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1.  A Macro-to-Micro Interface for the Control of Cellular Organization 
The spatial organization of cellular communities plays a fundamental role in determining intercellular communication and emergent behavior. However, few tools exist to modulate tissue organization at the scale of individual cells, particularly in the case of dynamic manipulation. Micromechanical reconfigurable culture achieves dynamic control of tissue organization by culturing adherent cells on microfabricated plates that can be shifted to reorganize the arrangement of the cells. While biological studies utilizing this approach have been previously reported, this paper focuses on the engineering of the device, including the mechanism for translating manual manipulation to precise microscale position control, fault-tolerant design for manufacture, and the synthetic-to-living interface.
doi:10.1109/JMEMS.2013.2278813
PMCID: PMC4495972  PMID: 26167106
Biological cells; Micromechanical devices; Tissue engineering
3.  Elevated intrinsic cancer stem cell population in human papillomavirus-associated head and neck squamous cell carcinoma 
Cancer  2013;120(7):992-1001.
Background
Human papillomavirus 16 (HPV16) is a major risk factor for the development of head and neck squamous cell carcinoma (HNSCC), in particular, oropharyngeal SCC (OPSCC). Cancer stem cells (CSCs) are resistant to conventional therapies and postulated to be responsible for disease recurrence and/or progression. Since the prognosis of HPV16-positive and HPV-negative HNSCC are distinct, we determine if differences in the CSC number may account for this clinical observation.
Methods
CSC population in HPV16-positive and HPV-negative HNSCC was assessed using the ALDEFLUOR assay, in vitro tumorsphere formation assay, and in vivo limiting cell dilution in NOD/SCID mice. A high-density tissue microarray was stained with ALDH1, a CSC marker, to determine the association between CSCs and HPV16-positive/HPV-negative OPSCC.
Results
HPV16-positive HNSCC had a higher intrinsic CSC pool than HPV-negative HNSCC. Inactivation of p53 is a major mechanism for elevated CSC population in HPV16-positive HNSCC. In vivo limiting cell dilution experiments using HPV16-positive and HPV-negative OPSCC patient tumors indicated that the CSC frequency is 62.5-fold higher in the HPV16-positive OPSCC tumor than in the HPV-negative OPSCC tumor. Primary tumors from HPV16-positive OPSCC patients were associated with elevated tumor ALDH1 staining further extending the association between HPV16 and CSC.
Conclusions
Our data and the clinical observation that HPV16-positive HNSCC patients respond more favorably than HPV-negative HNSCC patients to current treatment paradigms support the suggestion that CSC phenotype is not homogeneous. Therefore, the reliance on CSC number may be insufficient to accurately assess the potential of a particular tumor for disease recurrence and/or progression.
doi:10.1002/cncr.28538
PMCID: PMC3961512  PMID: 24382806
cancer initiating cells; cancer stem cells; head and neck cancer; human papillomavirus; ALDH1; prognostic biomarker
5.  A 10-year follow-up of transpedicular screw fixation and intervertebral autogenous posterior iliac crest bone graft or intervertebral B-Twin system in failed back surgery syndrome 
Asian Journal of Neurosurgery  2015;10(2):75-82.
Background:
The spine surgeons have been combining anterior and posterolateral fusion (circumferential fusion) as the final solution to treat spinal disorders and many have been using it to treat failed back surgery syndrome (FBSS). In present study, we analyzed and compared the clinical and radiological outcomes in patients with transpedicular screw fixation and intervertebral autogenous posterior iliac crest bone graft or in patients with transpedicular screw fixation and intervertebral B-Twin system for FBSS with a follow-up period of 10 years after the surgery.
Materials and Methods:
This study was a retrospective case study performed on 55 patients with FBSS. Clinical and radiological changes were compared between the two groups of patients on the basis of improvement of back pain, radicular pain, and work capacity. Outcome was measured in terms of Oswestry Low Back Pain Disability Index, and the changes in pain and function were documented every year from before surgery until 2012. We analyzed the evolution of 55 cases of FBSS those underwent segmental circumferential posterior fusions from June 2001 to February 2003, operated by a single surgeon and followed up during 10 years until February 2012. The patients were divided into 2 groups: In 25 patients, posterolateral fusions with Legacy™ (Medtronic, Inc. NYSE: MDT) screws and intersomatic autogenous posterior iliac crest bone graft was performed, and, in 30 patients, posterolateral fusions with the same screws and intersomatic fusion B-Twin (Biomet Spain Orthopaedics, S.L.) system was performed. In all cases, we used posterior lumbar interbody fusion (PLIF)/transforaminal lumbar interbody fusion (TLIF) approach for intervertebral graft, and the artrodesis was supplemented at intertransverse level with Autologus Growth Factor (AGF-MBA INCORPORADO, S.A.). The outcome was measured in terms of Oswestry Low Back Pain Disability Index, and the changes in pain and function were documented every year and compared from before surgery to the final follow-up visit. Preoperative and postoperative scores were available for all patients.
