the setting of progressive or recurrent disease. Pleuropulmonary involvement in lymphoma may occur as a single pattern or as a combination of multiple patterns which can often mimic unrelated pathologies. Methods Review of our institutional database from 01 Jan 2015 to 04 Oct 2017 revealed 90 patients with pulmonary and/or pleural lesions attributable to lymphoma. These lesions were classified into various categories, and the pattern of involvement was evaluated. Results Pulmonary involvement was seen in 17.6% of patients with Hodgkin lymphoma (HL) and in 10.5% of patients with non-Hodgkin lymphoma (NHL), whereas pleural involvement was seen in 6.5% of patients with NHL. Almost all the patients in our study had findings belonging to multiple categories. Pulmonary involvement in patients with HL was seen in the form of nodules (51.6%), masses (51.6%), and direct extension from a mediastinal/hilar mass (45.2%). Patients with NHL had pulmonary involvement in the form of nodules (42.4%), direct extension from a mediastinal/hilar mass (25.4%), pulmonary masses (18.6%), and interstitial pattern (2.4%). Pleural thickening (61.5%), masses (30.8%), and effusion (15.4%) were the three patterns of pleural involvement. Conclusion Nodules and masses were the two commonest patterns of pulmonary involvement in patients with HL, whereas nodules were the commonest pattern noted in patients with NHL. Pulmonary masses were seen more commonly in patients with HL than in those with NHL. Pleural involvement was seen exclusively in patients with NHL.

Objectives Hepcidin is linked to glucose metabolism in women with gestational diabetes mellitus (GDM). This systematic review and meta-analysis was conducted to determine the association between hepcidin levels and GDM. A literature search was performed using different databases to identify potential studies investigating hepcidin association in GDM patients. The effect sizes were calculated based on the standardized mean difference (SMD) and Fisher’s Z value with a 95% confidence interval (CI). Key findings Out of 827 articles, only 7 case–control studies satisfied the inclusion and exclusion criteria. The pooled SMD of circulatory hepcidin levels in GDM patients was considerably higher than normal pregnant women (SMD = 1.69; 95% CI, 0.86 to 2.53; P < 0.0001). This study also observed that hepcidin levels were positively correlated with ferritin levels (r = 0.264; Z = 0.27; P < 0.0001). Furthermore, a subgroup analysis of serum and plasma groups revealed significantly higher hepcidin levels in serum (SMD = 2.12; 95% CI, 0.44 to3.79; P = 0.001) than in the plasma group (SMD = 1.28; 95% CI, 0.32 to 2.2; I2 = 96%). Summary Our findings suggest that hepcidin levels may be elevated in GDM patients, making it a viable marker for GDM diagnosis, and regular monitoring of its levels could be helpful in aiding clinical decisions.

Study Design: A retrospective case-control study. Objective: Only a few studies have studied the incidence of new-onset SI joint pain following lumbar spine fusion surgery. We aimed to explore the association between new-onset SI joint pain following Transforaminal Lumbar Interbody Fusion (TLIF) for degenerative spine disorders and changes in spinopelvic parameters. Methods: A retrospective review of hospital records and imaging database of a tertiary care institute was done for patients who underwent TLIF from October 2018 to October 2019. The 354 patients who satisfied the eligibility criteria were divided into 2 groups(Group A, new-onset SI joint pain group, n = 34 and Group B, normal controls, n = 320). Symptomatic relief (>70% reduction in the VAS [Visual Analogue Scale] score) after 15 minutes of SI joint injection was considered diagnostic of SI joint pain. Clinical and radiological spinopelvic parameters were compared between the 2 groups. Results: Patients with postoperative SI joint pain (Group A) had significantly less preoperative and postoperative lumbar lordosis (p < 0.001) compared to the other group. Most of the patients in Group A had a cephalad migration of the apex postoperatively (30/34 patients) whereas majority of patients in group B had either predominant caudal migration (44/320 patients) or no migration of the lumbar apex (272/320 patients). Conclusions: The preoperative and postoperative lumbar lordosis are significantly less and the postoperative pelvic tilt is significantly high in patients with new-onset SI joint pain compared to the control group. The cephalad migration of the lumbar apex is significantly associated with new-onset SI joint pain.

