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Head and neck malignancies are the seventeenth most common malignancies, worldwide and second most common malignancy in India. So current study aims to compare between molecular marker p53 analysis and HPE for tumour positivity in primary resected margins in head and neck SCC. 61 patients with head and neck SCC were included in this prospective observational cross-sectional study performed in tertiary care hospital. A detailed history general physical examination blood investigation was done before the surgery. After the surgery, primary lesion from the resected tumour was sent for HPE analysis. From the same specimen, the margins at distance of 0.5–1 cm from primary tumour were sent for p53 mutation analysis. Report of p-53 mutation was noted and entered to the Performa. In our study we found out that in PDSCC HPE negative margins were found positive for p53 mutation in 81% cases. Which suggest that evaluation for p53 mutation should be done in PDSCC cases for HPE negative margins with in 1 cm. In patients of head and neck squamous cell carcinoma with free margins on HPE p-53 mutation is significantly associated to the PDSCC and margin upto 0.7 mm so recommended for p-53 profile can be beneficial in cases of the PDSCC and margins up to 0.7 mm for further management or for possibility of recurrence and its management to improve patients survival and decrease morbidity and mortality.

PurposeThe concepts associated with leadership and management have often been conflated, considered one and the same phenomenon by some and then considered by others to be quite distinctive. The same ambiguity is even truer at the level of application and practicality. Only a handful of studies have attempted empirically to differentiate between the two concepts. The study sought to develop an instrument to discriminate between the two concepts.Design/methodology/approachA prospective study was conducted with two groups of scholars in the areas of leadership and management. They completed the exploratory Leadership/Management Concept Scale (LMCS), the Leadership Practices Inventory (LPI) and provided demographic information. The results from the Initial group were compared with a validation group. Standard statistical techniques were used to analyze the two groups and investigate associations among the study measures.FindingsThe LMCS effectively differentiated actions associated with leadership from actions associated with management actions. There were four distinct choices consistently selected as most consistent with leadership: influencing, coaching, modeling and ensuring resilience. No significant correlations were found between scores on the LMCS and the LPI, providing evidence that the former was capturing actions other than those associated with leadership alone.Research limitations/implicationsIt is empirically possible to differentiate between the actions typically associated with the concepts of leadership and management. This distinction can be invaluable in various educational programs designed to develop either or both leadership and management abilities, as well as assist in the identification of those with proclivities to one or other of the two concepts. The LMCS shows promise in reliably differentiating between the two concepts and can be useful for scholars aiming to investigate leadership or management without confounding the two.Practical implicationsThere are numerous positions and organizational roles where leadership and management are differentiated, with one being much more needed than the other. The LMCS can differentiate empirically how potential candidates for leadership and/or management positions think about the two, which would allow a would-be employer to screen candidates for given opportunities and, depending on their conceptualization of leadership and management, assign them most appropriately.Originality/valueThis study fills a fundamental gap in both the leadership and management field: first in being able to provide evidence that the two concepts, while similar in some regards, are not the same and can be differentiated from each other and second, in developing an instrument (LMCS) that both practitioners and scholars can use to help their audiences better understand the differences between leadership and management and to develop actions appropriate to situational demands.

We designed a multiplex quantitative PCR to differentiate monkeypox virus clades. For clinical samples collected in the United Kingdom and Nigeria, sensitivity was 78% (95% CI 67.67%-86.14%) and specificity 94% (95% CI 80.84%-99.30%); for samples with cycle thresholds <35, sensitivity was 98% (95% CI 91.72%-99.96%) and specificity 94% (95% CI 80.84%-99.30%).

