Curative Purpose Research Articles

Is reduced-dose whole-brain radiotherapy also feasible in primary CNS lymphoma for curative or salvage purpose?

Recently, reduced-dose whole-brain radiotherapy (WBRT) has been used to treat primary central nervous system lymphoma (PCNSL). However, whether reduced-dose WBRT is also an acceptable option for curative or salvage purposes has not yet been reported. We analyzed the clinical outcomes of patients with PCNSL who received radiotherapy for curative or salvage purposes and compared the clinical outcomes according to the WBRT dose. A total of 66 patients were divided into two groups: those treated with 30Gy (2Gy per fraction) or less WBRT (low-dose WBRT, n = 34) and those treated with more than 30Gy WBRT (high-dose WBRT, n = 32). The median WBRT dose was 25.2 and 49.6Gy in low-dose and high-dose WBRT groups, respectively. The median total radiotherapy dose, including the boost dose, was 50Gy (range, 36.0-55.8Gy). The 3-year overall survival and progression-free survival were 77.8% and 29.8%, respectively. Intracranial relapse occurred in 31 patients (47.0%) at a median of 27 months after RT. Overall survival and progression-free survival did not differ between the two groups. The 3-year intracranial disease control rate did not differ between the two groups (35.2% vs. 41.6%, p = 0.300). Grade 3 or higher neurological toxicities were observed in six patients, of whom five were in the high-dose WBRT group. Reduced-dose WBRT in curative and salvage treatments for PCNSL had no significant negative effect on the intracranial disease control rate or survival. Therefore, without impaired efficacy, use of reduced-dose WBRT appears promising for reduction of neurotoxicity.

Study of Chytosan Membranes produced form the incorporation of extract of Anacardium Occidentale Linn

Society has been going through a process of evolution in all sectors, including in biotechnology with the improvement of dressings for skin wounds. Thus, the main objective of this research is to produce chitosan membranes with the incorporation of the extract of the stem bark of Anacardium occidentale L., aiming at obtaining a biomaterial with therapeutic potential in wound healing. For the study, membranes were prepared without and with incorporation of the hydroalcoholic extract of Anacardium occidentale L., and in different concentrations. The membranes were subjected to characterizations, in terms of qualitative macroscopic analysis, thickness, swelling, contact angle and surface tension. The membranes are similar in terms of homogeneity, transparency and flexibility, and are partially hydrophilic. As for the chemical and physical characteristics, they were compatible for a biomaterial with a curative purpose.

Diagnosis and management of hypertension understanding imperative role of various biomarkers

As hypertension, almost 90% of cases of hypertension with an unknown origin called essential hypertension, continue to be one of the most important risk factors for various fatal health conditions, its early diagnosis using trustworthy biomarkers to predict, diagnose, and monitor the therapeutic progress of hypertension is proving to be of utmost importance for the preventive as well as curative purpose of various health hazards. A rise in the activity of biochemical markers of endothelial dysfunction and blood lipids, notablyLow-density lipoprotein (LDL) andverylow-density lipoprotein(VLDL)measurements, and inflammation markers including C-reactive protein(CRP), cytokines, and adhesion molecules are linked to the development of hypertension. Growth and differentiation factor-15, red cell distribution width, uric acid, creatinine, inflammatory markers including interleukin-6, angiopoietins, and microRNAs are prognostic indicators in individuals with pulmonary arterial hypertension (PAH).The most extensively used blood markers for portal hypertension (PH) are the fibrosis-4 index and the improved liver fibrosis test. Likewise, Hepatic venous pressure gradient (HVPG), liver/SSMs and Plasma cyclic guanosine monophosphate (cGMP) being clinically significant tools to assess for PH. Along with Copeptin, serum levels of uric acid, potassium, and sodium may be crucial for the identification and monitoring of hypertension in pediatrics.Similarly, the severity of gestational hypertension correlates with hyperuricemia, elevated CRP, and interleukin-1 serum levels. Here, in this study, literature on biomarkers has been reviewed which are versatile diagnostic tools posing that influence healthcare professionals’ judgment and assist in patient education regarding diagnosis, prognosis, early detection, and treatment intervention.

