The data indicate that MMP-2 and MMP-9 can be useful to identify metastatic phenotype as well as for treatment monitoring in oral cancer.

The study concluded that activation of MMP-2 and MMP-9 was significantly higher in malignant tissues as compared to adjacent normal tissues. Further, activation ratio of MMP-2 was significantly elevated in patients with lymph node metastasis as compared to patients without lymph node metastasis, which could predict risk of lymph node metastasis development in node negative patients.

Background Recognising the significant extent of poor-quality care and human rights issues in mental health, the World Health Organization launched the QualityRights initiative in 2013 as a practical tool for implementing human rights standards including the United Nations Convention on Rights of Persons with Disabilities (CRPD) at the ground level. Aims To describe the first large-scale implementation and evaluation of QualityRights as a scalable human rights-based approach in public mental health services in Gujarat, India. Method This is a pragmatic trial involving implementation of QualityRights at six public mental health services chosen by the Government of Gujarat. For comparison, we identified three other public mental health services in Gujarat that did not receive the QualityRights intervention. Results Over a 12-month period, the quality of services provided by those services receiving the QualityRights intervention improved significantly. Staff in these services showed substantially improved attitudes towards service users (effect sizes 0.50–0.17), and service users reported feeling significantly more empowered (effect size 0.07) and satisfied with the services offered (effect size 0.09). Caregivers at the intervention services also reported a moderately reduced burden of care (effect size 0.15). Conclusions To date, some countries are hesitant to reforming mental health services in line with the CRPD, which is partially attributable to a lack of knowledge and understanding about how this can be achieved. This evaluation shows that QualityRights can be effectively implemented even in resource-constrained settings and has a significant impact on the quality of mental health services. Declaration of interest None.

Level V lymph node (LN) dissection has been significantly associated with postoperative shoulder dysfunction as a sequel of spinal accessory nerve (SAN) dysfunction. The aim of study was to determine the role of level V LN dissection in clinically node positive (cN+) oral cavity cancer. We have prospectively evaluated 210 patients of oral cavity squamous cell carcinoma (SCC). During neck dissection, the contents of the level V LN were dissected, labelled, and processed separately from the neck dissection specimen. We studied the prevalence of histopathologic metastasis to level V nodes in clinically node negative (cN0), cN1 and cN2 groups. Potential risk factors for the involvement of level V LN were also analysed. Of 210 cases, 48 were cN0. Out of them 77 % were pN0 and none of cNo (48) patients had level V metastases. Out of 162 cN+ cases, 112 were cN1 and 49 cN2. Amongst cN1 (112) cases, cN1 with palpable level lb LN (99), 60 % had pN0 and none of them had level V LN involvement but cN1 with palpable ll/lll LN (13), 85 % had pN+ and 1 patient had level V LN involvement (8 %). 8 patients from cN2 (49) group had level V LN involvement (16 %). Over all level V LN involvement was 4.3 %. Tongue was the most common site to give rise to level V LN metastases and extra capsular spread (ECS) was present in 100 % patient with level V LN metastases. Thus, we concluded that, apart from cN0, patients with cN1 oral cavity cancer with level lb as only site, carefully selected cases could safely undergo SND. Potential risk factors for level V LN metastases are clinically evident ECS, multiple LN involvement and cN1 with deep jugular chain of LN involvement.

According to the 2008 revision of the World Health Organization (WHO) classification of myeloid malignancies, philadelphia chromosome (Ph)-negative myeloproliferative neoplasms (MPNs) include clonal, hematologic disorders such as polycythemia vera, primary myelofibrosis, and essential thrombocythemia.Recent years have witnessed major advances in the understanding of the molecular pathophysiology of these rare subgroups of chronic, myeloproliferative disorders. Identification of somatic mutations in genes associated with pathogenesis and evolution of these myeloproliferative conditions (Janus Kinase 2; myeloproliferative leukemia virus gene; calreticulin) led to substantial changes in the international guidelines for diagnosis and treatment of Ph-negative MPN during the last few years.The MPN-Working Group (MPN-WG), a panel of hematologists with expertise in MPN diagnosis and treatment from various parts of India, examined applicability of this latest clinical and scientific evidence in the context of hematology practice in India.This manuscript summarizes the consensus recommendations formulated by the MPN-WG that can be followed as a guideline for management of patients with Ph-negative MPN in the context of clinical practice in India.