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  Most popular articles (Since July 15, 2019)

 
 
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EDITOR-IN-CHIEF MESSAGE
Inaugural message from the Editor-in-Chief
BS Ajaikumar
January-June 2020, 1(1):1-1
DOI:10.4103/WKMP-0197.298273  
  2,500 253 -
CASE REPORTS
Impact of precision medicine in head and neck cancers: An illustrative case report
BM Joshna, R Apoorva, S Anand, T Shalini, K Akshay, R Vishal, N Ravi, P Prasanth
January-June 2020, 1(1):3-8
DOI:10.4103/WKMP-0197.298270  
  2,415 203 -
REVIEWS
Oral microbiome: Tracing the microbial kingdom in oral cancer
A Kshitij, K Ankita, P Bharat, T Shalini, R Vishal, S Anand
January-June 2020, 1(1):16-19
DOI:10.4103/WKMP-0197.298267  
  2,382 186 -
EDITORíS MESSAGE
From the Editor's -Desk
Ravi C Nayar
January-June 2020, 1(1):2-2
DOI:10.4103/WKMP-0197.298281  
  2,270 207 -
CASE REPORTS
Precision onco-surgery for redefining resectability in head and neck cancer
BM Joshna, G Abhijith, S Anand, K Akshay, T Shalini, R Vishal, P Prasanth
January-June 2020, 1(1):9-15
DOI:10.4103/WKMP-0197.298271  
  2,298 146 -
ORIGINAL ARTICLE
Diagnostic evaluation of PET CT, USG neck & FNAC in clinically N0 neck
S Piyush, R Vishal, S Anand, S Shivakumar, S Sudhakar, K Kallur, R Veena
January-June 2020, 1(1):36-39
DOI:10.4103/WKMP-0197.298272  
Introduction : Extent of neck dissection is determined by the neck nodal positivity and indirectly has a bearing on neck dissection related morbidity. The current study prospectively compares the accuracy of these imaging techniques and FNAC to final histopathology. 31 patients of Oral cavity squamous cell carcinoma with no palpable lymphadenopathy were prospectively included in the study. Methodology : Thirty-one patients of oral cavity SCC who did not have any clinical lymphadenopathy treated at our centre from January 2018 to July 2018 were recruited for the study. All these patients underwent a whole body PET with contrast enhanced CT followed by a high-resolution ultrasound of the neck. Patients then underwent a US guided FNAC of the most suspicious lymph node. Results: 14 of the 31 patients had pathologically positive neck node. PET CT had 100 % negative predictive value. USG Neck diagnosed 22 patients to have suspicious lymph node with a negative predicitve value of 66.7% and positive predictive value of 50%. The combined yield of PET CT and USG Neck could produce a PPV of 100% and NPV of 68%. Conclusion : None of the test individually could predict the neck nodal positivity with absolute accuracy in our study. The best accuracy was when a combination of these tests were done.
  1,519 123 -
SYSTEMATIC REVIEW
A systematic review of methodology in prognostic and prediction modelling with radiomics for non-small cell lung cancer - Part IA systematic review of methodology in prognostic and prediction modelling with radiomics for non-small cell lung cancer – Part I
R Patil, L Wee, A Dekker
January-June 2020, 1(1):29-35
DOI:10.4103/WKMP-0197.298284  
Objective: The aim of this study was to systematically review the literature to synthesize and investigate repeatability and reproducibility of radiomic features, considered in building prognostic and prediction modelling with respect to NSCLC. Methods: The PubMed database was searched using combinations of the broad Haines and Ingui filters along with a set of text words specific to cancer, radiomics, reproducibility and repeatability. This systematic review was performed by two reviewers working entirely independently, and has been reported in compliance with PRISMA guidelines. Results: Out of 624 unique records, 41 full text articles were subjected to review. The studies were primarily in NSCLC. The imaging modalities were CT, PET and cone-beam CT – no studies addressed MR. Only 7 studies addressed in detail every methodological aspect related to image acquisition, pre-processing and feature extraction. Only few studies have made either the image set or software, or both, openly accessible. Due to heterogeneity in statistical metrics, a meta-analysis of pooled data was not possible. Conclusions: The repeatability and reproducibility of radiomic features are sensitive in varying degrees to processing details such as image acquisition settings, image reconstruction algorithm, image pre-processing and software used to extract radiomic features. Advances in Knowledge: Intra-class and concordance correlations were the most widely used statistical metrics, but arbitrarily selected cut-offs were variable. First-order features were overall more reproducible than shape metrics and textural features. Entropy was consistently reported as one of the most stable first-order features. There was no emergent consensus regarding either shape metrics or textural features.