The application of radiofrequency ablation in pancreatic cancer liver-only recurrence after radical pancreatectomy.

To evaluate the safety, feasibility, and survival benefit of radiofrequency ablation in liver-only recurrence pancreatic cancer patients after radical pancreatectomy. The data and follow-up of pancreatic cancer patients who suffered liver-only recurrence after radical pancreatectomy from 2015 to 2021 were retrospectively collected. Finally, 19 liver metastases radiofrequency ablation patients were assigned to radiofrequency ablation group, and 41 patients were to systemic treatment group. (1) the baseline, perioperative characteristics, and pathological outcomes were well-balanced. (2) Recurrence pattern showed there were more multiple (> 3) recurrence tumors in systemic treatment patients (multiple one vs. 19, P = 0.005). (3) Median radiofrequency ablation operation time was 30.0min, median blood loss was 1.0ml, 4 (21.05%) patients suffered postoperative complications, and 94.74% liver metastases tumors got complete necrosis. The first efficacy evaluation showed a significantly better effect of radiofrequency ablation, complete and partial response rate 72.22% vs. 27.78%, P < 0.001. Overall survival from the initial surgery and after liver recurrence was significantly longer in the radiofrequency ablation group (43.0 vs. 22.0months, 29.0 vs. 14.0months, P = 0.003, 0.006, respectively). Progression-free survival after treatment was longer in the radiofrequency ablation group (6.0 vs. 5.0months, P = 0.029). For liver recurrence tumor ≤ 3, overall survival from the initial surgery and after liver recurrence was significantly longer in radiofrequency ablation patients (43.0 vs. 22.0months, 29.0 vs. 14.0months, P = 0.011, 0.013, respectively). Progression-free survival after treatment was longer in the radiofrequency ablation group (7.0 vs. 4.0months, P = 0.042). Radiofrequency ablation could get a curative purpose for patients with liver-only recurrence after pancreatectomy, improve progression-free survival and overall survival, and with minor surgery damage and risk.

Semiautomatic interictal electric source localization based on long-term electroencephalographic monitoring: A prospective study.

Electric source imaging (ESI) of interictal epileptiform discharges (IEDs) has shown significant yield in numerous studies; however, its implementation at most centers is labor- and cost-intensive. Semiautomatic ESI analysis (SAEA) has been proposed as an alternative and has previously shown benefit. Computer-assisted automatic spike cluster retrieval, averaging, and source localization are carried out for each cluster and are then reviewed by an expert neurophysiologist, to determine their relevance for the individual case. Here, we examine its yield in a prospective single center study. Between 2017 and 2022, 122 patients underwent SAEA. Inclusion criteria for the current study were unifocal epilepsy disorder, epilepsy surgery with curative purpose, and postoperative follow-up of 2 years or more. All patients (N=40) had continuous video-electroencephalographic (EEG) monitoring with 37 scalp electrodes, which underwent SAEA. Forty patients matched our inclusion criteria. Twenty patients required intracranial monitoring; 13 were magnetic resonance imaging (MRI)-negative. Mean duration of analyzed EEG was 4.3 days (±3.1 days), containing a mean of 12 749 detected IEDs (±22 324). The sensitivity, specificity, and accuracy of SAEA for localizing the epileptogenic focus of the entire group were 74.3%, 80%, and 75%, respectively, leading to an odds ratio (OR) of 11.5 to become seizure-free if the source was included in the resection volume (p< .05). In patients with extratemporal lobe epilepsy, our results indicated an accuracy of 68% (OR=11.7). For MRI-negative patients (n= 13) and patients requiring intracranial EEG (n= 20), we found a similarly high accuracy of 84.6% (OR=19) and 75% (OR=15.9), respectively. In this prospective study of SAEA of long-term video-EEG, spanning several days, we found excellent localizing information and a high yield, even in difficult patient groups. This compares favorably to high-density ESI, most likely due to marked improved signal-to-noise ratio of the averaged IEDs. We propose including ESI, or SAEA, in the workup of all patients who are referred for epilepsy surgery.