Study Design: Cross-sectional study.Purpose: This study aimed to understand the sagittal spinopelvic parameters, segmental lumbar parameters, and lumbar apex location in asymptomatic adults and analyze their correlations with each other.Overview of Literature: Roussouly and his colleagues reported that pelvic incidence (PI) influences the lower arc of lumbar lordosis, whereas Pesenti and his colleagues reported that PI influences only the proximal part of lordosis and not the distal part. Both studies have their shortcomings.Methods: One hundred asymptomatic adult volunteers (mean age, 29.1±7.9 years; 69 males, 31 females) who satisfied the selection criteria were enrolled in this study. Standing antero-posterior and lateral whole spine and pelvis X-rays were performed, and the radiographic parameters were analyzed. We introduced a “segmentation line” bisecting the apical vertebra/disk to divide the upper arc of lumbar lordosis (ULL) and lower arc of lumbar lordosis (LLL).Results: The mean PI was 48.02°, ULL 29.12°, LLL 16.02°, total lumbar lordosis (TLL) 45.14°, lumbar tilt angle 4.73°, and location of the apex of lumbar lordosis (LLA) 4.11°. The location of the lumbar apex moved higher as the PI increased. The PI was strongly positively correlated with the LLL (r =0.582, p r =0.579, p r =0.196, p =0.05). The LLA was strongly positively correlated with the ULL (r =0.349, p r =−0.63, p r =−0.177, p =0.078).Conclusions: The PI influences the location of the lumbar apex, the LLL, and the TLL but not the ULL. The location of the lumbar apex significantly influences the segmental lordosis but not the TLL.

Background: Surgical decompressions are typically warranted in patients with magnetic resonance (MR) and clinical evidence of cauda equina syndromes (CESs). However, it is still unclear what MR findings best correlate with such CES. Here, we compared MR-documented canal size and level/extent of compromise in 52 patients with and 56 others without CES attributed to lumbar disc herniation. Methods: This was a retrospective study of 52 patients with and 56 patients without CES attributed to MR- documented lumbar disc herniations (IDHs). The anteroposterior diameters of the spinal canal and the levels of maximal compression were documented and compared utilizing MR scans from both groups. Results: The 52 patients with CES had more extensive narrowing of the canal diameters at the L4-L5 and L5- S1 levels and higher mean canal compression ratios versus 56 patients without CES. The mean percentage of compression in the CES group at L4-L5 and L5-S1 levels (70% and 67.5%, respectively) was less versus L2-L3 and L3-L4 levels (89.7% and 81.8%, respectively). Conclusion: The 52 patients with CES due to IDH had greater canal compromise versus 56 without CES. Further, the percentage of canal compromise was less at L4-L5 and L5-S1 levels compared to other levels in patients with CES.

Background Syndesmosis injuries are common with rotational ankle injuries, and placement of a positional syndesmotic screw to maintain its reduction is used as the ligaments heal. There is no clear consensus on routine removal or retention of syndesmotic screw. This study aimed to appraise the current evidence both on removal and retention of syndesmotic screw and to conduct a meta-analysis comparing outcomes and rate of complications of syndesmotic screw removal and retention. Methods Following PROSPERO registration, a systematic search using was performed using keywords (‘Syndesmosis’ OR ‘Syndesmotic’ OR ‘Transsyndesmotic’ OR ‘distal tibiofibular’) AND (‘Screw’) AND (‘Removal’ OR ‘Retention’) AND ‘Outcome’ in various databases. No language restrictions were applied and the meta-analysis incorporated the PRISMA statement. VAS (Visual analogue scale for pain), AOFAS (American Orthopaedic Foot And Ankle Society) scores expressed as mean ± SD, and both groups’ complication rates were compared. Comparisons with a random-effects model were performed, and heterogeneity between the studies was calculated using the I2 statistic. T-test for two independent sample means was used to compare pooled mean and Z-test for two proportions to assess the difference in the proportion of complications. Results A total of 7 studies with 522 patients were included in this review for analysis. Pooled analysis showed non-significant difference in AOFAS score (MD = −1.84; 95% CI: −4.33 to 0.66; p = 0.150) as well as for VAS score (MD = −0.48; 95% CI: −1.56 to 0.60; p = 0.390) between the two groups. The value of z and p-value for complication rates was 0.6021 and 0.5485, respectively, which was not significant. Conclusion There doesn’t appear to be a difference in functional outcome, pain scores, and complication rates between patients who had their syndesmotic screws removed and those where screw was retained. The fear of inferior outcomes with retained screws is thus unfounded, and routine removal adds to morbidity and financial burden. In conclusion, present data does not support the routine removal of the intact syndesmosis screw, and a change in practice is needed to abandon routine syndesmotic screw removal.