Interactions between the diet and intestinal microbiota play a role in health and disease, including obesity and related metabolic complications. There is great interest to use dietary means to manipulate the microbiota to promote health. Currently, the impact of dietary change on the microbiota and the host metabolism is poorly predictable and highly individual. We propose that the responsiveness of the gut microbiota may depend on its composition, and associate with metabolic changes in the host. Our study involved three independent cohorts of obese adults (n = 78) from Belgium, Finland, and Britain, participating in different dietary interventions aiming to improve metabolic health. We used a phylogenetic microarray for comprehensive fecal microbiota analysis at baseline and after the intervention. Blood cholesterol, insulin and inflammation markers were analyzed as indicators of host response. The data were divided into four training set - test set pairs; each intervention acted both as a part of a training set and as an independent test set. We used linear models to predict the responsiveness of the microbiota and the host, and logistic regression to predict responder vs. non-responder status, or increase vs. decrease of the health parameters. Our models, based on the abundance of several, mainly Firmicute species at baseline, predicted the responsiveness of the microbiota (AUC  =  0.77-1; predicted vs. observed correlation  =  0.67-0.88). Many of the predictive taxa showed a non-linear relationship with the responsiveness. The microbiota response associated with the change in serum cholesterol levels with an AUC of 0.96, highlighting the involvement of the intestinal microbiota in metabolic health. This proof-of-principle study introduces the first potential microbial biomarkers for dietary responsiveness in obese individuals with impaired metabolic health, and reveals the potential of microbiota signatures for personalized nutrition.

Background Poorly differentiated thyroid cancer (PDTC) presents the endocrinologist and surgeon with challenges of recognition and treatment given the lack of consensus on histopathologic definition and limited literature on surgical and nonsurgical treatment. Methods We offer an operational pathologic definition for PDTC, which should help guide future work in this area. Poorly differentiated thyroid cancer should include insular and trabecular variants but should not include solid type lesions (included by other workers) or more differentiated tumors that may have poor prognosis such as tall cell, columnar, diffuse sclerosing, and oncocytic lesions. Systematic evidence‐based literature reviews focusing on two questions were carried out: (1) is PDTC associated with an intermediate prognosis relative to anaplastic and WDTC? and (2) What are the postoperative treatment options for poorly differentiated thyroid cancer? Conclusions We have found level IV evidence that PDTC is intermediate between WDTC and anaplastic cancers in terms of prognosis. It represents a disease where appropriate administration of aggressive treatment not typically necessary for routine WDTC and not effective for anaplastic disease may uniquely result in substantial benefit. Limited level IV data show conflicting results regarding 131I treatment benefit. Given lack of morbidity and potential for benefit, we recommend that 131I therapy be considered in all patients postoperatively. Recommendation regarding external beam radiotherapy (XRT) is based primarily on extrapolation from studies in forms of poor‐prognosis WDTC where substantial data exist regarding treatment benefit. We recommend that external beam treatment be considered in all patients with PDTC with T3 tumors without distant metastasis, all patients with T4 tumors, and all patients with regional lymph node involvement.

Background Anaplastic thyroid carcinoma (ATC) accounts for only 1 to 2% of all thyroid carcinomas, but it is one of the most lethal neoplasms in humans. To date, most findings about ATC have been derived from single-institution studies with limited numbers of cohorts. To obtain further insights into this “orphan disease,” we have established a multicenter registry, the ATC Research Consortium of Japan (ATCCJ). We analyzed prognostic factors and treatment outcomes using the large cohort database of the ATCCJ. Methods Most of the Japanese centers involved in the treatment of thyroid cancer were invited to join the ATCCJ and have provided information on ATC patients treated between 1995 and 2008. The database includes 677 cases from 38 registered institutions. Survival curves were determined using Kaplan-Meier methods and were compared using the log-rank test. Cox’s proportional hazards model was used for multivariate analysis. Results Clinical varieties of ATC were classified into four types: common type ( n  = 547); incidental type ( n  = 29); anaplastic transformation at the neck ( n  = 95); anaplastic transformation at a distant site ( n  = 6). The incidental type followed by anaplastic transformation at the neck showed better outcomes than the other types. Anaplastic transformation at a distant site showed the worst outcomes. The 6-month and 1-year cause-specific survival (CSS) rates for common-type ATC were 36 and 18%, respectively. In all, 84 (15%) achieved long-term (>1 year) survival. Multivariate analysis identified age ≥70 years, presence of acute symptoms, leukocytosis (white blood cell count ≥10,000/mm 3 ), large tumor >5 cm, T4b tumor, and distant metastasis as significant risk factors for lower survival. CSS rates also differed significantly depending on UICC stages, with 6-month CSSs of 60% for stage IVA, 45% for IVB, and 19% for IVC. For 36 of 69 (52%) stage IVA patients who underwent radical surgery, adjuvant therapies, including radiation therapy (RTX) and chemotherapy (CTX) did not show additional benefit statistically. Conversely, among 242 stage IVB patients, 80 (33%) underwent radical surgery. For those patients, therapies combining RTX with CTX significantly improved CSS. Conclusions Long-term survival is possible for selected patients with ATC. To determine the treatment strategy, UICC stage (disease extent) and other prognostic factors (e.g., biologic malignancy grade) should be considered.