Three Months' PSA and Toxicity from a Prospective Trial Investigating STereotactic sAlvage Radiotherapy for Macroscopic Prostate Bed Recurrence after Prostatectomy-STARR (NCT05455736).

Biochemical recurrences after radical prostatectomy (RP) can be managed with curative purpose through salvage radiation therapy (SRT). RT dose escalation, such as stereotactic RT (SSRT), may improve relapse-free survival in this setting. STARR trial (NCT05455736) is a prospective multicenter study including patients affected by macroscopic recurrence within the prostate bed after RP treated with SSRT. Recurrence was detected with a Choline or PSMA CT-PET. In the current analysis, the early biochemical response (BR) rate and toxicity profile after three months of follow-up were assessed. Twenty-five patients were enrolled, and data about BR and toxicity at three months after treatment were available for 19 cases. Overall, BR was detected after three months in 58% of cases. Four G1-G2 adverse events were recorded; no G ≥ 3 adverse events were detected. SSRT appears feasible and safe, with more than half of patients experiencing BR and an encouraging toxicity profile. The STARR trial is one of the few prospective studies aimed at implementing this promising treatment strategy in this scenario.

Complication of Gastric Cancer Surgery: A Single Centre Experience.

Gastric cancer surgery is still characterised by high morbidity and mortality. However, in 2018 an online platform, GASTRODATA has been proposed in Europe to standardize the recording of gastric surgery complications. The aim of the study was to present a single center experience regarding incidence and grading of acute postoperative complications in a population of patients treated surgically for gastric cancer on the basis of the gastrodata online platform. The present study was a single center, observational, retrospective trial held in the General Surgery Unit of the Sant'Andrea Hospital of Rome. The study included 181 consecutive patients who underwent gastric surgical resection for cancer from May 2004 to December 2020 with curative R0 purpose. Thirty-three percent of patients reported at least one complication, while seventeen percent of the whole population reported a complication classified as at least grade 3 on the Clavien Dindo Classification. The most frequent complications were disorders of the respiratory system (13.3%), followed by bleeding (7.6%) and wound infections (6.2%). Deaths accounted for 3.7% of the population. A list of defined complications of gastrectomy, if systematically adopted in the Literature, could lead to a reduction in the wide variation of proposals for treatment and assessment. Objectively evaluating the impact of complications on outcomes can lead to quality improvement project proposals.

Dental caries and access to oral health services among children and adolescents

There are many social, economic, political and cultural factors that affect the ability of developing and resource poor countries to provide adequate oral health care for its people, including children and adolescents. Untreated carious teeth are common findings in African children, and Restorative index and Met Need Index among children and adolescents are very low. This could be as a result of limited access to oral health services in terms of cost, accessibility, awareness, acceptability and availability. Access tooral health care service among children for preventive, restorative, rehabilitative and curative purpose is important for optimal oral health and wellbeing of a child. Access to oral health services is limited in African countries, and carious teeth are often left untreated. The challenges associated with access to oral health care are common in African countries. They are faced with continuous oral health care delivery and access problems with variation in the availability of dentists between countries and poor funding for oral health. Most of the dentists that practice in African region are mostly delivering oral health services to children and adolescents in urban areas than rural areas. This can contribute to oral health inequalities among children and adolescents in slum areas, riverine areas, rural and remote areas. After searching articles from electronic databases, the aim of this article is to review the burden of dental caries, the dentist to patient ratio, Restorative index and Met need index of children and adolescents.