Results:
The average age of these patients was comparable in both groups (mean age 42.6 versus 50.2 years). The average follow-up period was 200.6 months in the first group (screws and intersomatic bone) and 184.4 months in the second group (screws and B-Twin). In the autologus bone graft group, the CT scan and Rx study revealed loss of height of intervertebral space between 25% and 45% of 24 h postoperative height of intervertebral operated disc, and the patients continued to lose the height until 20 months after the surgery. In the B Twin group, the CT scan and Rx study revealed a loss of height of the intervertebral level of 8-12% over a period of 9 months follow-up, followed by stability. A total of 31 patients (55%) had improved Oswestry Low Back Pain Disability Index >40% of the total possible points, although this did not reflect in PSI or return to work rate.
Conclusions:
The patients with rigid fixation do well in terms of correction of lumbar lordosis, but they do not do well in terms of recurrence of pain. Furthermore, they need some kind of intervention to control pain after the first year after surgery. In patients in whom bone graft is used, although they do not maintain and sustain the lumbar lordosis in the long term, they have less recurrence of pain with less chances of intervention for pain control.
doi:10.4103/1793-5482.145120
PMCID: PMC4421972  PMID: 25972934
Chronic low back pain; degenerative disc disease; failed back surgery syndrome; functional outcome; lumbar spinal fusion; spondylosis
7.  Tele-recruitment for Donor Retention 
Blood transfusion services are the integral part of health care system and these services have safe blood transfusion as the major goal. Voluntary blood donation is the key to safe blood and this safety is further enhanced when the voluntary blood donors become repeat/regular donors. Retention of donors is therefore a very crucial strategy to ensure enhanced blood safety. Tele-recruitment is an effective medium of recruiting and more importantly retaining donors via means of telephone/Short Message Service. This study was carried out at a standalone blood bank during the period from January to December 2011 with objectives of donor retention, relationship management with the support of personnel with good communication skills, Donor data base, Integrated software and communication facility. For Initial 4 months there was no tele-recruiter, then for 2 months two tele-recruiter and for next 6 months three tele-recruiter were dedicated. Only impact of tele-recruitment on in-house donation was taken into consideration. 2,091 donors were recruited through tele-recruitment in this eight-month period. This was 63 % of in-house donations and 13 % of total donations. In other words out of every five in-house donations, three donations were from people contacted through tele-recruitment. Repeat voluntary blood donation is the safest donation. Tele-recruitment does this by converting ‘first-time’ donors into repeat/regular donors. Simple intervention like reminder calls on telephone can be highly effective tool to retain donors. Tele-recruitment helped the blood center establish relationships with individual donors, and, maybe, even the society at large. Tele-recruitment is a very low-cost model which can be easily replicated in all kind of blood banks, be it standalone, or a hospital based. Even the blood centers which are largely dependent on replacement donors can possibly have good results and convert replacement donors into repeat/regular voluntary blood donors.
doi:10.1007/s12288-012-0197-0
PMCID: PMC3921330  PMID: 24554816
Voluntary blood donation; Donor retention; Relationship management
8.  Interscalene brachial plexus block for shoulder arthroscopic surgery: Prospective randomised controlled study of effects of 0.5% ropivacaine and 0.5% ropivacaine with dexamethasone 
Indian Journal of Anaesthesia  2015;59(3):171-176.
Background and Aims:
Various adjuvants have been used to prolong the duration of local anaesthetic action after peripheral and regional nerve blocks. We evaluated the effect of dexamethasone on the duration of pain relief in shoulder arthroscopic surgeries performed under interscalene brachial plexus using ropivacaine as local anaesthetic.