Background The surgical management of papillary thyroid microcarcinoma (PTMC), especially regarding the necessity of central lymph node dissection (CLND), remains controversial. This meta-analysis was conducted to investigate the clinicopathologic factors predictive of central compartment lymph node metastasis (CLNM) in patients diagnosed with PTMC. Methods PubMed, EMBASE, Ovid, Web of Science, and the Cochrane Library were searched from their inception to September 2013. Published studies that explored the association between clinicopathologic factors and CLNM in PTMC patients were included. From the identified studies, we extracted the number of individuals with or without each risk factor to calculate the CLNM-positive proportions and used fixed/random-effects models for the meta-analyses of overall relative risk (RR). The pooling analysis on the association between CLNM or the different CLNDs and prognosis was also conducted. Results A total of 19 eligible studies that included 8345 patients were identified. Three studies did therapeutic CLND, while the other 16 studies performed prophylactic CLND in PTMC patients. Meta-analyses revealed that CLNM was associated with male gender (RR = 1.36; 95 % CI 1.22–1.52, p  = 0.001), younger age (<45 years; RR = 1.15; 95 % CI 1.04–1.27, p  = 0.006), larger tumor size (>5 mm; RR = 1.51 95 % CI 1.32–1.65, p  = 0.001), multifocality (RR = 1.40; 95 % CI 1.27–1.54, p  = 0.001), and extrathyroidal extension (RR = 1.81; 95 % CI 1.34–2.43, p  = 0.001). Meta-regression analysis indicated that a disparity in the proportion of PTMC patients with CLNM in each study was the main factor resulting in heterogeneity among the 19 studies. In addition, the pooling analyses suggested that CLNM did not significantly predict neck recurrences [hazard ratio (HR) = 0.95, 95 % CI 0.67–1.22, p  = 0.054], and the prophylactic CLND group did not improve local control significantly compared to the therapeutic group (RR = 0.96, 95 % CI 0.46–2.01, p  = 0.544). Conclusion Prophylactic CLND may be performed in PTMC patients with clinically uninvolved central lymph nodes but with high risk factors; multicenter studies with long-term follow-up are recommended to better understand the risk factors and surgical management for central nodes in PTMC.

Background The clinical importance of papillary thyroid microcarcinoma (PTMC) remains controversial, with current guidelines suggesting that thyroid lobectomy alone is sufficient. The purpose of this study was to identify population-level treatment patterns in the USA for PTMC. Methods Patients with PTMC in SEER (1998–2010) were included; demographic, clinical (extent of surgery, administration of post-operative radioactive iodine [RAI]), and pathologic characteristics were examined. Outcomes of interest were 5- and 10-year overall survival (OS) and disease-specific survival (DSS). Results The cohort consisted of 29,512 patients. Mean age at diagnosis was 48.5 years; mean tumor size was 0.53 cm. Overall, 73.4 % of patients underwent total thyroidectomy, and RAI was administered to 31.3 %. In multivariate analysis, total thyroidectomy was more frequently performed in patients with multifocal (odds ratio [OR] 2.55), ‘regional’, or ‘distant’ PTMC (OR 2.90 and 2.59). Non-operative management was associated with male patients (OR 4.24) and those aged ≥65 years (OR 6.31). Post-operative RAI was associated with multifocal PTMC (OR 2.57). Overall, 5- and 10-year DSS was 99.6 and 99.3 %, respectively, with no difference in DSS between patients who underwent partial versus total thyroidectomy. OS of patients with PTMC who underwent any thyroid operation was similar to that of the general population of the USA. Conclusions An increasing number of patients are undergoing total thyroidectomy and RAI for PTMC. While there may be a subset of patients for whom more aggressive therapy is indicated, many patients with PTMC may be over-treated, with no demonstrable benefit to survival.