Evaluation of the Anti-Inflammatory Activity of the Leaf Extract and Fractions of Ipomoea Quamoclit in Albino Wistar Rats

Background: Medicinal plants have been shown to contain intrinsic active ingredients that can be used for curative purpose for some diseases. Ipomoea quamoclit is one of such ethnomedicinal plants of reported health benefits. Aim of Study: This study was aimed at evaluating the anti-inflammatory activity of ethanol extract and fractions of the leaves of Ipomoea quamoclit Mill. Materials and Methods: Ipomoea quamoclit leaves were harvested and extracted with 80% ethanol by cold maceration for 48 hours and the crude extract was fractionated to obtain n-hexane, n-butanol and ethyl acetate fraction, respectively. The crude extract and its fractions were screened to unveil the resident phytochemical constituents. The ethanol extract was tested for acute toxicity (LD50). The systemic acute inflammation of the crude extract and fractions of Ipomoea quamoclit was studied using the water (fluid) displacement method after inducing inflammation with egg albumin, using rats. The effect of the crude extract and fractions of Ipomoea quamoclit on arthritis was studied using the formaldehyde-induced arthritis model in rats. Results: The results of the qualitative phytochemical evaluation of the plant confirmed the presence of these phytoconstituents such as alkaloids, flavonoids, saponins, tannins, steroids, terpenoids, glycosides, carbohydrates, proteins, and coumarins. There were no deaths recorded for acute toxicity study for both phases of the test. In the acute anti-inflammation assay, significant (P&lt;0.05) anti-inflammatory activities were observed from the 5th hour for the ethyl acetate fraction (150 and 400 mg/kg) and the butanol fraction (400 mg/kg). The anti-arthritic activity of the crude extract (150 mg/kg), ethyl acetate fraction (150 and 400 mg/kg), n-hexane fraction (150 mg/kg) and butanol fraction (150 and 400 mg/kg) was obvious from the second day after administration. By the 10th day the crude extract (50, 150, and 400 mg/kg) and ethyl acetate fraction (150 and 400 mg/kg) brought about a significant reduction of chronic inflammation (arthritis) in the test animals to normal basal levels. Conclusions: This study thus provides scientific information and validates the ethnobotanical use of Ipomoea quamoclit leaves in management of diseases and inflammation inclusive. The findings of this study also reveal that potentially Ipomoea quamoclit could be a source of pharmacologically active compounds of pharmaceutical importance.

Does hypointense HCC in the Hepatobiliary Phase at Gadoxetate-Enhanced MRI Predict Recurrence After Surgery? A Systematic Review and Meta-analysis

The aim of the current study was to investigate whether hypointense hepatocellular carcinoma (HCC) in the hepatobiliary phase (HBP) on gadoxetic acid-enhanced MRI at pretreatment is a potential prognostic marker for tumor recurrence within 3 years after surgery conducted for a curative purpose (resection or liver transplantation). Systematic review was performed in the PubMed, Embase, Cochrane Library, and LILACS databases. Original articles focused on evaluating HCC signal intensity (SI) in HBP, as well as recurrence at least 3 years after surgery were included in the study. Odds ratio (OR) was measured based on the inverse variance method and the random-effects model. The Quality in Prognosis Studies (QUIPS) tool was used to assess the quality of the included articles. Five studies with 718 patients, in total, were analyzed. The odds ratio of disease recurrence in patients with hypointense HCC in the HBP, within 3 years after surgery, was 3.12 times higher than that observed in patients with hyperintense HCC in the HBP (OR 3.12; 95% CI 1.27-7.68; p=0.01). Heterogeneity was classified as intermediate (I2=52%). Articles included in the review overall presented a low risk of bias. Hypointense HCC in the HBP on gadoxetic acid-enhanced MRI at pretreatment has increased the likelihood of tumor recurrence in patients subjected to resection or liver transplantation. HCC SI in the HBP is a potential non-invasive imaging biomarker associated with patient prognosis.

Reductive rhinoplasty principles applied to the curative treatment of different nasal diseases.