Methods:
After Ethical Committee approval and informed consent from patients we performed a prospective, randomised, comparative study on patients scheduled for arthroscopic shoulder surgery under interscalene block (ISB). Patients in ropivacaine group (Group R) received 30 ml of 0.5% ropivacaine plus 2 ml normal saline (n = 50) and dexamethasone-ropivacaine (Group RD) received 0.5% ropivacaine 30 ml plus 8 mg dexamethasone (4 mg/ml) (n = 50). Duration of analgesia, onset of sensory and motor block, success and failure of block, and complications were recorded and compared. Computer software SPSS version-16 (SPSS Inc., Chicago, Illinois, USA) was used for statistical analysis. Chi-square test and Student's t-test were used and P < 0.05 was considered as significant.
Results:
The mean duration of analgesia in Group RD was 1103.72 ± 296.027 min and in Group R it was 551.54 ± 166.92 min (P = 0.0001). Onset of sensory block in Group RD was 12.24 ± 1.88 min and in Group R was 13.48 ± 1.81 min (P = 0.5170). Onset of motor block in Group RD was 16.24 ± 2.04 min and in Group R was 17.76 ± 2.21 min (P = 0.2244). Onset of surgical anaesthesia in Group RD was19.46 ± 1.86 min and in Group R was 20.84 ± 1.71 min (P = 0.0859).
Conclusion:
Dexamethasone significantly prolonged duration of analgesia of ropivacaine during ISB used for arthroscopic surgeries of shoulder. Dexamethasone when mixed with ropivacaine had no effect on the onset of sensory and motor effects of ISB with ropivacaine.
doi:10.4103/0019-5049.153039
PMCID: PMC4378078  PMID: 25838589
Brachial plexus block; dexamethasone; interscalene block; ropivacaine
9.  ‘Hot cross bun’ sign in a case of cerebrotendinous xanthomatosis: a rare neuroimaging observation  
BMJ Case Reports  2013;2013:bcr2012006641.
We report a 25-year-old young man presenting with cognitive decline, pancerebellar features, spastic quadriparesis, bilateral cataract (operated) and tendo-Achilles swelling (xanthoma). The CT of the head showed bilateral cerebellar hypodensities. There were bilateral cerebellar hypointensities involving dentate nuclei on T1-weighted images with corresponding hyperintensities on T2-weighted MRI. Additionally, an interesting MRI finding—‘hot cross bun’ appearance was seen in pons which has not been reported in the literature so far. Biopsy from tendo-Achilles confirmed xanthoma. He was treated with chenodeoxycholic acid following which he showed improvement in cognition and weakness.
doi:10.1136/bcr-2012-006641
PMCID: PMC3604450  PMID: 23417372
10.  Use of a Novel Receptor-Targeted (CD206) Radiotracer, 99mTc-Tilmanocept, and SPECT/CT for Sentinel Lymph Node Detection in Oral Cavity Squamous Cell Carcinoma 
IMPORTANCE
Sentinel lymph node biopsy has been proposed as an alternative to up-front elective neck dissection (END) for determination of pathologic nodal status in patients undergoing surgical treatment for oral cavity squamous cell carcinoma (OSCC) with clinically negative neck (cN0). Sentinel lymph node biopsy using current standard tracer agents and imaging adjuncts such as radiolabeled sulfur-colloid and planar lymphoscintigraphy (LS), however, is associated with several drawbacks.
OBJECTIVE
To assess the preliminary utility of technetium Tc 99m(99mTc)-tilmanocept, a novel molecular imaging agent for sentinel lymph node (SLN) mapping, in OSCC.
DESIGN, SETTING, AND PARTICIPANTS
Prospective, nonrandomized, single-arm, part of an ongoing phase 3 clinical trial. Patients had previously untreated, clinically and radiographically node-negative OSCC (T1-4aN0M0) at an academic tertiary referral center.
INTERVENTIONS
Patients received a single dose of 50 μg 99mTc-tilmanocept injected peritumorally followed by dynamic planar LS and fused single-photon emission computed tomography/computed tomography (SPECT/CT) prior to surgery. Surgical intervention consisted of excision of the primary tumor and radioguided SLN dissection followed by planned END. The excised lymph nodes (SLNs and non-SLNs) underwent histopathologic evaluation for presence of metastatic disease.
MAIN OUTCOMES AND MEASURES
False-negative rate and negative predictive value of SLNB using 99mTc-tilmanocept and comparison of planar LS with SPECT/CT in SLN localization.