Background Thyrotropin (TSH) is a known thyroid growth factor. Several studies have suggested its potential role in carcinogenesis and the progression of differentiated thyroid carcinoma. We have been conducting a prospective trial of nonsurgical observation for asymptomatic papillary thyroid microcarcinoma (PMC) since 1995. The aim of this study was to investigate whether serum TSH concentrations can be used to predict PMC growth. Methods This study examined 415 asymptomatic PMCs. Three hundred twenty-two patients decided to undergo nonsurgical observation by ultrasonography and were followed for ≥2 years. Results After a mean of 6.5 years of observation (range 2–22 years), 25 lesions (6 %) had increased in size, 377 (91 %) showed no change and 13 (3 %) had decreased in size. Both baseline TSH and mean TSH during follow-up for PMC that increased in size did not differ significantly from those lesions that were unchanged or decreased in size. Increases in size were seen in 0 of 18 (0 %), 15 of 260 (6 %), 10 of 126 (8 %), and 0 of 11 (0 %) for PMCs with baseline TSH < 0.50, 0.50–1.99, 2.00–3.99, and ≥4.00 mIU/L, respectively. A logistic regression model analyzing the association between baseline TSH and outcome showed an odds ratio of 1.01 (95 % confidence interval [CI], 0.66–1.29). No significant correlations were apparent between mean TSH during follow-up and change in PMC volume ( r  = 0.019, p  = 0.70). Conclusions No significant association between TSH and tumor progression was verified during the nonsurgical observation trial for PMC. TSH is not a good predictor of PMC growth.

Objective To analyze the clinical characteristics of malignant lymphoma that closely resembles IgG4-related disease (IgG4-RD). Methods This study retrospectively analysis involving 31 patients who were lymphoma mimicking, IgG4-RD and 50 contemporaneous IgG4-RD patients serving as controls. Lymphoma mimicking IgG4-RD was defined as presenting with masses in the typical sites of IgG4-RD, with or without elevated serum IgG4 levels, and ultimately confirmed to be lymphoma. The clinical data, including the extent of lymph node involvement, maximum diameter of lymph nodes, systemic symptoms, and laboratory parameters were assessed. Student’s t -test, the Mann–Whitney test, and the chi-squared test were used to compare the two groups. Results Fever emerged as a distinctive feature in lymphoma patients. Compared to IgG4-RD, lymphoma patients exhibited a greater extent of lymph node involvement ( p  < 0.001), larger maximum diameters of lymph nodes ( p  = 0.007), and higher frequency of enlargement in supraclavicular (41.9% vs 10.0%; p  = 0.001), armpit (45.2% vs 16.0%; p  = 0.004), retroperitoneal (70.9% vs 10.0%; p  < 0.001), and groin lymph nodes (41.9% vs 8.0%; p  < 0.001). In contrast, IgG4-RD patients were more likely to show involvement of submandibular gland (58.0% vs 29.0%; p  = 0.015) and pancreatic (44.0% vs 9.7%; p  = 0.001). Additionally, lymphoma patients presented with higher levels of erythrocyte sedimentation rate (ESR) ( p  = 0.010), C-reactive protein (CRP) ( p  < 0.001), and lactate dehydrogenase (LDH) ( p  = 0.002), along with a higher prevalence of anemia (35.5% vs 4.0%; p  < 0.001) and lower albumin levels ( p  = 0.039), while IgG4-RD patients had higher IgG4/IgG ratio ( p  < 0.001) and lower complement 3 (C3) ( p  = 0.009) levels than lymphoma patients. Conclusion Although patients with malignant lymphoma and IgG4-RD share some overlapping presentations, they differ significantly in some distinct features, including fever, pattern of lymph node and organ involvement distribution, and some laboratory parameters. Key Points • IgG4-related disease (IgG4-RD) is an immune-mediated disorder characterized by elevated serum IgG4 levels, presenting lymphadenopathy and tumor-like sclerosing lesions in extranodal sites . • Lymphoma, a malignancy that originates from lymphocytes, can present with a variety of clinical manifestations, including painless swelling of lymph nodes and enlargement of different organs . • While patients with malignant lymphoma and IgG4-RD share certain overlapping clinical presentations, they exhibit significant differences in distinct features, including fever, patterns of lymph node and organ involvement, and various laboratory parameters .