  1,468 112 -
REVIEWS
Precision surgery using davinci robotic system for prostate cancer & its role in improving functional outcome
P Rajkumar, K Anil, Vishruth , C Tejus, N Srivatsa, SK Raghunath
January-June 2020, 1(1):23-26
DOI:10.4103/WKMP-0197.298269  
  1,376 109 -
Emerging role of liquid biopsy in the practice of precision oncology
GK Babu
January-June 2020, 1(1):20-22
DOI:10.4103/WKMP-0197.298282  
  1,317 132 -
Radiomics: Potential tool to titrate the radiation dose
R Chauhan
January-June 2020, 1(1):27-28
DOI:10.4103/WKMP-0197.298268  
  1,326 117 -
IMAGE OF THE MONTH
Ac 225 quinoline theragnosis in recurrent advanced ovarian cancer
K Kallur, Prasanth
January-June 2020, 1(1):40-40
DOI:10.4103/WKMP-0197.298283  
  1,328 107 -
EDITORIAL
Transitional oncology and the evidence hyperloop
US Vishal Rao
January-June 2022, 2(1):1-2
DOI:10.4103/jpo.jpo_10_22  
  766 59 -
ORIGINAL ARTICLES
Kirsten rat sarcoma mutation in South Indians with non-small lung cancer: A cause for concern?
Gautam Balaram, Renjan Thomas, Suhas N Ghorpade, Prarthana V Kowsik, Baby Dharman, Yogesh Shivakumar, Shekar Patil, Satheesh Chiradoni Thungappa, HP Shashidhara, Somorat Bhattacharjee, Sridhar Papaiah Susheela, Radheshyam Naik, Srinivas Belagutty Jayappa, Tejaswini Bangalore Nanjaiah, Shivakumar Swamy Shivalingappa, Mithua Ghosh, BS Ajaikumar
January-June 2022, 2(1):3-8
DOI:10.4103/jpo.jpo_7_22  
Background: Lung cancer is the poster child for advances in molecular oncology with a myriad of targeted therapies in NSCLC (non-small cell lung cancer) management. Kirsten rat sarcoma (KRAS) mutations are routinely isolated in NSCLC and account for a third of NSCLC oncogene driver tumors in Caucasian populations. The mutation is classically notorious to target with most therapies employed in management of KRASmut NSCLC being inhibitors of downstream signaling such as mitogen-activated protein kinase inhibitors (trametinib and selumetinib). There is a lacuna of information regarding prevalence and molecular epidemiology of KRAS mutations in NSCLC from an Indian context. Materials and Methods: The following study is a retrospective analysis of the incidence of KRAS epidemiology in high concentration epidermal growth factor receptor (EGFR) samples at a tertiary care hospital in South India from 2015 to 2017. Samples were selected following histopathological assessment and were subjected to nucleic acid extraction. KRAS mutation testing was performed using real-time polymerase chain reaction to ascertain the molecular epidemiology of KRAS in NSCLC patients. Results: KRAS mutations were observed in 15/44 NSCLC patients (34.09%) with a M:F ratio of 2:1. Majority of the mutations were single mutations, with 3 cases showing double mutations. Codon 12 mutations were observed in 6 cases followed by codon 146 mutations seen in 5 cases. Exon 3 (codon 59 and codon 61) and exon 4 (codon 117 and codon 146) were isolated in 5 and 3 cases, respectively. The current study demonstrated an elevated frequency for KRAS mutations in comparison to Asian cohorts. Conclusion: The advent of directly targeting KRAS inhibitors such as sotorasib (KRAS G12C inhibitor) necessitates KRAS mutation testing and warrants inclusion in the initial molecular workup of NSCLC.