Unfortunately, the original version of this article has been published with misplaced data under the heading “Meta-analysis”.

Background/Objective: India is the world's most biodiverse region and is undergoing a period of dramatic social and economic change. Due to population's explosion, climate change and lax implementation of environmental policies, the incidence of breast cancer is increasing. From population-based cancer registry data, breast cancer is the most common cancer in women in urban registries where it constitutes more than 30% of all cancers in females. We conducted a meta-analysis of all breast cancer case–control studies conducted in India during 1991–2018 to find pooled estimates of odds ratio (OR). Materials and Methods: Eligible studies were identified through a comprehensive literature search of PubMed, EMBASE, and HINARI databases from 1991 to January 2018. This analysis included 24 observational studies out of 34 that reported the case–control distribution of reproductive factors, body mass index (BMI) and type of residence. The analysis was performed using RevMan 5.3 (Review Manager, 2017) applying the random-effects model. Results: A total of 21,511 patients (9889 cases and 11,622 controls) were analyzed, resulting in statistically significant association between breast cancer and the following reproductive factors: never breastfeed (OR: 3.69; 95% confidence interval [CI]: 1.70, 8.01), menopausal age >50 years (OR: 2.88; 95% CI: 1.85, 3.85), menarche age 25 years (OR: 1.57; 95% CI: 1.37, 1.80). Family history (FH) of breast cancer (OR: 5.33; 95% CI: 2.89, 9.82), obesity (OR: 1.19; 95% CI: 1.00, 1.42), and urban residence (OR: 1.22; 95% CI: 1.03, 1.44) were also found to be significant risk factors. Conclusion: The results of this meta-analysis are indicative of significant associations between reproductive factors and breast cancer risk, profoundly so among women experiencing menopause after the age of 50, women who never breastfeed and FH of breast cancer.

Oxidative stress (OS) plays an important role in Alzheimer's disease (AD) and glutathione (GSH) mitigates this effect by maintaining redox‐imbalance and free‐radical neutralization. Quantified brain GSH concentration provides distinct information about OS among age‐matched normal control (NC), mild cognitive impairment (MCI) and AD patients. We report alterations of in vivo GSH conformers, along with the choline, creatine, and N‐acetylaspartate levels in the cingulate cortex (CC) containing anterior (ACC) and posterior (PCC) regions of 64 (27 NC, 19 MCI, and 18 AD) participants using MEscher–GArwood‐Point‐RESolved spectroscopy sequence. Result indicated, tissue corrected GSH depletion in PCC among MCI (p = .001) and AD (p = .028) and in ACC among MCI (p = .194) and AD (p = .025) as compared to NC. Effects of the group, region, and group × region on GSH with age and gender as covariates were analyzed using a generalized linear model with Bonferroni correction for multiple comparisons. A significant effect of group with GSH depletion in AD and MCI was observed as compared to NC. Receiver operator characteristic (ROC) analysis of GSH level in CC differentiated between MCI and NC groups with an accuracy of 82.8% and 73.5% between AD and NC groups. Multivariate ROC analysis for the combined effect of the GSH alteration in both ACC and PCC regions provided improved diagnostic accuracy of 86.6% for NC to MCI conversion and 76.4% for NC to AD conversion. We conclude that only closed GSH conformer depletion in the ACC and PCC regions is critical and constitute a potential biomarker for AD.

