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December 2020
Volume 16 | Issue 8 (Supplement)
Page Nos. 1-253

Online since Monday, December 28, 2020

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REVIEW ARTICLES  

Effectiveness of mouthrinses in prevention and treatment of radiation induced mucositis: A systematic review Highly accessed article p. 1
Varsha Manoharan, Nusrath Fareed, Hemant Battur, Sanjeev Khanagar, Jaseela Praveena
DOI:10.4103/jcrt.JCRT_176_18  PMID:33380645
Mucositis is a frequent, severe consequence of radiation therapy among patients undergoing radiotherapy for the head-and-neck cancer, often requiring hospitalization and even breaks or discontinuity in treatment. Mouth rinsing with various agents has demonstrated effectiveness in the prevention and treatment of radiation-induced mucositis (OM), but evidence for the same is lacking. This systematic review is therefore conducted with the aim of assessing the evidence for the effectiveness of mouthrinses in prevention and treatment of OM. Joanna Briggs Institute guidelines were followed to conduct this review. Six databases were searched and a total of 25 randomized clinical trials published over a period of the past 31 years were included for qualitative synthesis. Analysis of 25 studies revealed that 1299 participants, aged 46–69 years were assigned to the test groups and control groups. A total of 16 different formulations were studied among patients over a duration of 6 days to 1 year in varying dosages. The overall preventive fraction ranged from 1.9% to 77.8% for a reduction in clinical grades of mucositis, 7.6%–83.3% for a reduction in pain and 20%–50% for a reduction in bacterial counts. Adverse effects such as mouth burning, altered taste, sore throat, have been reported, especially with chlorhexidine and benzydamine hydrochloride. Evidence for the included studies is IC and ID. Studies using herbal based products and tissue regenerating agents revealed comparatively better effectiveness with lesser side effects. However, the number of studies to support such a claim is very limited.
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Thyroid paraganglioma: A case-based systematic review of literature p. 11
Pritinanda Mishra, Somanath Padhi, Gayatri Behera
DOI:10.4103/jcrt.JCRT_713_18  PMID:33380646
Thyroid paragangliomas are distinctly rare primary thyroid neoplasms with nearly 75 cases reported worldwide. Due to their similar embryological origin and cytohistomorphology with other thyroid neoplasms, they may pose great diagnostic challenges for pathologists, radiologists, endocrinologists, as well as surgeons leading to unnecessary aggressive therapy. With recent advances in molecular genetics, the prognostic significance of such seemingly innocuous thyroid neoplasms has been better understood. In this manuscript, we describe such a case and present a systematic review of all reported cases till date giving an update on our current knowledge regarding their diagnostic pitfalls, pathology, and molecular genetics.
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The relevance of long noncoding RNAs in colorectal cancer biology and clinical settings p. 22
Atefeh Talebi, Mazaher Azizpour, Shahram Agah, Mohsen Masoodi, Gholam Reza Mobini, Abolfazl Akbari
DOI:10.4103/jcrt.JCRT_327_18  PMID:33380647
Colorectal cancer (CRC) is one of the most frequent causes of cancer-related death worldwide. The prognosis of the malignancy and patient survival is commonly poor. Therefore, the discovery of pertinent biomarkers is essential to provide an accurate diagnosis and effective therapy. Newly, a group of noncoding RNAs named long noncoding RNAs (lncRNAs) has been found to involve in CRC development and progression. In this review, we highlighted the biological function of lncRNAs and reviewed their potentials as clinical tools in the CRC. A literature search of PubMed, EMBASE, MEDLINE, Web of Science, Scopus, and Cochrane Library using the MeSH terms “CRC,” “long noncoding RNA,” “lncRNA,” and relevant was completed. The review included all articles that reported on the significance and role of lncRNAs in CRC development and clinical settings. All identified articles were cross-referenced for further articles, and any unavailable online were retrieved from hardcopy archive libraries. CRC-related lncRNAs could regulate a number of cellular processes, and their dysregulations have been suggested as potential biomarkers.
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ORIGINAL ARTICLES Top

Predicting outcome of advanced head-and-neck cancer by measuring tumor blood perfusion in patients receiving neoadjuvant chemotherapy p. 34
Kishore Singh, Rubu Sunku, Arun K Rathi, Gaurav S Pradhan
DOI:10.4103/jcrt.JCRT_195_18  PMID:33380648
Purpose: The purpose of this study was to correlate treatment response with tumor blood perfusion in patient of advanced head-and-neck cancer undergoing neoadjuvant chemotherapy. Materials and Methods: A total of 40 patients of advanced head-and-neck cancer, who were planned for neoadjuvant chemotherapy, were included in the study. All patients underwent diagnostic computed tomography (CT) with perfusion study for staging and quantitative measurement of tumor volume as well as perfusion parameters (including tumor blood volume, blood flow, permeability, and time to peak enhancement), at baseline and after completion of neoadjuvant chemotherapy. Total 3 cycles of neoadjuvant chemotherapy with paclitaxel, cisplatin, and 5 fluorouracil were given. Tumor response was evaluated in terms of change in tumor volume and correlated with perfusion parameters. Results: Out of 40 patients, 22 patients had more than 50% reduction in tumor volume, who were grouped as responder and remaining 18 patients had <50% decrease in tumor volume, grouped as nonresponder. Both the groups were similar in terms of age, gender, performance status, stage, nodal status, or addiction. Baseline CT scan shows a significant difference in tumor blood flow (P = 0.048) and marginal difference in time to peak enhancement (P = 0.058) in two groups. However, there is no difference in tumor blood volume (P = 0.32) and permeability surface area (P = 0.07). Conclusions: Evaluation of tumor blood flow by perfusion CT is helpful in predicting chemotherapy outcome and deciding appropriate treatment modality, but further evaluation with more number of patients is required for validating the predictive role of each perfusion parameters.
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Butyrylcholinesterase: An economical marker of disease activity in oral squamous cell carcinoma before and after therapy p. 39
Shradha Gagan Jaiswal, Gagan Rajesh Jaiswal
DOI:10.4103/jcrt.JCRT_207_16  PMID:33380649
Introduction: Biomarkers which can predict disease progression and serve as prognostic indicators are necessary for better management of oral cancer. Studies have shown that Cholinesterase plays an important role in cellular proliferation, differentiation and may have a possible involvement in tumor growth. Aim and Objective: The present study is aimed to determine the utility of serum Butyrylcholinesterase (BChe) levels as a marker for progression of oral squamous cell carcinoma (OSCC) in relation to the grade of the tumor and to determine if any variation occurred in the levels of BChe before and after therapy. Materials and Methods: A total of 120 patients were included in the study and divided into two groups as Group A-30 patients (healthy individuals) and Group B-90 cases of histopathologically diagnosed OSCC. The blood sample was collected before surgery, re-collected after the completion of radiotherapy (i.e., 3 and 6 months postsurgery) and analyzed biochemically for the concentration of BCh. Statistical Analysis: Paired t-test, ANOVA, and post hoc test (Bonferroni) were used for determining the statistical significance. Results: BChe levels were lower in OSCC (2940.32–1405.50 u/l when compared with controls (11149.60–11243.07 unit/l) and this difference was statistically significant. Postoperatively at 3 months, the serum BChe levels of OSCC patients increased almost two-fold compared to the preoperative values, and this difference was also statistically significant (P = 0.000) After 6 months, these levels further increased but did not reach those of controls. Conclusion: BChe can be used as an inexpensive, easy to use, noninvasive biomarker for the evaluation of disease-free survival in OSCC patients.
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Good prognostic factor in patients with nonmetastatic nasopharyngeal carcinoma: Programmed death ligand-1 expression in tumor cells p. 43
Hayriye Sahinli, Nalan Akyürek, Mukaddes Yılmaz, Olcay Kandemir, Ayşe Ocak Duran, Sezer Kulaçoǧlu, Gökhan Uçar, Elif Acar, Ahmet Özet, O Berna Ç. Öksüzoǧlu, Nuriye Y Özdemir
DOI:10.4103/jcrt.JCRT_759_19  PMID:33380650
Purpose: Programmed death ligand-1 (PD-L1) is the main ligand for programmed death-1 (PD-1), and is one of the major targets for cancer immunotherapy. Only a few studies are available for the clinical significance of PD-1/PD-L1 in nasopharyngeal carcinoma (NPC). There is a controversial association between PD-L1 expression and survival in NPC. This study aimed at defining any potential association between PD-L1 expression in tumor cells (TCs) and prognosis in NPC. Patients and Methods: A total of seventy NPC patients treated between January 2008 and December 2016 were included in the study. PD-L1 expression was assessed by immunohistochemistry (IHC) in tumor specimens. The IHC assay was considered positive if ≥5% of TCs are stained. Clinicopathological variables were documented. Variables included in the analysis were PD-L1 expression, clinicopathological characteristics, and prognosis. Results: The estimated 5-year overall survival (OS) rate was 62%. Nearly 55.7% (n = 39) of the TCs tested positive for PD-L1 expression. No associations were found between the level of PD-L1 in TCs and clinicopathological characteristics. Comparisons between patients with PD-L1-positive tumors and PD-L1-negative tumors revealed that OS was statistically significantly longer in patients with PD-L1-positive tumors as assessed by the univariate Cox regression analysis (hazard ratio [HR], 0.378; 95% confidence interval, 0.158–0.905; P = 0.029) and Kaplan–Meier curves (P = 0.023). Conclusion: PD-L1 expression is an important prognostic factor in NPC. PD-L1 expression positively correlates with survival.