Reductive rhinoplasty is generally intended as a facial plastic procedure aiming for functional and aesthetic outcomes in patients affected by nasal dysmorphism and/or obstruction. However, when applied to different pathologies of the nasal pyramid it holds great potentialities, beyond the solo cosmetic and functional objectives. We retrospectively analyzed preoperative conditions, surgical charts, and postoperative results of patients who underwent reductive rhinoplasty for different nasal diseases at our Institution. Principles and techniques of reductive rhinoplasty were described in the different possible applications to the treatment of nasal disease, from nasal septal perforation to benign and malignant diseases of the nose. Reductive rhinoplasty showed to play a crucial role in the curative purpose of different nasal diseases, representing a versatile tool in the expert hand of rhinoplasty surgeons who approach them. N/A.

Longevity Through Panchakarma in Healthy Life

In age of competition and industrialization risk of lifestyle disorders is increased. Lifestyle disorders are causing a greater number of mortality and morbidity. Lifestyle disorders is not only limited to adult but also it is found in young age. In previous few studies result shows that over 61 per cent of all deaths in India attributed to lifestyle or non-communicable diseases. They are spread in both urban and rural areas. This disease is burden over society as well as allopathy medicine, because they only control the disease not totally cure. On other side principle of ayurveda first deals with preventive care of healthy individuals and curative care of diseased individuals. Ayurveda is worked at four levels first is Nidanparivarjana(avoid causative factors), Sanshodhana(detoxification), Samshamana (palliative medicine) and Pathyapathya (specific diet according to disease). In this Sanshodhanais mainly concerned with Panchakarma. Panchakarma is use as preventive as well as curative purpose. Panchakarmaincludes Vamana (therapeutic emesis), Virechana (therapeutic purgation), Niruha Basti (therapeutic decoction enema), Anuvasan Basti (therapeutic unctuous enema)andNasya (medication through nasal route).Various Samhita describe Dinacharya(daily regimen) and Rutucharya(seasonal regimens) in which Acharyaexplained about daily and seasonal Panchakarmaprocedure for healthy life. So, this article aims to review the role of different type Panchakarma in order to explore the scientific approach for welfare of human beings.

Atypical cervical mass

Hemoptysis as first sign of a thyroid differentiated cancer represents an atypical behavior of a cervical mass, usually associating lung metastasis or direct tracheal invasion. Late presentation (for instance, due to COVID-19 pandemic circumstances) associates a poor prognosis. This is a case report. We aim to introduce a 70-year old female case who was admitted for an atypical cervical mass associating hemoptysis as onset; the diagnostic of metastatic papillary thyroid cancer was established; the delay of hospital admission did not allow a radical intervention with curative purpose. The lady was admitted as an emergency for an endocrine checkup of a progressively growing cervical mass in addition to hemoptysis that developed a few weeks before. Specific blood endocrine panel confirmed the normal thyroid function with negative thyroid autoimmunity. Anterior cervical ultrasound showed intensely hypoechoic, inhomogeneous, large structure, with macro-calcifications (TIRADS 5). Fine needle aspiration cytology exam revealed a papillary carcinoma of thyroid, consistent with Bethesda 6 score. Computed tomography detected a voluminous thyroid tumor process of 92 by 58 by 89 mm. The superior, middle and inferior left later-cervical lymph nodes which are located posterior to the later-cervical vascular package, have maximum diameters of approximately 30/34 mm (axial) and 54 mm (vertical). Multiple micro-nodules of oval form in both lungs have diameters up to 29 mm (probably secondary lesions). Osteolytic tumor lesion at the level of the lateral arch of the vertebral body thoracic T 1 and the head of the left first rib extends to the level of the left foramen from the spaces cervical C7 to thoracic T1, respective between thoracic T1 and T2, with maximum diameters of 23/32 mm. CT also showed brain metastasis, as a iodophil, inhomogeneous, well-contoured tumor that is located on the right frontal precentral gyrus, with maximum diameters of 10/13 mm (axially) and 13 mm (vertically) and small areas of perilesional edema. Further adjuvant therapy was refused by the patient; palliative tracheostomy is needed. Atypically aggressive presentation of well differentiated thyroid cancer of papillary type might be associated with delayed presentation; whether this comes as direct consequence of pandemic era is still a matter of debate.