Background: Whereas the concept of normal levels of various parameters is extensively used in medical practice, the concept of optimal levels has not received much attention. We propose that it is time to pay attention to the optimal levels so that positive health can be measured. Objective: The objective is to define optimal levels of medical parameters as that combination which prevents the occurrence of ailments or gives strength to fight these ailments if they occur. Methods: A large number of articles and other literature was reviewed in search of medical parameters and their levels that could be considered to indicate optimal levels. Result: The optimal combination of medical parameters that prevents occurrence of ailments and gives strength to fight if an ailment occurs, is conceptually beyond the ‘normal’ levels that we use in everyday clinical practice and can be considered to indicate positive health. This is illustrated with the help of several examples after dividing the concept of positive health into five domains on the pattern of quality-of-life assessment. Conclusion: A concept of positive health has been proposed and its link to the optimal level of medical parameters is described. We plead that more efforts be made to identify the positive parameters of health, and their optimal levels that measure positive health be delineated.

The presence of minimal residual disease (MRD) is one of the strong predictors of disease outcome in various hematological malignancies including B-ALL and T-ALL, independent of pre-therapeutic risk factors. There is scant Indian data on MRD by flowcytometry in T-ALL including gating strategies, clinical correlation etc. The primary aim of this retrospective observational study was to define the clinico-hematologic characteristics and prognostic significance of patients with ETP/near-ETP versus non-ETP immunophenotype, especially in terms of minimal residual disease at different time points as well as event-free survival (1 year). Baseline hematologic characteristics along with post-induction (Day-35) and post-consolidation (Day-78) MRD in bone marrow samples from newly diagnosed T-ALL patients were studied. 14.3% patients had ETP-ALL immunophenotype, 11.4% were near-ETP ALL patients and the remaining 74.5% were of non-ETP subtype. The ETP/near ETP patients was significantly associated with higher risk of MRD positivity ( > 0.01%) at the end of induction in comparison to the non-ETP patients (p = 0.033). Also, these patients showed a trend towards proclivity to anemia (p = 0.06) and higher rates of induction failure (p = 0.07) However, no difference was observed between the two subgroups in terms of age, high TLC, thrombocytopenia, adverse cytogenetics, steroid responsiveness on Day + 8 of induction, MRD-positivity > 0.01% at the end of consolidation and EFS-1 year. Through this preliminary study, it can be stated clearly that ETP status is associated with MRD > 0.01% post-induction but has no significant impact on long-term survival of these patients.

Spinal Cord Society (SCS) and Spine Trauma Study Group (STSG) established a panel tasked with reviewing management and prognosis of acute traumatic cervical central cord syndrome (ATCCS) and recommend a consensus statement for its management. A systematic review was performed according to the PRISMA 2009 guidelines. Delphi method was used to identify key research questions and achieve consensus. PubMed, Scopus and Google Scholar were searched for corresponding keywords. The initial search retrieved 770 articles of which 37 articles dealing with management, timing of surgery, complications or prognosis of ATCCS were identified. The literature review and draft position statements were compiled and circulated to panel members. The draft was modified incorporating relevant suggestions to reach consensus. Out of 37 studies, 15 were regarding management strategy, ten regarding timing of surgery and 12 regarding prognosis of ATCCS. There is reasonable evidence that patients with ATCCS secondary to vertebral fracture, dislocation, traumatic disc herniation or instability have better outcomes with early surgery (

Aim: Circulatory GDF-15, angiotensin II (Ang-II) and GDF-15 mRNA expression levels were examined in three groups, in other words, control (n = 25), Type 2 diabetes (T2DM; n = 25) and Type 2 diabetes with hypertension (T2DM_HTN; n = 36). Results: T2DM and T2DM_HTN subjects had significantly (p < 0.05) higher GDF-15 and Ang-II levels compared with control subjects. Significant positive correlation was found between Ang-II and GDF-15 levels. GDF-15 mRNA expression from blood cells was significantly elevated in T2DM_HTN (p < 0.05) but not in T2DM subjects. GDF-15 mRNA expression was significantly elevated in Ang-II-treated (50 nM) THP-1 (p < 0.001) and H9C2 (p < 0.05) cells but not altered after high glucose treatment. Conclusion: Collectively, our data suggest that higher levels of GDF-15 is associated with increased Ang-II levels in diabetic patients with concurrent hypertension.