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Eyelid carcinoma: An experience from a tertiary cancer center p. 48
Shivakumar Thiagarajan, Ameya Bahani, Devendra Chaukar, Anil K Dcruz
DOI:10.4103/jcrt.JCRT_559_18  PMID:33380651
Context: Eyelid carcinoma is rare tumors of the head and neck. They are rarely lethal but can be associated with significant morbidity if not treated early and appropriately. There are limited data available from world over and in particular the Indian subcontinent regarding eyelid carcinoma and its prognostic factors influencing treatment outcomes. Setting and Design:Retrospective study of patients treated in a tertiary cancer center between 2005 and 2016. Methodology: In this study, 51 patients with eyelid carcinoma treated at single tertiary cancer center were included. The demographic, clinical data, which includes the treatment received, histopathology report and follow–up, were recorded. All the relevant variables influencing disease-free survival (DFS) were analyzed. Results: Sebaceous carcinoma was the most common eyelid carcinoma followed by squamous cell carcinoma and basal cell carcinoma in descending order in this series. Lower eyelid was involved most often. The incidence of nodal metastasis was low (14%). Multivariate analysis revealed that margin status influenced the DFS (P= 0.001) (hazard ratios = 15.9 [95% confidence interval: 1.8–135.2]). The 5 years' DFS was 70%. Conclusion: Eyelid tumors are less common cancer with good prognosis if treated appropriately. The morbidity associated with treatment can be reduced if treated early.
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Cytopathology-histopathology correlation and the effect of nodule diameter on diagnostic performance in patients undergoing thyroid fine-needle aspiration biopsy p. 53
Nusret Yilmaz, Guven Baris Cansu, Serap Toru, Ramazan Sari, Guzide Gokhan Ocak, Cumhur Arici, Hasan Ali Altunbas, Mustafa Kemal Balci
DOI:10.4103/jcrt.JCRT_219_18  PMID:33380652
Introduction: Although thyroid fine-needle aspiration biopsy (FNAB) is established to have a good overall sensitivity and specificity, various outcomes have been reported on its performance in large nodules. The aim of the study was to evaluate the diagnostic performance of FNAB and the effect of the nodule diameter on its diagnostic performance. Materials and Methods: The outcomes of a total of 7319 patients who underwent FNAB over the course of 5 years were analyzed retrospectively and 648 patients who had undergone post-FNAB thyroidectomy or lobectomy were included in the study. FNAB results were classified according to the Bethesda system. After evaluating the compatibility between cytology and pathology results, all-nodules and diameter-based (<4 cm and ≥4 cm) sensitivity, specificity, false positivity, false negativity, and accuracy rates of FNAB were calculated. Results: Sensitivity of FNAB was 85.4% for all nodules, 88.3% for nodules <4 cm, and 75.8% for nodules >4 cm (P < 0.001). Specificity was 58.4% for all nodules, 49.3% for nodules <4 cm, and 75.1% for nodules >4cm (P < 0.001). While false positivity was 41.6% for all nodules, it was 50.7% for nodules smaller than 4 cm and was 24.9% for nodules larger than 4 cm (P < 0.001). False negativity was 14.6% for all nodules and was 11.7% for nodules smaller than 4 cm and 24.2% for nodules larger than 4 cm (P < 0.001). Finally, among the entire set of nodules, the accuracy was 64.4%, which was 59.2% in nodules smaller than 4 cm, and 75.2% in nodules larger than 4 cm (P < 0.001). Conclusion: Despite a higher rate of false negativity, FNAB has higher specificity and accuracy in large nodules than those in the small nodules. Nodule diameter should not be used alone as a criterion to recommend thyroidectomy to the patient.
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The radioprotective effect of melatonin against radiation-induced DNA double-strand breaks in radiology Highly accessed article p. 59
Farid Esmaely, Aziz Mahmoudzadeh, Mohsen Cheki, Alireza Shirazi
DOI:10.4103/jcrt.JCRT_370_18  PMID:33380653
Objective: The objective of this study is to observe the effect of 100-mg melatonin in reducing the levels of double-strand breaks (DSB) induced by 10 mGy and 100 mGy X-ray in peripheral lymphocyte applying H2AX immunofluorescence microscopy and comparing the different efficacies of melatonin ingestion 1 and 2 h before irradiation. Materials and Methods: Informed consent was obtained from five healthy males, nonathlete, and nonsmoking human volunteers aged between 25 and 35 years. Each volunteer was given a single oral dose of 100 mg melatonin at 9 a.m. Blood samples were collected in vacutainer tubes (without any preservative to separate the serum, and with heparin as an anticoagulant for separating leukocytes for in vitro exposure to gamma radiation) 5–10 min before then 1 and 2 h after melatonin ingestion. Afterward, each sample was subdivided into nonirradiated and irradiated groups (10 mGy and 100 mGy). After irradiation, lymphocytes of samples were separated. The isolated lymphocytes in each group were permeabilized for DSB assessment and stained against the phosphorylated histone variant γH2AX. Results: Melatonin ingestion 1 and 2 h before irradiation caused a significant reduction in γH2AX foci. Results further indicate that the change in ingestion of melatonin from 1 to 2 h before exposure had no significant effect. In addition, melatonin administration showed no side effects. Conclusion: The present study showed that melatonin will prove effective in radioprotection against ionizing radiation (IR)-induced DNA damage in human lymphocytes. Our results suggest ingestion of 100-mg melatonin by patients before exposure to IR in radiology.
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Estimation of cancer risk due to radiation exposure for some daily consumption of foods p. 64
Akbar Abbasi, Vali Bashiry
DOI:10.4103/jcrt.JCRT_259_18  PMID:33380654
Aims: Considering the increasing concern about the cancer risk caused by environmental radiological effects related to the food consumption, the study was carried out evaluate the activity concentrations and cancer risk assessments of 226 Ra,232 Th, and 40 K in 72 food samples collected from different suppliers in Tehran Province of Iran. Subjects and Methods: The specific activity concentration was determined by means of a high-resolution high-purity germanium gamma-spectroscopy system. The collected various sample groups were wheat, rice, meat, milk, and mushroom. Results: The maximum concentration of 226 Ra and 232 Th was found in the wheat sample, equal to 0.7862 Bq/kg and 0.968 Bq/kg, respectively, whereas for 40 K, it was 598.35 Bq/kg in the milk sample. The annual effective dose rate ranged from 2.47 μSv/y in mushroom to 64.66 μSv/y in rice. The average excess lifetime cancer risk (ELCR) was varied from 1.60 × 10–5 for mushroom to 4.20 × 10–4 for milk, with the total ELCR value from main daily diets 1.37 × 10–3, which was a little more than the acceptable ELCR limit of 10–3. Conclusions: The ELCR due to five main daily diets was a little more than the acceptable ELCR limit of 10–3 for radiological risk in general.
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Regulation of XPA could play a role in inhibition of radiation-induced bystander effects in QU-DB cells at high doses p. 68
Mohammad Taghi Bahreyni Toossi, Hosein Azimian, Shokouhozaman Soleymanifard, Habibeh Vosoughi, Elham Dolat, Abdul Rahim Rezaei, Sara Khademi
DOI:10.4103/jcrt.JCRT_503_18  PMID:33380655
Introduction: Radiation-induced bystander effects (RIBE) is the radiobiological effects detected in nonirradiated cells that have received signals from neighboring irradiated cells. In some studies, there are observations that RIBE unexpectedly reduces at high doses. In this study, the expression of two selected apoptotic and repair genes and their possible role in the formation of this unexpected reduction is examined. Materials and Methods: The QU-DB cells were irradiated with gamma rays of a60 Co teletherapy unit at doses of 2, 4, 6, and 8 Gy. One hour following irradiation, their culture media were transferred to bystander cells to induced RIBE. After 24 h incubation, the RNA of cells was isolated and cDNA synthesized. Expression levels of BAX, XPA, and XPA/BAX ratio were examined by relative quantitative reverse transcription-polymerase chain reaction. Results: In target cells, up-regulation of both genes was observed at all doses. In bystander cells, at the low dose (2 Gy), the expression of BAX was more than XPA; at 4 Gy, the ratio was balanced. A significant correlation was found between the XPA/BAX ratio and the dose, at high doses pattern of gene expression dominated by DNA repair gene. Conclusion: Gene expression profile was distinctive in bystander cells compared to target cells. The observed linear increasing of the ratio of XPA/BAX could support the hypothesis that the DNA repair system is stimulated and causes a reduction in RIBE at high doses.