Thrombocytopenia and Thrombosis

Introduction: Our interest in this topic was also provoked by observations and reports, from our and other cases, of thrombosis caused by vaccines against COVID-19 by polyvalent anti-COVID-therapy. Aim: We set ourselves the goal of presenting to the scientific audience our hypothesis about the occurrence of thrombosis after vaccination against COVID-19 or polyvalent anti-COVID therapy, as well as the mechanism of response in the treatment of patients with COVID-19 by plasma replacement therapy—either from recovered or healthy people. Tasks: To achieve this goal, we summarized the laboratory data of our patients, as well as the literature available to us on this issue. Material: We used CBC blood tests, coagulation status and biochemical markers of patients. Method: We compared the laboratory changes found by us with those indicated in the scientific literature. Results and Discussion: Based on the analyzed cases and the data provided in the scientific literature, we formulated our hypothesis about the mechanism of abnormal platelet reactivity to COVID-19 vaccines and polytherapeutic regimens in this disease, as well as our hypothesis for the treatment of patients with COVID-19 by plasma replacement therapy. Conclusion: According to our hypothesis, thrombosis during vaccination or polytherapy of COVID-19 is due to inactivation of the enzyme eADAMTS-13 and formation of thromboembryonic macromultimers of von Willebrand (vWF) factor by the mechanism of microcirculatory hyaline thrombosis in the pathogenesis of the acquired form of thrombotic thrombopenic purpura (TTP). The positive effect of plasma replacement therapy in patients with COVID-19 is based rather on dilution of defectively formed ultra-large vWF multimers and physiological substitution of the active enzyme eADAMTS-13, which is confirmed by the rapidly occurring clinical improvement in patients treated in this way, than on an Ag-At reaction the effect of which requires a longer period of time and which reaction is used in medicine as a prophylaxis, rather than a curative purpose.

Chemotherapy-triggered changes in stromal compartment drive tumor invasiveness and progression of breast cancer

BackgroundChemotherapy remains a standard treatment option for breast cancer despite its toxic effects to normal tissues. However, the long-lasting effects of chemotherapy on non-malignant cells may influence tumor cell behavior and response to treatment. Here, we have analyzed the effects of doxorubicin (DOX) and paclitaxel (PAC), commonly used chemotherapeutic agents, on the survival and cellular functions of mesenchymal stromal cells (MSC), which comprise an important part of breast tumor microenvironment.MethodsChemotherapy-exposed MSC (DOX-MSC, PAC-MSC) were co-cultured with three breast cancer cell (BCC) lines differing in molecular characteristics to study chemotherapy-triggered changes in stromal compartment of the breast tissue and its relevance to tumor progression in vitro and in vivo. Conditioned media from co-cultured cells were used to determine the cytokine content. Mixture of BCC and exposed or unexposed MSC were subcutaneously injected into the immunodeficient SCID/Beige mice to analyze invasion into the surrounding tissue and possible metastases. The same mixtures of cells were applied on the chorioallantoic membrane to study angiogenic potential.ResultsTherapy-educated MSC differed in cytokine production compared to un-exposed MSC and influenced proliferation and secretory phenotype of tumor cells in co-culture. Histochemical tumor xenograft analysis revealed increased invasive potential of tumor cells co-injected with DOX-MSC or PAC-MSC and also the presence of nerve fiber infiltration in tumors. Chemotherapy-exposed MSC have also influenced angiogenic potential in the model of chorioallantoic membrane.ConclusionsData presented in this study suggest that neoadjuvant chemotherapy could possibly alter otherwise healthy stroma in breast tissue into a hostile tumor-promoting and metastasis favoring niche. Understanding of the tumor microenvironment and its complex net of signals brings us closer to the ability to recognize the mechanisms that prevent failure of standard therapy and accomplish the curative purpose.