RESULTS
Twelve of 20 patients (60%) had metastatic neck disease on pathologic examination. All 12 had at least 1 SLN positive for metastases. No patients had a positive END node who did not have at least 1 positive SLN. These data yield a false-negative rate of 0% and negative predictive value of 100% using 99mTc-tilmanocept in this setting. Dynamic planar LS and SPECT/CT revealed a mean (range) number of hot spots per patient of 2.9 (1-7) and 3.7 (1-12), respectively. Compared with planar LS, SPECT/CT identified additional putative SLNs in 11 of 20 cases (55%).
CONCLUSIONS AND RELEVANCE
The high negative predictive value and low false-negative rate in identification of occult metastases shows 99mTc-tilmanocept to be a promising agent in SLN identification in patients with OSCC. Use of SPECT/CT improves preoperative SLN localization including delineation of SLN locations near the primary tumor when compared with planar LS imaging.
TRIAL REGISTRATION
clinicaltrials.gov Identifier: NCT00911326
doi:10.1001/jamaoto.2013.4239
PMCID: PMC4301415  PMID: 24051744
11.  Clinicopathologic predictors of recurrence and overall survival in adenoid cystic carcinoma of the head and neck: A single institutional experience at a tertiary care center 
Head & neck  2014;36(12):1705-1711.
Background
The purpose of this study was to determine factors that impact recurrence and long-term survival of head and neck adenoid cystic carcinoma (ACC).
Methods
We conducted a retrospective review of 87 patients with head and neck ACC who were evaluated between 1992 and 2009. Staining for Ki-67, p53, α-estrogen receptor (αER), and progesterone receptor (PR) was performed.
Results
Forty men (46%) and 47 women (54%) were included in this study. Median follow-up for patients was 98 months. Five-year recurrence-free and overall survival (OS) rates were 56% and 81%, respectively. Ki-67 and p53 expression was observed in 5 (6%) and 2 (2%) patients, respectively. αER and PR were all negative. The most important determinants of disease-free survival (DFS) were perineural invasion (PNI; p = .001) and female sex (p = .027). Disease site (major vs minor salivary gland) was the only predictor of worse OS on multivariate analysis.
Conclusion
Perineural invasion, female sex, and disease site were the most consistent predictors of poor outcome in head and neck ACC.
doi:10.1002/hed.23523
PMCID: PMC4299584  PMID: 24166847
adenoid cystic carcinomas; head and neck; prognostic factors; disease-free survival; overall survival
12.  Intraoperative Scintigraphy Using a Large Field-of-View Portable Gamma Camera for Primary Hyperparathyroidism: Initial Experience 
BioMed Research International  2015;2015:930575.
Background. We investigated a novel technique, intraoperative 99 mTc-Sestamibi (MIBI) imaging (neck and excised specimen (ES)), using a large field-of-view portable gamma camera (LFOVGC), for expediting confirmation of MIBI-avid parathyroid adenoma removal. Methods. Twenty patients with MIBI-avid parathyroid adenomas were preoperatively administered MIBI and intraoperatively imaged prior to incision (neck) and immediately following resection (neck and/or ES). Preoperative and intraoperative serum parathyroid hormone monitoring (IOPTH) and pathology (path) were also performed. Results. MIBI neck activity was absent and specimen activity was present in 13/20 with imaging after initial ES removal. In the remaining 7/20 cases, residual neck activity and/or absent ES activity prompted excision of additional tissue, ultimately leading to complete hyperfunctioning tissue excision. Postexcision LFOVGC ES imaging confirmed parathyroid adenoma resection 100% when postresection imaging qualitatively had activity (ES) and/or no activity (neck). The mean ± SEM time saving using intraoperative LFOVGC data to confirm resection versus first IOPTH or path result would have been 22.0 ± 2 minutes (specimen imaging) and 26.0 ± 3 minutes (neck imaging). Conclusion. Utilization of a novel real-time intraoperative LFOVGC imaging approach can provide confirmation of MIBI-avid parathyroid adenoma removal appreciably faster than IOPTH and/or path and may provide a valuable adjunct to parathyroid surgery.
doi:10.1155/2015/930575
PMCID: PMC4300023  PMID: 25629056
13.  One decade follow up after nucleoplasty in the management of degenerative disc disease causing low back pain and radiculopathy 
Asian Journal of Neurosurgery  2015;10(1):21-25.
Objectives:
Nucleoplasty is a minimally invasive procedure that is developed to treat patients with symptomatic, but contained disc herniations or bulging discs. The purpose of this study was to evaluate a decade follow-up of coblation nucleoplasty treatment for protruded lumbar intervertebral disc.