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Inhibition of Ehrlich ascites cancer, hypoxia-inducible factor-1 alpha, and the kinase insert domain-containing receptor/fms-like tyrosine kinase-binding domains of vascular endothelial growth factor by Thiazole Acetamide Derivatives p. 74
LN Madhu, Sandeep Telkar, Divyalaxmi Kamath, Melita Evan D. Souza, Shama Rao, Prakash S Nayak, BK Sarojini
DOI:10.4103/jcrt.JCRT_577_16  PMID:33380656
Background: Tumor cells that have the ability to express vascular endothelial growth factor (VEGF) are more competent to growth and metastasize by the adequate amount of blood and oxygen supply by the blood vessels to the growing mass of cells. Hypoxic tumors are known for its aggressiveness and resistance to the treatment. Targeting VEGF and hypoxia-inducible factor-1 alpha (HIF-1α) is an attractive strategy to interrupt the multiple pathways crucial for tumor growth. In the present study, two thiazole acetamide derivative's anticancer property, anti VEGF and HIF-1α inhibitory property were investigated. Methodology: Two thiazole acetamide compounds were synthesized, TA1 and TA2 and its anticancer property was studied in Erlich's ascites cancer cells. To evaluate the anticancer property the assays such as 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, DNA diffusion assay for apoptosis, and lactate dehydrogenase leakage assay were carried out. The cell culture media was used to assess the secreted VEGF level. Molecular docking studies were performed to analyze the binding efficiency of the study compounds to the kinase insert domain-containing receptor (KDR) and fms-like tyrosine kinase (FLT)-binding domains of VEGF protein. HIF-1α inhibitory study was performed by flow cytometry analysis using HUVEC cell line. Results: The study compounds inhibited HIF-1α and VEGF secretion, these data shown positive prop up for the anticancer property of the derivatives. The docking studies showed moderate binding of study compounds to KDR and FLT-binding domains of VEGF protein. Conclusion: These results conclude the anticancer and anti-angiogenic property of the synthesized thiazole-acetamide derivatives.
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Decreased risk of cholangiocarcinoma in diabetic patients treated with metformin p. 82
Pathum Sookaromdee, Viroj Wiwanitkit
DOI:10.4103/jcrt.JCRT_368_18  PMID:33380657
Background: Cholangiocarcinoma is an important biliary tract cancer. The high incidence of this cancer is observed in tropical Asia. Several underlying factors are mentioned for this cancer including to diabetes mellitus. The use of the antidiabetic drug, metformin, is mentioned for possibility for decreasing risk for cholangiocarcinoma. Methods: The work is aimed to estimate the change in risk of local people in the endemic area of cholangiocarcinoma in scenario that diabetic patients are treated with metformin in the highly endemic area of cancer in Thailand. Results: In this study, the authors estimated the change in risk of local people in the endemic area of cholangiocarcinoma in scenario that diabetic patients are treated with metformin. Conclusion: The results show a slight decreased risk of cholangiocarcinoma in that scenario.
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Antiangiogenic activity of zinc and zinc-sorafenib combination using the chick chorioallantoic membrane assay: A descriptive study p. 84
Manu Kumar, Girish Gulab Meshram, Tripti Rastogi, Sonal Sharma, Rachna Gupta, Seema Jain, Anisha Prasad, Vikas Galav, SK Bhattacharya
DOI:10.4103/jcrt.JCRT_737_16  PMID:33380658
Aim: Zinc, a trace element, is known for downregulating several proangiogenic growth factors and cytokines. However, its antiangiogenic activity is not adequately studied. The present study was aimed to evaluate the possible antiangiogenic activity of zinc via the chick chorioallantoic membrane (CAM) assay. Furthermore, the antiangiogenic activity of the combination therapy of zinc with various doses of sorafenib, a tyrosine kinase inhibitor, was evaluated. Materials and Methods: A pilot study was initially conducted so as to select suitable doses of zinc and sorafenib. The antiangiogenic activity after combining zinc 2.5 μg/embryo with sorafenib 1 and 2 μg/embryo was also evaluated. The antiangiogenic activity was quantified in terms of total length of blood vessels, number of junctions, number of branching points, and mean length of the blood vessels. Results: Zinc 2.5 μg/embryo showed significant (P < 0.05) antiangiogenic activity, as compared to the control group. However, its effect was not comparable to that of sorafenib 2 μg/embryo. The combination of zinc 2.5 μg/embryo with sorafenib 2 μg/embryo did not show an additive/synergistic effect. The combination of zinc 2.5 μg/embryo with sorafenib 1 μg/embryo produced an antiangiogenic activity which was comparable (P > 0.05) to that of sorafenib 2 μg/embryo. Conclusion: Zinc caused significant antiangiogenic activity in the CAM assay. The lack of addition/synergism in the zinc-sorafenib combination could have been due to the variability in the dose/ratio selection. Addition of zinc to sorafenib therapy could improve treatment tolerability, reduce cost of therapy, and reduce the emergence of drug resistance. Future mechanistic studies could identify the exact pharmacodynamics of zinc as an angiogenesis inhibitor.
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Bioinformatics analysis of regulated MicroRNAs by placental growth factor signaling in cancer stem cells p. 90
Zohreh Salehi, Hassan Akrami, Homeyra Seydi
DOI:10.4103/jcrt.JCRT_316_17  PMID:33380659
Aim of Study: Since the effect of placental growth factor (PlGF) on MicroRNAs (miRNAs) at molecular level was remained unknown, the aim was to predict the transcription factors (TFs) and their regulated miRNAs that activated by PlGF and analysis the function, biological processes, and cancer stem cells (CSCs)-related signaling pathways of miRNAs that regulated in PlGF signaling pathway. Subjects and Methods: The aim of this study is to find the TFs that activated by PlGF, we used three online software programs PCViz, PubAngioGen, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway. Then, the regulatory miRNAs downstream of the TFs were identified by four software TMHD, chipbase, circuits, and transmir databases. Target genes of miRNAs were predicted by three online software program TargetScan, Pictar, and miRanda algorithms. Moreover, Mirwalk database was used to find the validated miRNAs in angiogenesis process. Furthermore, Gene ontology (GO) biological process, GO molecular function, KEGG pathway, BIOCARTA pathway, Panther pathway, and Reactome pathway in Database for Annotation and Visualization and Integrated Discovery tools were used to find the functions and signaling pathways of target genes. Results: Many target genes of miRNAs in PlGF pathway were involved in CSCs-related signaling pathways such as Hedgehog, Wnt/b-catenin, Notch, mTOR, epidermal growth factor EGF, and transforming growth factor-beta signaling pathways. Regulatory miRNAs in PlGF signaling pathway probably promote cell proliferation, migration, tubulogenesis, and metastasize in CSCs. Conclusions: Bioinformatic analysis revealed that regulatory miRNAs and their target genes in PlGF pathway played important roles in the progression of CSCs-related signaling pathways.
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Therapeutic results of Denver percutaneous peritoneovenous shunt in cancer patients with malignant ascites p. 95
Hiroshi Tamagawa, Toru Aoyama, Hirohide Inoue, Hirohito Fujikawa, Sho Sawazaki, Masakatsu Numata, Tsutomu Sato, Takashi Oshima, Norio Yukawa, Manabu Morimoto, Makoto Ueno, Yashushi Rino, Munetaka Masuda
DOI:10.4103/jcrt.JCRT_606_18  PMID:33380660
Background: Intractable ascites secondary to malignant disease deteriorates patients' quality of life. The purpose of this study was to evaluate the safety and efficacy of percutaneous peritoneovenous (Denver) shunt in treating intractable malignant ascites in cancer patients. Materials and Methods: Thirty-five patients who had undergone Denver peritoneovenous shunt for the treatment of ascites associated with malignant tumor from October 2014 to 2017 were retrospectively analyzed. The demographic characteristics, laboratory values, and complications were recorded. Univariate and multivariate logistic regression analyses were performed. Results: The sites of primary tumor were pancreatic cancer in 19 patients, bile duct cancer in 8, gallbladder cancer in 5, breast cancer in 2, and peritoneal malignant mesothelioma in 1. Palliation of abdominal distention was achieved in 29 patients (82.9%). Postoperative complications of Grade 2 or higher were seen in 11 patients (31.4%), and Grade 5 complications were observed in three patients (8.6%). Patients with a high American Society of Anesthesiologists (ASA) grade and high ascites drainage volume had a significantly higher incidence of postoperative complications than a low ASA grade and low ascites drainage volume, and a multivariate logistic analysis showed that the intraoperative ascites drainage volume was an independent risk factor for all complications. Conclusions: The Denver shunt for malignant ascites is useful for improving patients' quality of life if the indications are selected properly. Drainage of intraoperative ascites was a risk factor for postoperative complications after the Denver shunt technique in cancer patients with malignant ascites. Further experience and discussion are necessary to establish the patient selection criteria.