  762 58 -
An experience of Methylguanine-DNA Methylation Assay (MGMT) characterization in glial tumors
Amrit Kaur Kaler, Renjan Thoma, NG Suhas, VK Prarthana, Baby Dharman, Gautam Balaram, Mithua Ghosh, R Veena, Shekhar Patil, PS Sridhar, Shivakumar Swamy, CT Satish, S Bhattacharjee, BS Ajaikumar
January-June 2022, 2(1):9-13
DOI:10.4103/jpo.jpo_4_22  
Background: MGMT (O6-methylguanine DNA methyltransferase) is a DNA repair enzyme, that rescues tumor cells from damage by alkylating agents like temozolomide (TMZ). Promotor methylation of MGMT leads to epigenetic silencing and potentially increased sensitivity to TMZ. MGMT methylation (mMGMT) is an independent favorable prognostic factor, and has confounded its role as a predictive biomarker in making therapeutic decisions for glial tumors, particularly glioblastoma multiforme (GBM). Materials and Methods: This retrospective cross-sectional study was conducted for 5 years in high-grade tumors (HCG) Cancer Hospital between January 2016 and December 2020. Methylation-specific polymerase chain reaction of MGMT gene using bisulfite modification of tumor DNA was utilized to ascertain the methylation status of cases in the cohort. Results: A total of 54 glial tumors comprising 35 males and 18 females between the age group 11 years to 76 years underwent mMGMT testing. About 64.8% (35 cases) of all glial tumors demonstrated mMGMT in the cohort; GBM accounting for a majority of the cases (80.0%; 28 cases). The percentage of mMGMT cases in males and females was found to be 60.0% and 73.0% of cases, respectively. The confluent necrosis commonly seen in GBM is present in 41.0% of methylated cases and minimal in 77.3% of unmethylated cases with a significant P < 0.05. Conclusion: MMGMT is a valuable predictive biomarker and is essential in taking the therapeutic decision in newly diagnosed glial tumors. Necrosis can be used as an indicator of mMGMT status according to the present study.
  588 63 -
Evaluation of tumor-infiltrating lymphocytes as a prognostic indicator of head-and-neck squamous cell carcinomas: A prospective study
N Apoorva Reddy, BM Joshna, Abhijith George, VP Indu, Shalini Thakur, Anand Subash, Akshay Kudpaje, US Vishal Rao
January-June 2022, 2(1):19-24
DOI:10.4103/jpo.jpo_4_21  
Introduction: The incidence of Head-and-Neck Squamous Cell Carcinomas (HNSCC) is on the rise in our country and worldwide, with a worsening prognosis. The abundance of tumor-infiltrating lymphocytes (TILs) is evolving to be a novel prognostic indicator in assessing treatment response of HNSCC. TILs mainly comprise T lymphocytes, which migrate from blood into the tumor as part of the body's immune response. In this context, targeting the tumor microenvironment with the help of immunotherapy may present a potential approach for better cure of head-and-neck cancers. In the present study, we evaluated the potential TILs parameters which can be used in clinical practice to predict treatment outcomes in HNSCC. Materials and Methods: This is a prospective observational study of 41 patients conducted at a tertiary cancer center between September 2019 and September 2020. All patients with biopsy proven, primary/recurrent HNSCC, without distant metastasis, and complete clinicopathological data were included in the study. Patients with a nonsquamous cell carcinoma, patients who underwent upfront chemotherapy or chemoradiotherapy were excluded from the study. Patients who had follow-up of <1 year or lost to follow-up were excluded from the study. Parameters analyzed include mean age; percentage of cluster of differentiation 3 (CD3) cells; CD4, CD8, and FOXP3cell counts; distribution of CD57 and CD3/FOXP3 ratio. Results: A total number of 19 patients were grouped under the nonrecurrence TILs and 22 patients under recurrent TILs category. Majority of the patients (90.2%) had oral cavity squamous cell carcinoma. 68.42% of nonrecurrent cases and 36.36% of recurrent cases were found to be harboring Hot tumors. Using odds ratio, it was noted that the odds of having Hot tumor is 3.79 times (95% confidence interval: [1.03,13.91]) higher in nonrecurrent TILs than in recurrent TILs group. CD3 cell count was higher in nonrecurrent cases (54.74 ± 18.37) than in recurrent cases (42.73 ± 16.09) with P = 0.0157. Using two tailed t-test, it was noted that the mean of CD4, CD8, and FOXP3 is not significantly different between nonrecurrent and recurrent tumor TILs groups. Conclusion: To summarize, we have shown that the CD3/FOXP3 cell ratio, rather than the individual proportion of TILs, is a significant prognostic indicator in HNSCC. It's also been shown that people with Cold tumors have a higher risk of recurrence than those with Hot tumors. Our findings confirm the importance of host immunity in prognosis and suggest that the degree of immune cell infiltration in the tumor microenvironment is a major independent prognostic factor that merits further investigation as a potentially valuable biomarker in HNSCC patients.