Methods:
In this retrospective study there a total 50 patients who underwent intradiscal coblation therapy for symptomatic, but contained lumbar degenerative disc disease were included. Relief of low back pain, leg pain and numbness after the operation were assessed by visual analog pain scale (VAS). Function of lower limb and daily living of patients were evaluated by the Oswestry disability index (ODI) and subjective global rating of overall satisfaction were recorded and analyzed.
Results:
There were 27 male and 23 female with followup mean follow up of 115 months (range 105–130 months) with a mean age was 52 years (range 26–74 years). Analgesic consumption was reduced or stopped in 90% of these cases after 1 year. At 24 months follow up VAS was four points and ODI was 7.2. In three patients, we repeated the cool ablation after 36 months, at L3–4 level in two cases. Ten patients continue to be asymptomatic after 114 months of intervention. There were no complications with the procedure including nerve root injury, discitis or allergic reactions.
Conclusions:
Nucleoplasty may provide intermittent relief in contained disc herniation without significant complications and minimal morbidity. In accordance with the literature the evidence for intradiscal coablation therapy is moderate in managing chronic discogenic low back pain; nucleoplasty appears to be safe and effective.
doi:10.4103/1793-5482.151504
PMCID: PMC4352623  PMID: 25767571
Degenerative disc disease; low back pain; minimally invasive surgery; sciatica
14.  Outcomes of transoral robotic surgery: a preliminary clinical experience 
Objective
To report long-term, health-related quality of life (HRQOL) outcomes in patients treated with transoral robotic surgery (TORS).
Study Design
Prospective clinical study on functional and HRQOL outcomes in TORS.
Setting
University tertiary care facility.
Subjects
Patients who underwent TORS at The Ohio State University Medical Center.
Methods
All patients undergoing TORS were asked to complete the Head and Neck Cancer Inventory before treatment, and at 3 weeks, 3, 6, and 12 months postoperatively. Demographic, intraoperative, clinicopathological, and follow-up functional data were collected for each patient.
Results
Sixty four patients who underwent TORS were enrolled with a median age of 56.8years. A total of 113 TORS procedures were performed. Mean follow up time was 16.3 ± 7.49 months (range 6 to 33). Majority of TORS were performed for squamous cell carcinoma (88%). No patients experienced immediate postoperative complications, with all of the patients tolerating an oral diet without any airway compromise on the day of surgery. There was a decrease from baseline in the speech, eating, aesthetic, social, and overall QOL domains immediately after treatment. At the one year follow up, the HRQOL scores in the aesthetic, social, and overall QOL domains were near baseline. Patients with malignant lesions had significantly lower postoperative HRQOL scores in the speech, eating, social, and overall QOL domains (p<.05). Forty nine patients (77%) underwent adjuvant radiation therapy (RT), and 61% had chemoradiation (CRT) therapy. Patients who underwent adjuvant XRT or CRT had lower postoperative scores in the eating, social and overall QOL domains, compared to those who did not (p<.05).
Conclusion
TORS is a safe procedure with good functional and HRQOL outcomes. Patients who undergo TORS for malignancies and receive adjuvant therapy tend to have lower HRQOL outcomes. TORS is a promising future alternative surgical treatment for laryngopharyngeal tumors.
doi:10.1177/0194599811402172
PMCID: PMC4277657  PMID: 21810777
Transoral robotic surgery; health-related quality of life; head and neck cancer
15.  Quality-of-Life Outcomes in Transoral Robotic Surgery 
Objective
To report long-term, health-related quality-of-life (HRQOL) outcomes in patients treated with transoral robotic surgery (TORS).
Study Design
Prospective, longitudinal, clinical study on functional and HRQOL outcomes in TORS.
Setting
University tertiary care facility.
Subjects and Methods
Patients who underwent TORS were asked to complete a Head and Neck Cancer Inventory before treatment and at 3 weeks and 3, 6, and 12 months postoperatively. Demographic, clinicopathological, and follow-up data were collected.
Results
Sixty-four patients who underwent TORS were enrolled. A total of 113 TORS procedures were performed. The mean follow-up time was 16.3 ± 7.49 months. The HRQOL was assessed at 3 weeks and at 3, 6, and 12 months, with a response rate of 78%, 44%, 41%, and 28%, respectively. TORS was performed most frequently for squamous cell carcinoma (88%). There was a decrease from baseline in the speech, eating, aesthetic, social, and overall QOL domains immediately after treatment. At the 1-year follow-up, the HRQOL scores in the aesthetic, social, and overall QOL domains were in the high domain. Patients with malignant lesions had significantly lower postoperative HRQOL scores in the speech, eating, social, and overall QOL domains (P < .05). Patients who underwent adjuvant radiation therapy or chemotherapy and radiation therapy had lower postoperative scores in the eating, social, and overall QOL domains (P < .05).