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Prognostic and predictive factors in cancer patients with obstructive jaundice treated by percutaneous transhepatic biliary drainage: A single-center experience p. 99
Hayriye Sahinli, Ahmet Özet
DOI:10.4103/jcrt.JCRT_521_19  PMID:33380661
Background: Short-term survival rates are reported in the patients undergoing percutaneous transhepatic biliary drainage (PTBD). The purpose of this study was to determine the factors predicting survival following percutaneous biliary drainage. Materials and Methods: The data of 90 patients undergoing PTBD due to malignant biliary obstruction were analyzed retrospectively between January 2009 and November 2014. Results: The median age of the patients were 64 years. Fifty-one (57%) of the patients were male. Median survival following PTBD was 44 days. Survival rates at 1 month, 3 months, and 6 months following PTBD were 58%, 33%, and 8.9%, respectively. Multivariate Cox's regression analysis showed that platelet (PLT) count is significantly associated with predictors of survival; the other factors affecting survival were receiving chemotherapy following PTBD, liver metastasis, and serum albumin levels. Conclusion: Lower serum PLT level following PTBD is associated with the short-term survival. Survival of patients who are not able to receive chemotherapy after PTBD, having a low level of serum albumin, and patients with liver metastasis were shorter.
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Demographic and clinicopathological profile of patients of gastrointestinal stromal tumor from a tertiary care center of North India: An observational study p. 104
Mayank Aggarwal, Archana Aggarwal, Savita Arora, Arun Kumar Rathi, Kishore Singh
DOI:10.4103/jcrt.JCRT_322_18  
Background: Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal system. This study was aimed to analyze the demographic and clinicopathological data of the patient with a primary diagnosis of GIST, who were treated at our center. Materials and Methodology: Patients of GIST registered at our center from September 1, 2008, to August 31, 2016, were enrolled for this study. Patient's demographic and clinicopathological data were collected from clinical records. The data were represented as absolute number, percentage, and median (range: minimum to maximum), whichever applicable. Results and Observations: The analysis of 27 patients revealed that pain was the most common clinical feature. The stomach was the most common primary site. Most of the patients underwent upfront radical surgery (92.6%) followed by adjuvant imatinib. Histopathological data revealed that most tumors were >10 cm in size, 51.8% of patients had low mitotic index, and all these patients were either immunohistochemical positive for cluster differentiation 117 or KIT. The median duration of tyrosine kinase inhibitors therapy (imatinib) in our study individual was 2.5 years with a range of 4.8 months–3 years. Response assessment revealed 74.1% complete remission, 11.1% stable disease, and 3.7% progressive disease. Median overall survival in study individuals was 2.63 years (range: 0.1–8.6 years). Patient- and tumor-related factors were analyzed for prognostic significance using univariate survival analysis; however, none was found to have a significant prognostic correlation. Conclusions: Patients who underwent upfront surgery followed by adjuvant imatinib has shown good response to the treatment. However, the limitation of the small sample size and short follow-up in this study may not be a true data representation of the entire population
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Circulating annexin A2 as a biomarker in patients with pancreatic cancer p. 110
Mehmet Karabulut, Cigdem Usul Afsar, Murat Serilmez, Senem Karabulut
DOI:10.4103/jcrt.JCRT_755_18  PMID:33380663
Background: Pancreatic cancer (PC) is a highly lethal malignancy. There are only few predictive or prognostic markers for PC. This study was conducted to investigate the serum levels of annexin A2 (AnxA2) in patients with PC and its relationship with tumor progression and known prognostic parameters. Materials and Methods: Serum samples were obtained on the first admission before any treatment. Serum AnxA2 levels were determined using enzyme-linked immunosorbent assay. Age- and sex-matched healthy controls were included in the analysis. All statistical tests were carried out using two-sided test, and P ≤ 0.05 was considered statistically significant. Results: The median age at diagnosis was 59 years. The most common metastatic site was liver in 23 patients with metastasis (n = 19, 83%). At the end of the observation period, thirty-two patients (97%) were dead. Thirty-nine percent of 23 metastatic patients who received palliative chemotherapy (CTx) were CTx responsive. Median overall survival of the whole group was 41.3 ± 8.3 weeks (95% confidence interval = 25–58 weeks). The baseline serum AnxA2 levels were significantly higher in patients with PC than in the control group (P = 0.01). Serum AnxA2 levels were significantly higher in the patients with high erythrocyte sedimentation rate (P = 0.04). Conversely, serum AnxA2 concentration had no prognostic role on survival (P = 0.18). Conclusions: AnxA2 is identified as a novel secretory biomarker for PC, but it has no role as a prognostic or predictive marker.
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The age-adjusted Charlson comorbidity index is an independent prognostic factor in pancreatic cancer patients who receive curative resection followed by adjuvant chemotherapy p. 116
Toru Aoyama, Naoto Yamamoto, Mariko Kamiya, Masaaki Murakawa, Hiroshi Tamagawa, Sho Sawazaki, Masakatsu Numata, Satoshi Kobayashi, Makoto Ueno, Manabu Morimoto, Manabu Shiozawa, Norio Yukawa, Takashi Oshima, Takaki Yoshikawa, Yasushi Rino, Munetaka Masuda, Soichiro Morinaga
DOI:10.4103/jcrt.JCRT_440_18  PMID:33380664
Background: We investigated the impact of the age-adjusted Charlson comorbidity index (ACCI) on the pancreatic cancer survival and recurrence after curative surgery followed by adjuvant chemotherapy. Patients and Methods: This study included 155 patients who underwent curative surgery followed by adjuvant chemotherapy for pancreatic cancer between 2005 and 2014. The risk factors for the overall survival (OS) and recurrence-free survival (RFS) were identified. Results: An ACCI of 8 was regarded as the optimum critical point of classification considering the 1-, 3- and 5-year survival rates. The OS rates at 3 and 5 years after surgery were 25.7% and 19.0% in the ACCI-low group, respectively, and 7.6% and 0% in the ACCI-high group, which amounted to a statistically significant difference (P = 0.019). The RFS rates at 3 and 5 years after surgery were 17.3% and 13.8% in the ACCI-low group, respectively, and 7.1% and 0% in the ACCI-high group, which amounted to a marginally statistically significant difference (P = 0.104). A multivariate analysis showed that the ACCI was a significant independent risk factor for both the OS and RFS. Conclusions: The ACCI was a risk factor for the OS in patients who underwent curative surgery followed by adjuvant chemotherapy for pancreatic cancer. An effective plan is needed for determining the optimum surgical strategy according to the ACCI.
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Clinical impact of adjuvant chemotherapy and radiation for carcinoma stomach: Experience from a tertiary care center p. 122
Jomon Raphael Chalissery, T Anilkumar Jose, Sreekumar Pillai, Harikumar Unni, K Mathew Varghese, G Paul Gopu, K Venkatesan
DOI:10.4103/jcrt.JCRT_470_18  PMID:33380665
Objectives: The main objectives of this study are (1) To assess the patient compliance for adjuvant radiotherapy and chemotherapy for carcinoma stomach, (2) Tolerance of adjuvant radiotherapy with the use of conformal techniques, and (3) Disease-free and overall survival benefits of adjuvant chemotherapy and radiation in carcinoma stomach. Materials and Methods: Carcinoma stomach patients who registered in the institution during the period of December 2011–2014 were taken for the analysis. Treatment details of patients who received the planned adjuvant treatments, radiotherapy, and chemotherapy were collected. The treatment protocol was made as per the institutional multidisciplinary meeting decisions. The radiotherapy dose given was 45 Gy in 25 fractions using an intensity-modulated radiotherapy technique and concurrent chemotherapy offered with capecitabine 825 mg/m2 twice daily. Adjuvant chemotherapy protocol was selected from the major clinical trial information. Results: A total of 61 patients who satisfied the inclusion criteria were selected. Males 52 (85%) and females (15%). The median age of the patients was 57 years. Stage II patients were 52%, and 48% were stage III. All patients tolerated the planned dose of radiotherapy 45 Gy in 25 fractions, and 74% of patients tolerated six or more cycles of adjuvant chemotherapy. Mean follow-up period was 48 months, and the Kaplan–Meier survival analysis shows 3 and 5 years survival percentages were 57% and 48%, respectively. Conclusion: Adjuvant chemotherapy and radiation using conformal technique are well-tolerated. These were reflected in the overall outcome and survival of the patients. Based on the surgical pathology findings, an individualized approach of adjuvant treatment protocol can improve the outcome.
