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The best training method in laparoscopic surgery has not been defined. We evaluated the efficacy of laparoscopic skills acquisition in a short-term focused program. Two hundred fifty-six participants undergoing training on a phantom model were divided into 2 groups. Group 1 had no exposure and group 2 had performed a few laparoscopic surgeries. Acquisition of laparoscopic skills was assessed by operation time and the modified Global Operative Assessment of Laparoscopic Skills (GOALS) scale. A questionnaire was sent to the participants after 3 to 6 months for assessment of impact of training. There was a statistically significant improvement in the assessed parameters and in the mean score of all 5 domains of GOALS. The participants in group 2 performed better than those in group 1 in the first case. The difference between both the groups disappeared after the training. Participants who responded to the questionnaire felt that training helped them in improving their performance in the operation theater.

Mixed serous neuroendocrine neoplasms are extremely rare tumors that are usually seen in female patients and are often associated with von Hippel Lindau (VHL) disease. We describe the case of a 38-year-old male who presented with complaints of anorexia, weight loss, and abdominal pain. CT abdomen showed a mass in the head of the pancreas, multiple small nodules in the body of pancreas, and bilateral adrenal masses. Fine needle aspiration cytology (FNAC) from the mass showed features of a neuroendocrine tumor, with many of the cells demonstrating abundant clear cytoplasm. Histopathological examination of the pancreaticoduodenectomy specimen showed a mixed serous neuroendocrine neoplasm with two components viz. serous cystadenoma and neuroendocrine tumor (NET) World Health Organization (WHO) grade 2. In addition, he was diagnosed to have bilateral pheochromocytomas and a paraganglioma. The synchronicity of these tumors suggested the possibility of VHL disease. Thus, identification of a NET with clear cells or of a mixed serous neuroendocrine neoplasm should raise suspicion of VHL disease. In a mixed tumor, FNAC may identify only one of the two components. Thorough processing of all pancreatic serous tumors for pathological examination is recommended, as NET may occur as a small nodule within the serous cystadenoma.

Field experiments were conducted during the win- ters of 1987-88 and 1988-89 at Haryana Agricultural Uni- versity, Hisar, India to evaluate the response of winter wild oat to sowing date and isoproturon application time in wheat. In another experiment, the effect of sowing time on emer- gence and growth of winter wild oat and wheat sown sepa- rately was studied. The treatments that provided more than 75% control of winter wild oat were: isoproturon at 0.75 kg ha'l applied at the 2-leaf stage of winter wild oat; isoproturon I kg ha-' applied at the 4-leaf stage of winter wild oat in the November 30 planting; and isoproturon 0.50 kg ha-1 applied at the 1- to 2-leaf stage of winter wild oat in the December 20 sowing. Isoproturon did not provide more than 50% control of winter wild oat in the November 10 sowing. Mortality of winter wild oat increased from 38 to 72 to 87% in November 10, November 30, and December 20 sowings, respectively. Mortality of winter wild oat was similar in November 30 and December 20 sowings but higher grain yield was recorded in November 30 sowing. Due to vigorous growth of winter wild oat in the November 10 sowing, isoproturon did not provide good control. December 20 sowing favored wheat growth due to lower density and late emergence of winter wild oat but reduction in wheat grain yield was greater. When averaged over isoproturon treatments, the grain yield of wheat was 4607,5297, and 4457 kg ha-' in the November 10, November 30, and December 20 sowings, respectively. Nomenclature: Isoproturon, N'-(4-isopropylphenyl)-N,N-dimethyl urea; winter wild oat, Avena ludoviciana Durieu #3 AVELU; wheat, Trificum aestivum (L.) 'WH-283.'