Conclusion
The preliminary data show that patients who undergo TORS for malignancies and receive adjuvant therapy tend to have lower HRQOL outcomes. TORS is a promising, minimally invasive, endoscopic alternative surgical treatment of laryngopharyngeal tumors.
doi:10.1177/0194599811421298
PMCID: PMC4277658  PMID: 21881053
transoral robotic surgery; health-related quality of life; head and neck cancer
16.  Transoral robotic approach to carcinoma of unknown primary 
Head & neck  2013;36(6):848-852.
Background
The management of carcinoma of unknown primary (CUP) is one of the challenging conditions in head and neck oncologic surgery. Despite various diagnostic tools, the primary tumor site in more than half of cases remains unidentified. The purpose of this study was to assess the feasibility and efficiency of utilizing transoral robotic surgery (TORS) for the diagnosis and treatment of CUP in the head and neck.
Methods
In this prospective, single-institutional, clinical TORS trial, 22 of 181 patients were treated for CUP between 2008 and 2012.
Results
Among all those 22 patients, primary tumor site identification and complete tumor removal was achieved in 17 patients (77.3%) with TORS. Tonsil (59.1%) and base of tongue (18.1%) were identified as the most common tumor locations.
Conclusion
Together with panendoscopy, directed biopsies, and positron emission tomography (PET)/CT, TORS is a valuable option in the identification and treatment of primary tumor sites.
doi:10.1002/hed.23385
PMCID: PMC4266274  PMID: 23720223
carcinoma of unknown primary; transoral robotic surgery; daVinci
17.  Functional and Quality-of-Life Outcomes of Transoral Robotic Surgery for Carcinoma of Unknown Primary 
The Laryngoscope  2014;124(9):2089-2095.
Objectives/Hypothesis
To determine speech, eating, aesthetics, social disruption, and overall quality-of-life outcomes over a year period in patients who underwent transoral robotic surgery as part of carcinoma of unknown primary diagnosis and treatment.
Study Design
Observational prospective study.
Methods
Twenty-two patients who underwent transoral robotic surgery for the management of carcinoma of unknown primary were included. Patients prospectively completed the Head and Neck Cancer Inventory during a preoperative visit, and at 3-week, 3-month, 6-month, and 12-month postoperative visits. Patients’ demographic, pathological, and follow-up information were also collected.
Results
The mean follow-up time was 19.8 months. There were overall declines in all quality of life scores during treatment period, which was followed by a continuous recovery. The scores immediately after transoral robotic surgery (3 weeks) were significantly higher than the scores after conclusion of adjuvant therapy (3 months) in multiple domains (P <.05) and the 6-month scores in speech (P = .02) and eating (P = .008) domains. All scores, except for eating (P = .01) returned to pre-treatment levels at 1 year. Patients with detected primaries displayed similar quality-of-life scores compared to patients with occult primaries. Human papillomavirus status and type of adjuvant treatment had no significant impact on quality of life.
Conclusions
Transoral robotic surgery is a promising, minimally invasive procedure for the surgical management of carcinoma of unknown primary. Patients maintain high functional and quality-of-life status at 1 year after surgery.
doi:10.1002/lary.24705
PMCID: PMC4266325  PMID: 24706455
Transoral robotic surgery; carcinoma of unknown primary; quality of life; transoral robotic surgery; carcinoma of unknown primary; neck metastasis
18.  Would a Massive Intra-abdominal Malignant Peripheral Nerve Sheath Tumor with Growth into the Inguinal Canal and Scrotum Preclude Surgical Option? A Case Report and Review of Literature 
The Indian Journal of Surgery  2013;75(6):500-503.