  576 50 -
Cost-effectiveness of cervical cancer screening in rural Bengaluru with demographic analysis of epithelial cell abnormalities: A cross-sectional descriptive study
Amrit Kaur Kaler, M Shilpa Rao, M Roopamouli, Y Srinivasalu, SN LV Narasimha Raju, US Vishal Rao
January-June 2022, 2(1):14-18
DOI:10.4103/jpo.jpo_5_22  
Aim: Cervical cancer is the fourth-most common cancer in women worldwide and ranks third among all the malignancies for women. In contrast to developed countries, cervical cancer is a public health problem in developing countries like India and accounts for a quarter of the global disease burden. It is also one of the leading causes of cancer mortality in India, accounting for 17% of all cancer deaths among women aged between 30 and 69 years. The aim of this study is to perform a demographic analysis of cervical cancer by using Papanicolaou (PAP) test as a screening modality in Doddaballapur, rural Bengaluru, Karnataka. Materials and Methods: A cross-sectional descriptive study was conducted on cervical cancer screening utilizing PAP smear screening. Camps were organized in Doddaballapur, rural Bengaluru, organized by Non-Profit Organization, Sahaya Hastha Trust between December 2017 and 2018. The PAP smears were stained and evaluated for epithelial cell abnormality using Bethesda System criteria free of cost at The Oxford Medical College and Hospital, Bengaluru. Results: A total of 647 patients were evaluated in this prospective study and abnormal epithelial cell abnormalities (ECA) were observed in 24 (3.7%) cases. Among the 24 cases, 2 cases (8.3%) of squamous cell carcinoma, 11 cases (45.8%) of atypical squamous cell of undetermined significance, 5 cases (20.8%) of Atypical Squamous cells - cannot rule out high-grade squamous intraepithelial lesion (HSIL), 3 cases (12.5%) of low-grade squamous intraepithelial lesion (3), 2 cases (8.3%) of high-grade squamous intraepithelial lesion (HSIL), and a single case (4.2%) of atypical glandular cells of undetermined significance were noted. Of the remaining 623 smears (96.2%) diagnosed with negative for intraepithelial lesion or malignancy, 428 cases (68.7%) were reported as nonspecific inflammation, while 56 smears (8.9%) showed atrophic smears and 20 cases (3.1%) were unsatisfactory for evaluation. 119 cases (19.1%) displayed a specific infectious etiology; coccobacilli (bacterial vaginosis) being the most common 66 cases (55.5%), followed by Trichomonas vaginalis 46 cases (38.6%) and Candida infection has 7 cases (5.8%). Conclusions: In Dodabullapur, a rural Bengaluru suburb, 3.7% of cervical cancer patients had ECA. It is hypothesized that a low-cost screening program is exceptionally beneficial in lowering the disease burden of cervical cancer, especially among middle-aged women and those living in low-income areas. This humanitarian purpose might motivate women in rural regions to be educated with the sole goal of uplifting the impoverished.