Prognostic Value of Combined CA19-9 with Aspartate Aminotransferase to Lymphocyte Ratio in Patients with Intrahepatic Cholangiocarcinoma After Hepatectomy.

PurposeThe prognosis of intrahepatic cholangiocarcinoma (ICC) patients after surgical resection remains poor. Effective prognostic biomarkers are expected to stratify ICC patients and optimize their treatment strategies. To investigate the prognostic value of carbohydrate antigen 19-9 (CA19-9), aspartate aminotransferase to lymphocyte ratio index (ALRI), and their combination (CAC) in predicting long-term outcomes in ICC patients after hepatectomy.Patients and MethodsICC patients underwent initial hepatectomy for curative purpose from January 2009 to September 2017 were reviewed retrospectively. Area under the receiver operating characteristics curve (AUC) was used to distinguish the identification effectiveness of three different measures. Kaplan–Meier curves and Cox proportional hazards regression were used to assess the value of preoperative CAC grade in predicting overall survival (OS) and disease-free survival (DFS).ResultsA total of 530 patients were included and randomly divided into two groups (derivation cohort and validation cohort). During a median follow-up of 18 months (1–115.4 months), 317 patients (59.8%) died and 381 patients (71.9%) developed tumor recurrence. Lower ALRI, decreased serum CA19-9 level and CAC grade were found to be associated with better OS and DFS (both P<0.001). Importantly, the AUC for CAC grade was significantly greater than ALRI and CA19-9. In addition, results from Cox proportional hazards regression from both cohorts suggest that tumor number, node invasion, and CAC grade as independent prognostic factors for both OS and DFS.ConclusionThis study demonstrated that CAC grade is a valuable biomarker for the prognosis of ICC patients. Specifically, patients with elevated CAC grades were correlated to worse long-term outcome after the hepatectomy. Our data suggest that increased CAC grades can be used to stratify patients and help to decide their treatment strategies.

Food-Medicine Interface and its Application in International Level, Comparative Jurisdictions and Sri Lankan Legal Context

There has been a growing interest in the Food-medicine interface due to its legal and commercial importance with the development of both food and medicine industries. Food and medicine--even though some foods have therapeutic (curative or preventive) properties--are two different entities, regulated by different legal regimes. Hence, the distinction between food and medicine is crucial in order to protect the interests of consumers. This study is a doctrinal review on the food-medicine interface at international level with particular reference to its application in the Sri Lankan context.&#x0D; There seems to be a lack of global policy consensus or coherent legal regime regarding the food-medicine interface, and the same is true for Sri Lanka. Both Western and Ayurveda drugs are registered with the competent authorities in Sri Lanka: The National Medicines Regulatory Authority and Ayurveda Department, respectively. To register a food as a drug, these authorities can use two criteria: 1. recognised medicinal properties and 2. therapeutic (curative or preventive) purpose of consumption. The registration of a food commodity by these two competent authorities can be taken as a criterion to identify them as medicines thus, to differentiate them in a legal sense from food per se. From a legal perspective, any food not registered by one of these two authorities--irrespective of their therapeutic (curative or preventive) benefits—is considered to be simply a food. This demarcation of the food-medicine interface could be used by industries for the purpose of marketing strategies and law enforcing officers for the purposes of law enforcement.

A risk stratification scheme for synchronous oligometastatic non-small cell lung cancer developed by a multicentre analysis