Malignant peripheral nerve sheath tumors (MPNST) are rare spindle-cell sarcomas derived from Schwann cells or pluripotent cells of the neural crest accounting for less than 10 % of all soft tissue sarcomas. They arise from major or minor peripheral nerve fibers or their sheaths. The World Health Organization coined the term MPNST for tumors of neurogenic origin with similar biological behavior replacing all the previous heterogeneous and, often, confusing nomenclature including malignant schwannoma, malignant neurilemmoma, and neurofibrosarcoma. The retroperitoneum and the lower extremities are the most common sites, but MPNST may arise anywhere in the body. Its location in the retroperitoneum in a patient without neurofibromatosis is an exceedingly rare occurrence. Imaging is routinely performed to assess the extent of the disease and to plan surgical resection. Surgical resection is the first line of therapy, ideally with total removal of the tumor. Owing to a high risk of recurrence with incomplete resection, postoperative irradiation and chemotherapy are necessary; however, they are often used as adjuvant therapy even if the tumor is completely resected.
doi:10.1007/s12262-013-0953-x
PMCID: PMC3900742  PMID: 24465112
Malignant peripheral nerve sheath tumor; MPNST; Retroperitoneal sarcomas
19.  Esthetic crown lengthening with depigmentation using an 810 nm GaAlAs diode laser 
Indian Journal of Dentistry  2014;5(4):222-224.
Hyperpigmentation of gingiva becomes more pronounced if it is associated with “gummy smile.” Correction of gummy smile and depigmentation together are key to complete patient satisfaction. An 810 nm (1.5 W, pulsed) GaAlAs diode laser was used to achieve the desired results in a 22-year-old female patient. The 6-month follow-up results showed excellent color and contour of the gingiva. Mere depigmentation without correcting gummy smile may look cosmetically good but esthetically unacceptable. Diode laser was used as it is known to be an excellent tool as compared with other conventional surgical procedures in terms of patient and operator comfort.
doi:10.4103/0975-962X.144739
PMCID: PMC4260390  PMID: 25565758
Crown lengthening; depigmentation; diode laser; gummy smile
20.  Single port microsurgical technique for excision of third ventricular colloid cysts 
Asian Journal of Neurosurgery  2014;9(4):189-192.
Introduction:
Colloid cysts are benign space-occupying lesions that account for 0.5-1.0% of brain tumors and arise from the velum interpositum or the choroid plexus of the third ventricle.
Material and Methods:
We are describing a modified surgical technique that combines the positive attributes of being minimalistic, while retaining the effectiveness of microsurgery. In all 20 consecutive symptomatic patients with a preoperative magnetic resonance imaging (MRI) diagnosis of colloid cyst who came to the senior author between 2008 and 2011 were included in the study. The patient was kept supine with the head positioned neutrally in the sagittal plane and neck flexed at 20°. The tube of a 5 ml plastic syringe having an external diameter of 13 mm and an internal diameter of 12.6 mm was cut toward the nozzle end to the appropriate length depending upon the cortical thickness measured on the preoperative MRI.
Results:
The average operative time was around 90 min with maximum of 120 min. None of the patients had seizures preoperatively or postoperatively and in all cases antiepileptic medication could be stopped after 3-6 month of surgery. Two patients had short-term memory impairment which returned to near normal by 1-year following surgery.
Conclusion:
A volume of 5 ml plastic syringe port technique decreases the operative morbidity and operative time. The wider corridor of working makes the simultaneously maneuverability of two surgical instruments feasible enhancing safety and completeness of excision.
doi:10.4103/1793-5482.146599
PMCID: PMC4323961  PMID: 25685214
Approach; colloid cysts; single port; third ventricle
21.  Long term preservation of motion with artificial cervical disc implants: A comparison between cervical disc replacement and rigid fusion with cage 
Asian Journal of Neurosurgery  2014;9(4):213-217.
Background:
With the advancement of technologies there is more interest in the maintenance of the spine's biomechanical properties focusing on the preservation of the functional motion segment. In present article we describe our experience with 25 cases managed with artificial cervical discs with 28 Solis cage following cervical discectomy with a mean follow-up period of 7.5 year.
Materials and Methods:
All surgeries were performed by single surgeon from March 2004 to June 2005 with a follow-up till date. Patients with symptomatic single or multiple level diseases that had no prior cervical surgery were candidates for the study. Cohort demographics were comparable. Standardized clinical outcome measures and radiographic examinations were used at prescribed post-operative intervals to compare the treatment groups. Relief in radicular pain, cervical spine motion, and degenerative changes at follow-up were noted.
Results:
In a total 53 cases, the mean age in prosthesis group was 47 years (age range: 30-63 years) and mean age in cage group was 44 years (32-62 years). Mean hospital stay was 2.7 days in both the groups. At 4 weeks complete cervical movements could be achieved in 19 cases in artificial disc group. Maintenance of movement after 7.5 years was in 76% of these patients. Lordosis was maintained in all cases till date. There was no mortality or wound infection in our series.