  404 57 -
MINI REVIEWS
Detection of antinuclear antibodies in oncology from slide to multiplexing: An overview
Amrit Kaur Kaler, Ravi Gaur, Anita Jain, Junu Rajan, US Vishal Rao
January-June 2022, 2(1):36-39
DOI:10.4103/jpo.jpo_11_22  
Antinuclear antibodies (ANA) are autoantibodies considered as the immune biomarkers of systemic autoimmune diseases. ANAs are directed against antigens of the cell nucleus and are named after their biochemical characteristics (deoxyribonucleic acid [DNA], histones, ribonucleoprotiens), the disease is associated with the corresponding autoantibody, e.g., Sjögren syndrome antigen A [SS-A] and Systemic Sclerosis (SS-B); progressive systemic sclerosis, polymyositis, or occasionally after the patient in whom the corresponding antibody was first detected (Sm, Ro, La). Positive ANA can also be used as an aid to early diagnosis of solid tumors and prognosis in hematological malignancies such as non-Hodgkin's lymphoma patients. Positive ANA has been found in the sera from patients with head and neck, lung, breast cancers by multiple studies. Most commonly patients with chronic lymphocytic leukemia (CLL) frequently present with autoimmune disorders (AIDs) which include autoimmune hemolytic anemia (AIHA), immune thrombocytopenia, pure red cell aplasia and autoimmune granulocytopenia, and nonhematological AIDs such as paraneoplastic pemphigus, neuropathies, SS, rheumatoid arthritis, and systemic lupus erythematosus. The presence of AIHA was previously demonstrated to be a poor prognostic indicator and also proved the negative survival impact of positive direct antiglobulin test on CLL patients.
  328 26 -
CASE REPORTS
A novel technique of vascularised fibular epiphyseal transfer combined with cryosterilized autograft and 3D printing in a 2-year-old child with Ewing's sarcoma: A case report
Giovanni Beltrami, Pramod S Chinder, R Sreeraj, Suraj Hindiskere, Sohan Pothaganahalli Raghavendra, Srinath Doddarangappa
January-June 2022, 2(1):44-48
DOI:10.4103/jpo.jpo_2_21  
Vascularized fibular epiphyseal transfer (VFET) though technically challenging, is a technique which can be used in skeletally immature patients to preserve the limb length in tumors near physis. As limb salvage at a young age adds to the complexity of the procedure since the growth potential of the limb has to be considered to restore the optimal function of the salvaged limb. This case report documents the treatment of an Ewing's Sarcoma of the left proximal tibia in a 2-year-old boy, following VFET modified with free freezing liquid nitrogen and three-dimensional printing. We succeeded in improving the patient's oncological and functional outcome because our patient was mobilized early and no postoperative complications occurred. This technique can thus be considered for the biological reconstruction of very young children as it has the least influence on limb lengths and growth potential.
  306 33 -
Management of the anuric patient after Robotic-Assisted Laparoscopic Prostatectomy (RALP): A case report
Antonio Devanti Bardoli, Amit Patel, Sebastian Chang, Christopher Lawrence, Alex Hampson, Gowrie Mohan Shan, Nikhil Vasdev
January-June 2022, 2(1):40-43
DOI:10.4103/jpo.jpo_1_21  
Robotic-assisted laparoscopic prostatectomy (RALP) has been linked to lower perioperative blood loss, lower transfusion rates, and shorter hospital stays. In addition, recent studies show that as compared to standard open prostatectomy surgery, there is less intraoperative blood loss. The authors report a unique case of anuric patients who have undergone RALP as well as the complications that arise when dealing with anuric patients after RALP.
  309 20 -
ORIGINAL ARTICLES
Multigene profiling to identify clinically relevant actionable mutations in head and neck cancers: An Indian study
Sateesh S Kunigal, Shalini Thakur, Yogesh Shivkumar, ML Sheela, CR Krishna, Anindita Kundu, Jaya Jain, Urvashi Bahadhur, KS Gopinath, Gururaj Arakeri, Mithua Ghosh, US Vishal Rao, BS Ajaikumar
January-June 2022, 2(1):25-32
DOI:10.4103/jpo.jpo_3_22  