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Is there any relationship between Helicobacter pylori infection and human epidermal growth factor receptor 2 expression in gastric cancer? p. 128
Efnan Algin, Meltem Baykara, Guldal Yilmaz, Bulent Cetin, Ozgur Ekinci, Aytug Uner, Ahmet Ozet
DOI:10.4103/jcrt.JCRT_891_18  PMID:33380666
Purpose: Helicobacter pylori(HP) is a significant causative agent of gastric cancer (GC). However, the underlying mechanisms involved in its pathogenesis and association with oncoproteins are unclear. The aim of the present study was to evaluate the relationship between HP infection and human epidermal growth factor receptor 2 (HER2) expression in GC patients. Materials and Methods: Surgery (173) or endoscopic biopsy (35) specimen of 208 patients diagnosed with GC was evaluated for the presence of HER2 and HP. HER2 expression was assessed by fluorescence in situ hybridization (FISH) method, whereas HP status was evaluated histologically. Giemsa stain was used to identify HP status, in case HP could not be recognized in routine H and E-stained sections despite careful examination Results: The median age was 63 years (27–91), and most patients were male (male/female: 149/59). Of all the 208 patients, HP was positive in 87 (41.8%) and negative in 121 (58.2%) patients. FISH positivity for HER2 was observed in 41 (19.7%) patients, whereas FISH negativity was observed in 167 (80.3%) patients. According to the Chi-square test, patient distribution was 21 in HER2-positive HP-negative group, 20 in HER2-positive HP-positive group, 100 in HER2-negative HP-negative group, and 67 in HER2-negative HP-positive group. No correlation was found between HP and HER2 status (P = 0.314). HP positivity had significant effect on median overall survival (27.4 vs. 12.9 months, P = 0.046). Conclusions: Our results suggest that there is no relationship between HP infection and HER2 status in patients with GC.
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Dosimetric comparison of modern radiotherapy techniques for gastric cancer after total gastrectomy p. 133
Pelin Altinok, Ertugrul Tekçe, Fatih Karaköse, Kemal Berk, Ümmühan Kalafat, Huriye Senay Kiziltan, Züleyha Akgün, Alpaslan Mayadagli
DOI:10.4103/jcrt.JCRT_548_18  PMID:33380667
Purpose: The purpose of this study is to investigate the optimal radiotherapy technique for postoperative irradiation of gastric cancer treated with total gastrectomy. Materials and Methods: The database of ten patients was used for this study. Three-dimensional (3D) conformal radiotherapy, intensity-modulated therapy (IMRT), volumetric modulated arc therapy (VMAT), and helical tomotherapy (HT) plans were created for each dataset. The prescription dose was 45 Gy in 25 fractions. Comparative analyses of the target volume coverage and the doses of organs at risk were performed. Results: HT was significantly provided more homogeneity. The best conformal plans were achieved with VMAT. Both kidneys were better preserved with HT and VMAT. HT significantly lowered the V13 of the left kidney and VMAT significantly lowered V20. However, the mean left kidney doses were not statistically different. The lowest liver V30 was obtained with VMAT but not with statistically different than IMRT and HT. Mean liver doses were statistically inferior with 3D. The worst spinal cord doses were seen with 3D. The integral dose of the body did not differ among the techniques. Conclusion: In comparison of the four techniques, 3D seems to be the most unsuitable method regarding sparing the normal tissues. According to availability, HT and VMAT should be primarily preferred. IMRT can also be used with carefully paying attention to the clinical condition of the patient.
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A retrospective evaluation of geriatric patients with gastric cancer receiving systemic chemotherapy p. 138
Ali Murat Tatli, Zuhat Urakci, Didem Tastekin, Dogan Koca, Sema Sezgin Goksu, Ummugul Uyeturk, Mehmet Ali Kaplan, Hasan Senol Coskun
DOI:10.4103/jcrt.JCRT_563_18  PMID:33380668
Background: The most common age at which gastric cancer is diagnosed is 70 years, and the majority of patients diagnosed are at the metastatic stage. However, although gastric cancer is a geriatric disease, there is no suggestion to discriminate treatment for the general geriatric patient population. Here, we evaluated patients receiving palliative chemotherapy for gastric cancer owing to advanced age. Patients and Methods: Multicenter data of geriatric patients receiving palliative chemotherapy because of metastatic gastric cancer were retrospectively reviewed. Results: In total, 262 geriatric patients with gastric cancer were included in the study. Of these, 167 patients, including 134 (51.8%) patients with metastasis at diagnosis and 33 patients with relapse after surgery, were evaluated for palliative therapy. Chemotherapy was started in 87 (52.1%) of 167 patients. The overall median survival of the patients receiving chemotherapy was 9.3 months. There was no difference in overall survival (OS) between patients aged >70 and <70 years. However, a significant difference was detected in OS of patients depending on their Eastern Cooperative Oncology Group (ECOG) performance status (PS) before treatment; survival was 15 months in the group with PS 0–1 and 7 months in the group with PS ≥2. Conclusion: Advanced age chemotherapy receiving rates in patients with metastatic gastric cancer is decreasing. Survival is not associated with age, but pretreatment ECOG PS is important. Therefore, ECOG PS and comorbidities should be evaluated in detail, and combination therapies could contribute to patient survival.
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The hematologic inflammatory index is a new prognostic marker in patients resected for gastric cancer p. 144
Hayriye Sahinli, Sema Türker
DOI:10.4103/jcrt.JCRT_560_19  
Background: The role of the systemic inflammatory response in cancer has been shown in many studies. The present study aims to investigate the prognostic significance of a new hematologic index obtained by the combination of platelet, neutrophil, and lymphocyte counts in patients undergoing curative gastrectomy for gastric cancer. Methods: We retrospectively analyzed 95 consecutive patients who underwent curative gastrectomy for gastric cancer between January 2013 and December 2018. Receiver operating characteristics curve analysis was used to determine the optimal cutoff values for hematologic inflammatory index (HII). The optimal cutoff value for HII was 2.69. Baseline parameters categorized into two groups were compared with the Chi-square test. Variables were evaluated by the univariate analysis were further assessed by the multivariate analysis using Cox's proportional-hazards regression model. Results: According to HII, 44 patients (46.3%) had values lower than 2.69 and 51 patients (53.7%) had values higher than 2.69. HII was significantly correlated with depth of tumor invasion (P = 0.009), tumor histologic type (P = 0.048), and need for adjuvant therapy (P = 0.04). Median disease-free survival (DFS) (P = 0.003, hazard ratio (HR), 0.423; 95% confidence interval [CI], 0.234–0.762) and median overall survival (OS) (P = 0.002, HR, 0.385; 95% CI, 0.207–0.716) were found to be significantly shorter in the patient group where HII was higher than 2.69 compared to the patient group whose HII was lower than 2.69. When the multivariate analysis was performed, both DFS (P = 0.025, HR, 0.484; 95% CI, 0.257–0.912) and OS (P = 0.04, HR, 0.497; 95% CI, 0.255–0.970) were found to be independent prognostic factors. Conclusions: In this retrospective study, HII is independently associated with both DFS and OS in gastric cancer. HII is an inexpensive, powerful, and easily accessible prognostic marker.
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Human papillomavirus infection and p53 mutation in esophageal squamous cell carcinoma and its impact on treatment outcome p. 150
Tanmay Singh, Nadia Shirazi, Saurabh Bansal, Meenu Gupta, Sunil Saini, Mushtaq Ahmad
DOI:10.4103/jcrt.JCRT_296_17  PMID:33380670
Introduction: Human papillomavirus (HPV) is emerging as a risk factor for esophageal squamous carcinoma. The prognostic value of the HPV status has been investigated. However, the results are much controversial. Aim: This study aims to document the association of HPV infection and mutation of p53 gene in esophageal squamous cell carcinoma (ESCC) and its impact on treatment outcome. Subjects and Methods: The study was conducted over a period of 12 months. A total of 30 cases of ESCC who were primarily to be treated with radiotherapy/chemoradiotherapy were included in the study. All the tissue samples for biopsy were subjected to immunohistochemistry to study p53 and p16 expression, which is a surrogate marker for HPV. The patients were treated by radiotherapy alone or concurrent chemoradiotherapy depending on performance status and stage of disease. The impact of p16 and p53 on overall survival (OS) and disease-free survival (DFS) was determined. Results: The median OS of HPV-positive patients was 22 months (95% confidence interval [CI] 12–31) as compared to 13 months (95% CI 7–18) for HPV-negative patients (P = 0.298). The median DFS for HPV-positive patients was 16 months (95% CI 7–24) as compared to 5 months (95% CI 4–6) for HPV-negative patients (P = 0.048). The median OS of p53-positive patients was 13 months (95% CI 6.7–19) as compared to 22 months (95% CI 12.7–31.2) for p53-negative patients (P = 0.080). The median DFS for p53-positive patients was 5 months (95% CI 3.7–6.2) as compared to 22 months (95% CI 15.7–29.4) for p53-negative patients (P = 0.014). Conclusion: Clinical findings of our result can be used to sum up that both HPV infection and p53 mutation status are reliable biomarkers and can help clinicians to predict treatment outcome and prognosticate patients better.