Conclusions:
We conclude that artificial cervical disc could be an alternative to fixed spinal fusion as it represents the most physiological substitute of disc. However, there is need for further studies to support the use of artificial cervical disc prosthesis.
doi:10.4103/1793-5482.146608
PMCID: PMC4323965  PMID: 25685218
Arthrodesis; cervical disc herniation; cervical arthroplasty; cervical prosthesis; prosthesis; spondylosis
22.  Highly Aggressive HPV-related Oropharyngeal Cancer: Clinical, Radiologic, and Pathologic Characteristics 
Objectives
While the majority of HPV+ oropharyngeal squamous cell carcinomas have a favorable prognosis, we search for markers of poor prognosis by carefully examining a subset of highly-aggressive cases.
Study Design
Seven patients with HPV+ oropharyngeal cancer who presented with non-pulmonary distant metastasis or developed distant metastasis post-treatment were identified. Eight control cases were chosen which responded well to treatment. Pathology and radiological studies were reviewed and compared.
Results
Two cases displayed a small cell carcinoma (SmCC) component upon pathologic review. Biomarker analysis revealed lower expression of NOTCH1 in the aggressive cohort in comparison to controls (p=0.04). Cases showed a predominance of clustering of lymph nodes, extracapsular spread and central tumor necrosis.
Conclusion
While most HPV-related oropharyngeal cancers display a positive prognosis, it is evident that there is a subset, which behave more aggressively. This early investigation identifies pathologic and radiologic features that may help to predict this behavior.
doi:10.1016/j.oooo.2013.04.011
PMCID: PMC3748144  PMID: 23770280
Head and neck cancer; Oropharyngeal squamous cell carcinoma; aggressive; HPV; human papillomavirus; neuroendocrine; small cell carcinoma; NOTCH1; p53; radiology
23.  ABO and Rh (D) group distribution and gene frequency; the first multicentric study in India 
Background and Objectives:
The study was undertaken with the objective to provide data on the ABO and Rh(D) blood group distribution and gene frequency across India.
Materials and Methods:
A total of 10,000 healthy blood donors donating in blood banks situated in five different geographical regions of the country (North, South, East and Center) were included in the study. ABO and Rh (D) grouping was performed on all these samples. Data on the frequency of ABO and Rh(D) blood groups was reported in simple numbers and percentages.
Results:
The study showed that O was the most common blood group (37.12%) in the country closely followed by B at 32.26%, followed by A at 22.88% while AB was the least prevalent group at 7.74%. 94.61% of the donor population was Rh positive and the rest were Rh negative. Regional variations were observed in the distribution. Using the maximum likelihood method, the frequencies of the IA, IB and IO alleles were calculated and tested according to the Hardy Weinberg law of Equilibrium. The calculated gene frequencies are 0.1653 for IA (p), 0.2254 for IB (q) and 0.6093 for IO (r). In Indian Population, O (r) records the highest value followed by B (q) and A (p); O > B > A.
Conclusion:
The study provides information about the relative distribution of various alleles in the Indian population both on a pan-India basis as well as region-wise. This vital information may be helpful in planning for future health challenges, particularly planning with regards to blood transfusion services.
doi:10.4103/0973-6247.137452
PMCID: PMC4140055  PMID: 25161353
ABO; blood group; rhesus
24.  Intravenous Ketamine for Refractory Bronchospasm Precipitated by H1N1 Infection 
Acute severe bronchospasm is an emergency situation and sometimes these children may fail to respond to conventional treatment and deteriorate rapidly to respiratory failure requiring mechanical ventilation. We present a case of 2-year-old girl, who presented with severe bronchospasm resulting in respiratory failure not responding to conventional management including mechanical ventilation and was found to be H1N1 positive. She was treated with ketamine infusion, which led to prompt improvement in airway obstruction.
doi:10.3389/fped.2014.00024
PMCID: PMC3980093  PMID: 24765619
H1N1 infection; ketamine; wheezing; bronchospasm; acute severe asthma
25.  Large retroperitoneal calcifying fibrous tumor 
doi:10.1016/j.mjafi.2012.02.008
PMCID: PMC3862714  PMID: 24600097
Calcifying Fibrous Tumour; Retroperitoneal tumor; Childhood fibrous pseudotumor

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