Background: Head and neck squamous cell carcinoma (HNSCC) represents approximately 5%–10% of malignancies worldwide. The most appropriate treatment approach for HNSCC varies with the disease stage and disease site in the head and neck (H&N). Radiotherapy (RT) combined with chemotherapy has become the standard of care for patients having locally advanced tumors. However, there is significant morbidity associated with these treatments, and recurrent or metastatic diseases will occur in 50%–60% of patients. Moreover, the detection of residual viable tumor at the end of therapy remains an important issue. It is therefore an unmet need to improve the outcome of therapy by identifying predictive (prognostic) indicators at the molecular level and radioresistance that will enable the clinicians to select the logical treatment modality. Materials and Methods: Fifty H&N cancer patients aged 27 to 85 years diagnosed at HCG between April 2015 and 2017 were screened using Illumina's TSCAP panel and MiSeq technology for hotspot mutations in 48 cancer-related genes. All the cases had histopathological reviews and comprised tumors from the following sites – oral, nasopharynx, throat, hypopharynx, larynx, thyroid, or nasal cavity and paranasal sinuses. The average coverage across 220 hotspots was >1000X. Data were processed using Strand Avadis NGS™. Mutations identified in the tumor were assessed for “actionability,” i.e., response to therapy and impact on prognosis. Results: Somatic variants were detected in 65% of cases with direct impact on therapy and/or prognosis. Genetic aberrations were identified in major RAS/RAF signaling pathways in nearly 15% of H&N cancers, out of which HRAS activating mutations were the most common (n = 5). HRAS was also found to be co-mutated with phosphatidylinositol 3-kinase (n = 3) and PTEN deletions (n = 3). In contrast to the MAPK signaling pathways, mutant HRAS is able to signal exclusively through PI3K-AKT, reducing the response to cetuximab and increasing the response to MEK inhibitors including selutinib and tramatinib. Based on the results, cetuximab was discontinued in two patients who had presented with metastatic HNSCC. Other targetable mutations included PIK3CA (n = 3), EGFR (n = 1), cKIT (n = 1), RB1 (n = 1), and PTEN (n = 3) were reported. Further, disruptive and nondisruptive mutations in TP53 alone were found in 45% of H&N cancers, varying widely among different histologies, indicating a poor response to cisplatin- and 5FU-based chemotherapy. Interestingly, all metastatic/recurrent patients treated with cisplatin presented with very short progression-free survival of 9–12 months were found to have TP53. TP53 was also found to be co-mutated with ATM gene (n = 1), an important prognostic marker indicating poor response to chemotherapy and RT. Conclusion: This study validates the utility of multigene profiling in H&N cancer patients, both early diagnosed and advanced cases, to stratify based on their molecular profile that could potentially benefit/not benefit from targeted therapy and chemoradiation. Few ongoing prospective studies and randomized clinical trials may help us confirm the independent prognostic and therapeutic value of the mutations in a larger cohort of Indian population.
  290 32 -
COMMENT
The role of the pathologist in the next-generation era of molecular oncology
Amrit Kaur Kaler, US Vishal Rao
January-June 2022, 2(1):52-53
DOI:10.4103/jpo.jpo_9_22  
  278 23 -
MINI REVIEWS
Image “OMICS” in cancer - Synergy of qualitative and quantitative data analytics for futuristic precision medicine
G Lohith, Kritika Murugan, Krithikaa Sekar, Sudhakar Sampangi, Mahesh Bandemagal, Shivakumar Swamy
January-June 2022, 2(1):33-35
DOI:10.4103/jpo.jpo_12_22  
There are several methods for generating and analyzing big data in oncology, the most well-known of which are genomics, proteomics, and metabolomics. Similarly, “omics” clusters in imaging are frequently referred to as “radiomics.” A quantitative approach to medical imaging that tries to improve current qualitative data with modern computation and often counterintuitive mathematical analysis. This paper describes the breakthroughs in the use of radiomics in breast cancer, as well as the future challenges of radiomics research.
  276 21 -
CASE REPORTS
Febrile neutropenia: An unusual cause of Pantoea Agglomerans bacteremia in acute myeloid leukemia
Sachin Suresh Jadhav, Jyothi Goutham Kumar, Priyank Tripathi, Anjali Matani, Shobha K Ganesan, Vishnupriya , Amey C Panchal, Chintan Kumar H.Kaswala, Nishit , Samuel L Koramati, BS Ajaikumar
January-June 2022, 2(1):49-51
DOI:10.4103/jpo.jpo_8_22  
We present a case of febrile neutropenia in a patient with acute myeloid leukemia caused by an uncommon bacterial species. The patient was treated with antibiotics for 14 days before being discharged. Pantoea agglomerans is a plant soil and water-dwelling agricultural organism. It is both a commensal and pathogen of animals and humans, according to earlier research. In conclusion, p. agglomerans should be considered a bacterial threat in cancer patients who are undergoing highly myelotoxic chemotherapy.
  262 17 -
SHORT COMMUNICATION
Gross picturesque: Case of the journal
Amrit Kaur Kaler
January-June 2022, 2(1):54-55
DOI:10.4103/jpo.jpo_13_22  
  192 24 -