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LRFN2 gene variant rs2494938 provides susceptibility to esophageal cancer in the population of Jammu and Kashmir p. 156
Ruchi Shah, Varun Sharma, Hemender Singh, Indu Sharma, Gulzar Ahmed Bhat, Idrees Ayoub Shah, Beenish Iqbal, Rumisa Rafiq, Najma Nissa, Mansha Muzaffar, Malik Tariq Rasool, Ghulam Nabi Lone, Sandeep Kaul, Mohd Maqbool Lone, Ekta Rai, Nazir Ahmed Dar, Swarkar Sharma
DOI:10.4103/jcrt.JCRT_613_19  PMID:32880595
Background: Leucine-rich repeat and fibronectin type 2 gene (LRFN2) variant rs2494938 has recently been found associated with esophageal cancer in a genome-wide association study in an Asian population. However, this association has not been replicated in any Indian population despite high incidence of the disease. Materials and Methods: In the present case–control study, 166 cases and 459 controls were included. Taqman assay technique using real-time PCR was employed to investigate the association of the variant with esophageal cancer in the population of Jammu and Kashmir (J&K). The Hardy-Weinberg equilibrium for rs2494938 was assessed using the Chi-square test. The allele- and genotype-specific risk was estimated by odds ratio (OR) with 95% confidence interval (CI). Results: Variant rs2494938 was observed to be significantly associated with esophageal cancer with an allelic OR of 1.59 (1.23–2.04 at 95% CI, P = 0.0003). Conclusion: The study highlights LRFN2 as a candidate gene for esophageal cancer susceptibility in the population of J&K and calls for a detailed study with a large sample size and involving more ethnic groups of India.
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Sentinel lymph node mapping in colorectal cancers with radioactive tracer; is it an efficient method? p. 160
Seyed Hassan Babaee, Mehdi Jabbari Nooghabi, Ramin Sadeghi, Abbas Abdollahi, Amer Falsafi, Mehrdad Fakhlaei, Zahra Gholami
DOI:10.4103/jcrt.JCRT_272_17  PMID:33380671
Context: The sentinel lymph nodes (SLNs), as most other regions, are prone to tumoral invasion. In colorectal cancers, they can help the higher levels of pathological examination techniques. Aims: We attempted to investigate the efficiency of the use of radioactive tracer in identifying SLNs in colorectal cancers using the same pathological technique. Settings and Design: This cross-sectional, single-center study was carried out from 2014 to august 2016 at Mashhad University of Medical Sciences. Subjects and Methods: The study population included 100 patients with colorectal cancers. We used a radioactive tracer to detect SLNs and to compare the number and involvement of SLNs and non-SLNs generally and in terms of the tumor site. For pathological study, we used the same conventional method in both the groups. Statistical Analysis Used: Statistical analysis was performed using SPSS 22.0 software (IBM Corp., Armonk, NY, USA) with Chi-square and Fisher's exact test, Student's t-test, ANOVA test, Mann–Whitney U-test, and Kruskal–Wallis test. Results: SLNs were detected in 89 of 100 patients. All the remaining 11 patients had T4 lower rectal cancer and the injection was performed ex vivo. We noted ten cases of upstaging due to SLN mapping and nine cases of false negative. Thus, the sensitivity was found to be 43.75%at and the accuracy was 78.65%. Conclusions: We used the same traditional method in both the groups, and our sensitivity, accuracy and upstaging rate were fewer than similar studies. Our recommendation for further studies is to use intensive SLN biopsy method in both groups of SLNs and non-SLNs.
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Downregulation of human leukocyte antigen Class I expression: An independent prognostic factor in colorectal cancer p. 165
Ehsan Nazemalhosseini-Mojarad, Hamid Asadzadeh-Aghdaei, Somayeh Mohammadpour, Amir Torshizi Esfahani, Mohammad Amin Porhoseingholi, Mahsa Molaei, Amir Jalali, Peter J K. Kuppen, Mohammad Reza Zali
DOI:10.4103/jcrt.JCRT_429_18  PMID:33380672
Aim: In the present study, we evaluated the clinical prognostic value of human leukocyte antigen (HLA (Class I tumor cell expression in a series of colorectal cancer (CRC) patients and also explored the association of this expression profile with molecular features such as mutation status of KRAS and BRAF, microsatellite stability status, and clinicopathological characteristics of the patients. Patients and Methods: Formalin-fixed paraffin-embedded tumor tissue of 258 CRC patient's sections were immunohistochemically stained and subsequently quantified for HLA Class I expression by the tumor cells. Determination of microsatellite instability (MSI) tumor status was ascertained using mononucleotide repeat microsatellite targets. KRAS and BRAF mutations were screened by polymerase chain reaction (PCR)-sequencing and cast-PCR, respectively. Results: HLA Class I expression was normal in 91 cases (35.3%), downregulated in 119 (46.1%), and loss of expression in 48 (18.6%) cases. Forty (15.5%) tumors were MSI-H (MSH), 49 were MSI-L (19%), and 169 were microsatellite stable (MSS) (65.5%). Thirty-six (14%) and 15 (5.8%) of the patients exhibited mutation in the KRAS and BRAF, respectively. It was found that patients with downregulated expression of HLA Class I were associated with Stage II tumors (P < 0.001) and a MSS tumor status (P < 0.001), while patients with loss of expression were associated with MSH status (P < 0.001). Univariate and multivariate analyses revealed that HLA Class I downregulated expression was an independent prognostic parameter for shorter overall patient survival time (hazard ratio: 1.8, P = 0.003). Conclusions:HLA Class I expression is an independent and sensitive clinical prognostic marker that might be used in CRC patients.
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Increased incidence of young age presentation of colorectal carcinoma: A tertiary cancer hospital study p. 172
Pandu Ranga Kumari Motepalli, Rajya Lakshmi Nukala
DOI:10.4103/jcrt.JCRT_912_17  PMID:33380673
Background: Colorectal cancer is relatively uncommon malignancy in India when compared with the Western world, disease affecting individuals above 40 years of age and is rare below 40 years of age. However, now there is an increase in young age presentation globally and India. Materials and Methods: We conducted a retrospective study of all colorectal carcinomas colorectal cancer (CRC) that were diagnosed during the past 6 years, i.e., from January 2011 to December 2016. Patients were divided into two groups – below 40 years and above 40 years. The records were analyzed in detail for age, gender, site of primary tumor, and histopathological type. The results of the two groups were compared and in turn compared with population-based cancer registry (PBCR) of Delhi, Mumbai, Kolkata, Chennai, and Bengaluru. Results: Two hundred and twenty-three patients were diagnosed to have CRC. Patients diagnosed below 40 years of age comprised 39.5% (88) compared with PBCR of Delhi (19.75%, P value significant at <0.05), Mumbai (10.9%), P value significant at <0.05), Kolkata (13.1%, P value significant at <0.05), Chennai (8.6%, P value significant at <0.05), and Bengaluru (13.6%, P value significant at <0.05). Among patients below 40 years of age, majority were males (56.8%), most occurred in the rectum (75%). Poorly differentiated, mucin-secreting, signet ring type adenocarcinomas are most frequent (35.2%) and presented at advanced stage (33%). This was similar to those reported in other literatures. Conclusions: Study shows that there is a rise in younger age presentation in our institution with rectal site predominance, advanced stage, and poor histopathological variants.
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The effect of body mass index on location of recurrence and survival in early-stage colorectal cancer p. 176
Abdullah Sakin, Nilay Sengul Samanci, Saban Secmeler, Serdar Arici, Orcun Can, Nurgul Yasar, Caglayan Geredeli, Cumhur Demir, Sener Cihan
DOI:10.4103/jcrt.JCRT_326_18  PMID:33380674
Introduction: Obesity has become one of the major public health problems in many countries. Controversial results were reported in publications on the relationship between obesity and mortality in patients diagnosed with colorectal cancer (CRC) and that receive curative treatment. In this study, we evaluated the effects of body mass index (BMI) on the location of recurrence and disease-free survival (DFS) in patients with early-stage CRC. Materials and Methods: Patients that were followed up and treated in the Department of Medical Oncology between 1999 and 2016 were retrospectively included in the study. Patients with operated Stage I, II, and III CRC were included in the study. Patients were divided into three groups based on their BMI (kg/m2) of below 25, between 25 and 30, and above 30. Results: A total of 950 patients, of which 527 (55.5%) were male and 423 (44.5%) were female, were included in the study. The median age of the patients was 56 years. Of the patients, 408 (42.4%) had BMI of <25, 370 (38.9%) had BMI between 25 and 30, and 172 (18.2%) had BMI of ≥30. Local recurrence rate was significantly higher in the group with BMI ≥30 compared to the other groups (P <0.01). When compared with DFS, there was a statistically significant difference between groups with BMI of <25 and ≥30 (P = 0.02) and that difference was more evidently observed in Stage III (P = 0.02). There was no statistically significant difference of overall survival in the BMI groups (P = 0.87). In multivariate analysis, the BMI ≥30 (hazard ratio [HR], 1.49, 95% confidence interval [CI], 1.02–2.17), rectal tumor (HR, 1.70, 95% CI, 1.15–2.51), Stage III (HR, 3.91, 95% CI, 1.86–8.25), number of positive lymph nodes (HR, 1.05, 95% CI, 1.03–1.07), and R1 resection (HR, 3.47, 95% CI, 1.71–7.05) were identified as independent risk factors negatively affecting DFS. Conclusion: In this study, we observed that the high BMI increased the risk of recurrence, especially in Stage III CRC patients, and that the recurrence frequently occurred locally.