Chemotherapy-induced vomiting is a common adverse effect of cancer treatment. We assessed the non-inferiority of palonosetron versus ondansetron in prevention of acute chemotherapy-induced vomiting in children with cancer in 2–18 years of age. In this single-center, open-label, randomized study, children receiving moderate and high emetogenic chemotherapy were assigned to get either ondansetron or palonosetron in addition to other antiemetic prophylaxis. The primary efficacy endpoint was the proportion of children with complete response during the acute phase of the first on-study chemotherapy cycle. Non-inferiority was assessed by demonstration of lower limit of the 97.5% confidence interval for differences in complete response rates in palonosetron arm to be superior by − 15%. Risk factors for suboptimal response and the cost of administration of two drugs were also analyzed. A total of 108 children were analyzed and various factors likely to influence response were equally distributed in two arms. These 108 patients received 412 blocks of chemotherapy. During the acute phase, complete responses were recorded in 72.2% (39/54) and 83.3% (45/54) receiving ondansetron and palonosetron, respectively (ΔCR + 11.1%). The lower limit of 97.5% confidence interval (− 6.95–28.39) for this difference was greater than − 15% in palonosetron arm. Only statistically significant risk factor that predisposed response was use of dexamethasone (p value

The purpose of the present study was to measure six vitamin D metabolites and to find the association between vitamin D deficiency and coronary artery diseases in diabetes (T2DM_CAD). Four groups [control (n = 50), type 2 diabetes (T2DM, n = 71), coronary artery diseases (CAD, n = 28), T2DM_CAD (n = 38)] of total 187 subjects were included in the study. Six vitamin D metabolites (D2, D3, 25(OH)D2, 25(OH)D3, 1,25(OH)2D2, 1,25(OH)2D3), total 25(OH)D and total 1,25(OH)2D were measured by UPLC/APCI/HRMS method in these subjects. Although all the vitamin D metabolites were significantly decreased in T2DM_CAD as compared to both control and T2DM subjects (p 3 and total 25(OH)D were significantly (p 3, 1,25(OH)2D2, 25(OH)D, and 1,25(OH)2D levels were significantly decreased in T2DM_CAD subjects as compared with CAD subjects (p 2D can be used to predict T2DM (OR 0.82.95% CI 0.68–0.99; p = 0.0208) and T2DM with CAD (OR 0.460, 95% CI 0.242–0.874; p = 0.0177), respectively. Our data concludes that lower concentration of 1,25(OH)2D is associated with type 2 diabetes coexisting with coronary artery diseases in South Indian subjects.

Background & objectives: Breast cancer is the most common cancer of women. Inferior prognosis in some patients has been attributed to the higher proliferative capability of the tumour. Immunohistochemistry (IHC) for Ki-67, despite being a simple and cost-effective method, has not become a valid tool to evaluate this biomarker. This is ascribed to variation in pre-analytical and analytical techniques, variable expression, hotspot distribution and inter-and intra-observer inconsistency. This study was aimed at defining the analytical and clinical validity of real-time quantitative polymerase chain reaction (RT-qPCR) as an alternative to IHC evaluation. Methods: This study included a total of 109 patients with invasive breast cancers. Ki-67 IHC visual assessment was compared with the mRNA value determined by RT-qPCR. Concordance between both the methods was assessed. Receiver operating characteristic (ROC) curve analysis and Cohen's kappa value with intraclass correlation were performed. Results: The threshold value for Ki-67 by RT-qPCR obtained by ROC curve was 22.23 per cent, which was used to divide breast cancer cases into high proliferative and low proliferative groups. A significant correlation was observed between both the breast cancer groups formed using RT-qPCR threshold as well as median laboratory value of Ki-67 labelling index by IHC. Interpretation & conclusions: The study results showed a significant correlation between the two methods. While IHC is subject to technical and interpretative variability, RT-qPCR may offer a more objective alternative.