BackgroundsOligometastatic Non-Small Cell Lung Cancer (NSCLC) patients represent a category without a standard therapeutic approach. However, in selected oligometastatic NSCLC, radical surgery seems to offer a good prognosis. This retrospective study aimed to analyse the long-term outcomes of synchronous oligometastatic patients treated with curative intent and identify the factors associated with better results and the proposal of a risk stratification system for classifying the synchronous oligometastatic NSCLC. MethodsThe medical records of patients from 18 centres with pathologically diagnosed synchronous oligometastatic NSCLC were retrospectively reviewed. The inclusion criteria were synchronous oligometastatic NSCLC, radical surgical treatment of the primary tumour with or without neoadjuvant/adjuvant therapy and radical treatment of all metastatic sites. The Kaplan – Meier method estimated survivals. A stratified backward stepwise Cox regression model was assessed for multivariable survival analyses. Results281 patients were included. The most common site of metastasis was the brain, in 50.89 % patients. Median overall survival was 40 months (95 % CI: 29–53). Age ≤65 years (HR = 1.02, 95 % CI: 1.00–1.05; p = 0.019), single metastasis (HR = 0.71, 95 % CI: 0.45–1.13; p = 0.15) and presence of contralateral lung metastases (HR = 0.30, 95 % CI: 0.15 – 0.62; p = 0.001) were associated with a good prognosis. The presence of pathological N2 metastases negatively affected survival (HR = 2.00, 95 % CI: 1.21–3.32; p = 0.0065). These prognostic factors were used to build a simple risk classification scheme. ConclusionsTreatment of selected synchronous oligometastatic NSCLC with curative purpose could be conducted safely and at acceptable 5-year survival levels, especially in younger patients with pN0 disease.

Is there any place for novel agents in treating biliary tract cancer?

Biliary tract cancer is an uncommon cancer in developed countries. In localized stages, surgery is the cornerstone of treatment with curative purpose. Conversely in advanced stages, chemotherapy with platinum-gemcitabine combination is the standard of care. Biliary tract cancers are a biologically heterogeneous group of malignancies, which perhaps explains the failure of targeted therapies in unselected patient populations to demonstrate benefit in advanced disease, although there are promises in selected populations (e.g. PD1/PD-L1 positive, BRAFV600E-mutated or IDH1-mutant). In view of the limited benefit of second line therapies in metastatic biliary tract cancer, various targeted agents have been tested in progressive disease. Furthermore, several ongoing trials are using next-generation sequencing of multiple genes to identify molecular abnormalities in the tumors of patients with refractory cancers that may potentially be used in pretreated disease (e.g. FGFR or IDH genes). Immunotherapy with immune checkpoint inhibitors may be interesting for patients whose tumors have programmed cell death 1 ligand 1 (PD-L1) overexpression. Ongoing and future trials will further advance our knowledge toward the optimal treatment strategy for the management of biliary tract cancer in its different stages, starting from metastatic and then reaching early stages of disease. We here provided an overview of these novel treatment strategies for advanced biliary tract cancers not amenable of curative treatment modalities.

COMPARATIVE PHYSICOCHEMICAL ANALYSIS OF WET AND DRY GUDUCHI (TINOSPORA CORDIFOLIA WILLD.) MIERS.

Bhaishajya Kalpana is a branch of Ayurveda which deals with pharmaceutics. It is based on certain scientific principles which need to be followed for quality pharmaceutical preparations. Use of dry form drugs over fresh form in pharmaceutical preparation is one of the principles. It excludes some drugs such as Guduchi (Tinospora cordifolia) As Guduchi is being widely used in Ayurveda for preventive as well as curative purpose; it has been selected for the study. In order to find difference between morphological and physicochemical characteristics analysis of wet and dry Guduchi, was carried as per standards of Ayurved Pharmacopeia of India (API). It was noticed that almost all the Macroscopic and Microscopic profile matches with standard parameters of Guduchi in API. It is observed that pH Value of fresh Guduchi was more than its dry form which is directed to its alkaline nature. Foreign matter content was found to be negligible in Fresh form. Fresh Guduchi also showed more water soluble extractive than dry, however alcohol soluble extractive was higher in dry form. This study has added new analytical parameters for wet Guduchi i.e. pH. Value, Total ash, water soluble and alcohol soluble extractive other than foreign matter and moisture content. So, it could be considered as a standard for future study. This study evidenced classical principle of using Fresh Guduchi over dry. Further qualitative analysis needs to be done by using qualitative parameters.