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A study on the frequency and clinicopathological correlates of mismatch repair-deficient colorectal cancer p. 183
Paraashar R Rai, Nishitha Shetty, Pareekshith R Rai, Dinesh Shet, Arpitha Shetty
DOI:10.4103/jcrt.JCRT_526_18  PMID:33380675
Introduction: Microsatellite instability is an important pathway of tumorigenesis in colorectal cancer, and there is a need to understand its genetic and phenotypic profile. This study aimed to study the occurrence of deficient mismatch repair (dMMR) in an Indian cohort of patients and document the corresponding clinicopathological correlates. Materials and Methods: This is a retrospective study of patients admitted between January 2016 and December 2017. dMMR data from immunohistochemistry reports were correlated with histopathological data and demographic details. The data were then analyzed in terms of means and percentages. Results: About 29% of cases were found to be dMMR and 66.7% of dMMR tumors occurred in males. About 44.4% of dMMR tumors occurred in the ascending colon. MSH2 loss was seen in 44.4% of cases while MLH1 loss was seen in 33.3%, and there were two cases with loss of PMS1. Conclusions: dMMR tumors in our study were more common in males, presented earlier, were bulky, were less likely to show lymphovascular or perineural invasion, had lower preoperative carcinoembryonic antigen levels, and yielded high number of lymph nodes. Expected differences in age, stage, and grade were not observed. Compared to other studies, a higher proportion of cases in our study had MSH2 and PMS2 loss.
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Preoperative neutrophil-to-lymphocyte ratio as a predictive factor for survival in nonmetastatic colorectal cancer p. 189
Kaptan Gülben, Uğur Berberoğlu, Bahadır Öndeş, Osman Uyar, Onur Can Güler, Sevim Turanlı
DOI:10.4103/jcrt.JCRT_489_18  PMID:33380676
Background: The pretreatment ratio of neutrophils to lymphocytes (NLR) has been suggested as an indicator of poor outcome in various cancers. This study aimed to determine whether the preoperative NLR may be a predictor of survival in patients who underwent curative resection for colorectal cancer (CRC). Materials and Methods: The records of 219 CRC patients underwent curative resection between 2008 and 2014 were retrospectively evaluated. NLR was calculated by preoperative complete blood counts. The effects of age, gender, anatomic location, histologic grade, lymphovascular invasion, pathological T, pathological N, and tumor-node-metastasis stages and NLR on disease-free survival (DFS) and overall survival (OS) were analyzed using univariate and multivariate analyses. The optimal cutoff value for NLR was determined using receiver operating characteristic curve analysis. Results: The best cutoff value of NLR was 2.8. Multivariate analysis showed that NLR was not a predictor of DFS. However, NLR was found as an independent prognostic factor for OS (Hazard ratio, 5.4; 95% confidence interval, 2.3–12.5; P = 0.0001). Conclusion: A preoperative NLR of more than 2.8 might be an independent predictor for OS in patients with CRC. This simple and routinely available laboratory parameter may be used as a useful marker for identifying patients with a worse prognosis.
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Long-term oncologic and complication outcomes in anal cancer patients treated with radiation therapy p. 194
Ji Hyeon Joo, Jin-hong Park, Sang Min Yoon, Jin Cheon Kim, Chang Sik Yu, Tae Won Kim, Jong Hoon Kim
DOI:10.4103/jcrt.JCRT_34_18  PMID:33380677
Aim: The aim of the study is to analyze prognostic factors for tumor control, survival, and late toxicity in patients with anal cancer treated with chemoradiation. Materials and Methods: Anal cancer patients treated between 1996 and 2010 were analyzed. Patients received radiotherapy and concurrent 5-fluorouracil and mitomycin-C. Results: Data from 70 patients were analyzed. With a median follow-up of 6.4 years, 5-year overall survival and progression-free survival were 88% and 84%, respectively. Female gender and total radiation dose (≥54 Gy) were significantly associated with better local control. For survival, female gender, patient age, and tumor size were significant prognostic factors. The most common late toxicity was lymphedema. Possible prognosticators were examined, and only radiation dose to the inguinal area was significant. Conclusion: Despite moderately high radiation doses, local recurrence, and late complications were problems in treating anal cancer. In the intensity-modulated radiotherapy era, consensus on accurate target volume based on the pattern of failure analysis is required.
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BRIEF COMMUNICATIONS Top

Single-nucleotide polymorphisms in dendritic cell (dendritic cell-specific intercellular adhesion molecule 3-grabbing nonintegrin) gene of hepatocellular carcinoma patients from India p. 201
Manash Pratim Sarma, Dipu Bharali, Akan Das, Minakshi Bhattacharjee, Premashis Kar
DOI:10.4103/jcrt.JCRT_748_17  PMID:33380678
Objective: Hepatocellular carcinoma (HCC) is one of the major causes of morbidity and mortality in the world. Numerous genomic and proteomic studies have been carried out across the globe to understand cancer biology related to HCC. Dendritic cell-specific intercellular adhesion molecule 3-grabbing nonintegrin (DC-SIGN) is also known as cluster of differentiation 209. The current study was designed to investigate the association of mutation in DC-SIGN promoter region in HCC patients and healthy controls and to analyze the association of these mutations as a risk factor for HCC development from India. Materials and Methods: total of 40 cases of HCC and 40 healthy controls without any underlying liver diseases were included in the study. A total of 5 ml of peripheral blood samples were collected, and genomic DNA was isolated using phenol–chloroform method. Polymerase chain reaction amplification was carried out for DC gene, and the amplicons were subjected to direct sequencing (Macrogen, Korea). Mutations were analyzed comparing these sequences with those published sequences from the database using bioinformatics software. Results: A total of eight point mutations were observed in the HCC cases. The natures of mutation observed were deletion, transition, and transversion. All mutations were located in the 19th chromosome at nine different loci (51,079, 51,493, 51,561, 51,124, 51,125, 51,127, 51,169, 51,170, and 51,172). Conclusion: Mutation in the promoter region of the DC-SIGN gene may be a possible risk factor for the development of HCC in India. The findings of the study reveal the possible role of these mutants with HCC, and future large-scale prospective studies will further validate the findings of the current study.
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Lutetium therapy-induced carcinoid crisis: A case report and review of literature p. 206
Sanjay Kumar Yadav, Chandan Kumar Jha, Shrinivas Patil, Deepanksha Datta, Anjali Mishra, PK Pradhan
DOI:10.4103/jcrt.JCRT_22_18  PMID:33380679
Peptide receptor radionuclide therapy with 177lutetium (Lu)-labeled somatostatin analogs is a promising new tool in the management of patients with inoperable or metastatic neuroendocrine tumors. Some of these patients may present with carcinoid syndrome and it is known that rarely carcinoid crisis can be precipitated by surgical or other interventions in these patients. However, there are anecdotal reports of carcinoid crisis after Lu-labeled peptide therapy. We are reporting our experience of successful management of one such case of carcinoid crisis which was precipitated by Lu therapy.
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Fungal profile and antifungal susceptibility pattern of candidiasis in esophageal cancer patients p. 209
Abhijit Talukdar, Rashmisnata Barman, Anupam Sarma, Manigreeva Krishnatreya, Jagannath Dev Sharma, Amal Chandra Kataki
DOI:10.4103/jcrt.JCRT_581_18  PMID:33380680
Aim: This study was carried out to determine the fungal profile and antifungal susceptibility pattern in the brushing samples of candidiasis in patients with carcinoma of esophagus. Materials and Methods: The study was carried out in the Departments of Microbiology and Surgical Oncology of a regional cancer center from January 2017 to December 2017. Samples were collected under all aseptic precaution and Clinical Laboratory Standards Institute guidelines 2017 was followed for antifungal susceptibility testing. Results: A total of 132 endoscopy brushing samples were collected from histological proven esophageal cancer patients and processed for fungal culture. Of which, 75 (56.81%) samples showed culture positivity and were recruited. Candida albicans in 40 (53.33%), Candida krusei in 25 (33.33%), Candida tropicalis in 7 (9.33%), and Candida glabrata in 3 (4%) patients were seen. Among the 40 C. albicans isolates, all were sensitive to caspofungin – 40 (100%), 34 (85%) showed sensitivity to fluconazole, and 32 (80%) showed sensitivity to flucytosine. C. krusei and C. tropicalis showed 100% sensitivity to caspofungin, and C. glabrata isolates showed 100% resistance to caspofungin and 80% resistance to Amphotericin B. Conclusion: The present study revealed the emergence of multidrug-resistant, nonalbicans Candida isolates in cancer esophagus patients with candidiasis in northeast India.
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CASE REPORTS Top

Radiation-induced neovascular glaucoma: A devastating disease p. 213
Megha Gopalakrishna, Kavitha Srinivasan, Venkatesh Rengaraj
DOI:10.4103/jcrt.JCRT_900_18  PMID:33380681
Neovascular glaucoma (NVG) is a potentially blinding form of secondary glaucoma, with radiation being one of the rare causes. This report is aimed to discuss a case of NVG caused secondary to radiotherapy (RT) given for a nasal malignancy. A 50-year-old male presented with enophthalmos, dry eye, and NVG 3 years after receiving RT for chondrosarcoma of nasal and paranasal cavities. He was given topical antiglaucoma medications, retinal laser, and intravitreal bevacizumab injection and thus prevented the eye from becoming a painful blind eye. The radiation oncologist and ear, nose, and throat specialists have to liaise closely with ophthalmologist when patients receive radiation involving the eye in the treatment field to prevent, diagnose, and treat this devastating condition.
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Diffuse peritoneal leiomyomatosis: An exceptional entity in a male patient p. 217
Hajar Khibri, Amal Bousseaden, Badreddine Alami, Saïd Boujraf, Samira Rabhi
DOI:10.4103/jcrt.JCRT_688_17  PMID:33380682
Diffuse peritoneal leiomyomatosis is a benign peritoneal tumor which develops from smoother muscular fibers. It is a rare entity in females undergoing hormonal effects. This pathological entity is exceptional in male patients. Hence, we report a unique case of diffuse peritoneal leiomyomatosis that occurred in a male patient without hormonal stimulations. The etiopathology and genesis are not completely elucidated. Besides, the clinical symptoms are not specific. The positive diagnosis is based on sets of imaging argument. The anatomicopathological studies allow confirming the diagnosis and reject any tumoral origin. The evolution of the pathology is often favorable. The malignant transformation is exceptional. The treatment is based on abolishing any of the hormonal stimulations. The surgical exeresis is indicated in case of higher peritoneal mass. In case of recurrence or progression, luteinizing hormone-releasing hormone analogs or surgical castrations are indicated.
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Preoperative diagnosis of pancreatic schwannoma – Myth or reality p. 222
Vaibhav Kumar Varshney, Taruna Yadav, Poonam Elhence, Binit Sureka
DOI:10.4103/jcrt.JCRT_730_18  PMID:33380683
Pancreatic schwannoma is a rare, well-encapsulated tumor of the pancreas. Preoperative diagnosis of this tumor is uncommon due to marked degenerative change, its rarity, and overlapping clinical and imaging features with other pancreatic neoplasms. Here, we report two cases of pancreatic schwannoma, suspected preoperatively based on their multimodal imaging features, so that enucleation was possible. Extensive pancreatic surgeries can be avoided if imaging can provide clues about the benign nature of the pancreatic masses preoperatively.
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Ten years and counting: Survival in stage IV metastatic squamous cell carcinoma of anal canal following radical treatment p. 227
Shaurav Maulik, Vinod Hande, Reena Engineer, Umesh Mahantshetty
DOI:10.4103/jcrt.JCRT_118_18  PMID:33380684
A 60-year-old male ptient presented with a 2-month history of altered bowel habits and occasional bleeding per rectum. On evaluation, he was diagnosed with squamous cell carcinoma of the anal canal (SCCAC) with an isolated hepatic lesion in segment II estimated as 4.3 cm × 3.5 cm on ultrasound. Subsequent needle biopsy confirmed metastatic squamous cell carcinoma deposits. The final diagnosis was SCCAC, cT4N1M1 (Stage IV). The patient was offered radical intent treatment. As per institutional protocol, the patient received two cycles of induction cisplatin + 5fluorouracil (FU) followed by chemo-radiation. 5FU and mitomycin C was given concurrently with irradiation. The primary and metastatic sites were irradiated using 6 MV photons on helical tomotherapy using conventional fractionation. Fluorodeoxyglucose positron emission tomograph-computed tomography performed 4 months after treatment completion showed a complete metabolic and morphological response. As of the date of writing, the patient is alive and disease free, 10 years after treatment with no long term sequelae.
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Radiation-induced leiomyosarcoma of oral cavity: Two cases with a review of literature p. 230
Nishant Sagar, Meeta Singh, Neelakshi Goyal, Nita Khurana, Kishore Singh, Ravi Meher
DOI:10.4103/jcrt.JCRT_682_18  PMID:33380685
Radiation-induced sarcoma is a rare entity, with leiomyosarcoma (LMS) in the oral cavity post radiation being extremely rare. We report two such cases who presented with swelling in the oral cavity with a history of moderately differentiated squamous cell carcinoma. Both cases prior to the diagnosis of LMS had been managed with surgery and radiation therapy and later developed swelling in the oral cavity. The management of LMS is uncertain; hence, this article aims to spread awareness about this rare diagnosis and to know the importance of differentiation from other more common lesions including recurrence.
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Epithelial–myoepithelial carcinoma at the base of the tongue presented with metastatic disease in the absence of myoepithelial anaplasia p. 233
Mahima Yadav, Neha Gupta, Richa Katiyar, Shashikant C U. Patne
DOI:10.4103/jcrt.JCRT_840_17  PMID:33380686
Epithelial–myoepithelial carcinoma (EMC) is a biphasic low-grade malignant tumor that shows ductal structures lined by the ductal cells with surrounding myoepithelial cells. EMC is most commonly reported in the parotid gland followed by other major and minor salivary glands. EMC of the tongue is an extremely uncommon tumor, with only five previously published case reports. We herein report the sixth case of EMC of the tongue. A 40-year-old female who had throat pain, dysphagia, and right earache for 3 years showed a 4 cm × 4 cm nodular tumor at the base of her tongue. Histopathological and immunohistochemical features were diagnostic of EMC with cervical lymph node metastasis. The metastatic behavior of EMC of the tongue in the absence of myoepithelial anaplasia or high-grade histological features is unusual and reported in this case report for the first time.
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Gastric signet ring cell carcinoma presenting with widespread osteoblastic metastases p. 237
Ayşegül İdil Soylu, Eylem Odabaşı, Seda Gün, Mustafa Bekir Selçuk
DOI:10.4103/jcrt.JCRT_834_18  PMID:33380687
Gastric cancer infrequently metastasizes to the bone. These metastases are generally osteolytic. On the other hand, osteoblastic metastases are very rare. In this case report, a patient with signet ring cell gastric carcinoma presenting with diffuse osteoblastic bone metastases who had no laboratory abnormalities at the time of diagnosis is described. To our knowledge, our patient represents the longest surviving case compared with the similar cases in literature.
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F-18 fluorodeoxyglucose positron emission tomography/computed tomography in conjunctival melanoma with recurrence p. 240
Anurag Jain, Arun Ravi John, Braj Kishore, MG Vishnoi, Aniruddha G Pandit, Amit Sharma, Abhinav Jaimini, Mayuri Jain, Anirudh Singh
DOI:10.4103/jcrt.JCRT_453_17  PMID:33380688
Ocular melanoma is classified under the category of noncutaneous melanomas. Noncutaneous melanomas are relatively rare. Ocular melanoma commonly arises from choroid. Conjunctival melanoma is a rare but potentially lethal form of ocular melanoma. It can invade locally. Systemic spread is seen in up to 25% of cases, often associated with lymph node involvement. Metastatic sites include the lungs, liver, gastrointestinal tract, and the central nervous system. F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET-CT) scanning is indicated for staging cutaneous melanoma patients. However, few studies have evaluated its role in the management of conjunctival melanoma. This case highlights the use of F-18 FDG PET/CT for imaging, preoperative staging, and evaluation for metastasis in conjunctival melanoma.
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Brain atypical teratoid rhabdoid tumor in an adult with long-term survival: Case report and review of literature p. 243
Rim Moujahed, Khalil Ghedira, Alia Zehani, Slim Charfi, Sonia Nagi
DOI:10.4103/jcrt.JCRT_554_18  PMID:33380689
Atypical teratoid/rhabdoid tumor (AT/RT) represents a rare malignant embryonic tumor of infant and early childhood. Its prognosis remains dismal despite aggressive multimodal treatment. We report the case of a 24-year-old male who was diagnosed with left parietal AT/RT after total resection and who is still in good health and recurrence free 4 years after surgery and adjuvant chemotherapy and radiotherapy.
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LETTERS TO THE EDITOR Top

Risk of cancer due to flower garland for offering in religious practice p. 246
Sora Yasri, Viroj Wiwanitkit
DOI:10.4103/jcrt.JCRT_340_18  PMID:33380690
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Isolated dural metastasis of follicular carcinoma of the thyroid presenting as scalp swelling p. 248
Vikram Singh, Apinderpreet Singh, Sanjay Kumar Bhadada, Ritambhra Nada
DOI:10.4103/jcrt.JCRT_461_18  PMID:33380691
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Paraoxonase and arylesterase are the same enzyme in humans p. 250
Mike Mackness
DOI:10.4103/jcrt.JCRT_604_18  PMID:33380692
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Dermatomyositis: Look beyond skin p. 251
Karthik K Prasad, Manish S Bhatia, Nagesh T Sirsath
DOI:10.4103/jcrt.JCRT_773_17  PMID:33380693
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Helicobacter pylori infection and pancreatic cancer p. 253
Amin Talebi Bezmin Abadi
DOI:10.4103/jcrt.JCRT_244_17  PMID:33380694
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