Background: Gallbladder cancer (GBC) is the most common biliary tract malignancy worldwide. Cancer of gallbladder usually refers to as an Indian disease as it is more common in Indian subcontinent especially in north and central India. Incidence rate of GBC in women in Delhi is as high as 21.5 per 100,000 population. It is an aggressive malignancy, which spreads locally to liver, adjacent organs and lymph nodes as well as to distant organs. Cathepsin L (CTSL) and B (CTSB) are lysosomal cysteine proteases implicated in protein turnover and tissue remodeling. Deregulated expression of these proteases has been associated with invasion and metastasis in several solid tumors. Objective: To assess the expression and clinical significance of CTSL and CTSB in human gallbladder cancer. Methods: We assayed the activities of CTSL and CTSB via spectroflurometrically in whole tissue lysates of gallbladder cancer patients (N = 23) and normal gall bladder tissue samples with gallstones (N = 31) / without gallstones (N = 34), which served as controls. Activities of these proteases were correlated with several clinic pathological parameters in GBC patients. CTSL and CTSB mRNA levels were determined in tissues samples by Real time PCR. Furthermore serum levels of these proteases were also assayed using sandwich based ELISA in GBC patients and controls. Results: Significant increase in the enzymatic activities of CTSL+B, CTSL and CTSB was observed in gallbladder cancer tissue samples in comparison to normal gall bladder both with and without gallstones (p < 0.001). ROC analysis confirmed the diagnostic relevance of CTSL and CTSB analysis with area under the curve 0.791 and 0.840 respectively for gallbladder cancer patients with respect to controls. Over expression of CTSB was also significantly associated with involvement of lymph node (p = 0.05) in gall bladder carcinoma. Secretory levels of CTSL and CTSB in serum were significantly elevated in GBC patients (p Conclusion: Our study for the first time demonstrated a significant increase in the levels of cathepsin L and B in GBC patients as compared to controls. Elevated levels of these proteases may serve as potential biomarkers for human gall bladder cancer. Citation Format: SIDDHARTH MEHRA, MANISH KUMAR, RAJESH PANWAR, NIHAR RANJAN DASH, RATNAKAR SINGH, RAJNI YADAV, SIDDHARTHA DATTA GUPTA, PEUSH SAHNI, SHYAM S. CHAUHAN. Diagnostic significance of cathepsin L and cathepsin B expression in human gallbladder cancer - A pilot study. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3986.

In this sequel, to an earlier article, we discuss the laws of Mechanics, Thermodynamics and Vectors as they apply to soft and bony tissues. These include the Laplace’s Law as applied to colonic perforation, compression therapy, parturition, variceal rupture, disc herniations etc. The Pascal’s Law finds use in hernia repair and the Heimlich maneuver. Trigonometrically derived components of forces, acting after suturing, show ways to reduce cut-through; the thickness and the bite of suture determines the extent of tissue reaction. The heating effect of current explains the optimum gap between the prongs of a bipolar cautery and the use of law of transfer of heat in determining relation between healthy wound healing and ambient temperature.

The greatest disadvantage of conservative surgical procedures in the management of hydatid cyst of the liver is their association with high recurrence rates. Radical surgical procedures such as closed total pericystectomy avoids spillage thereby minimizing recurrences. The use of laparoscopy in performing these radical surgical procedures further reduces the morbidity associated with the open surgery. This study has been carried out to assess the safety and feasibility of laparoscopic pericystectomy in the management of hydatid cyst of liver. Small, peripherally located cysts lying away from major vessels are amenable to laparoscopic pericystectomy successfully whereas, cysts larger than 10 cm, posteriorly located cysts and those lying in close proximity to the major ducts and vessels required conversion owing to bleeding. Therefore, laparoscopic pericystectomy can be regarded as a gold standard for the management of hydatid cyst of the liver in selected patients.

Laparoscopic cholecystectomy in patients with situs inversus can be a technically challenging procedure. Although laparoscopic cholecystectomy has been described in patients with situs inversus, no standard technique has been described. We are presenting our experience of laparoscopic cholecystectomy in two patients with situs inversus and discuss the problems encountered during surgery and likely remedies.

with liver disease. Well-designed, controlled studies are required to fully determine the benefits. We evaluated the efficacy of GCSF therapy in an open labelled randomized control trial. Methods: In a prospective study consecutive patients with decompensated cirrhosis were randomized to GCSF (5 mg/kg/day) for 5 days + standard medical therapy versus standard medical therapy alone. Their baseline, clinical and biochemical parameters were compared with parameters at 6 months follow up. Results: A total of 113 patients (median age 53, range 31–76, 84% males) and 93 age and sex-matched controls were included in the study. The baseline median Child-Turcotte-Pugh (CTP) score and MELD scores were 10 (range 7–13) and 16 (range 4–34), respectively. Baseline characteristicswere similar inboth groups. All patients were able to successfully complete the 5-day therapy with GCSF without any significant adverse effect requiring stoppage of therapy. Compared to baseline values there was a significant increase in median CD34 count post therapy (1 10/mm versus 11 10/mm; P < 0.01). Over a period of 6 months CTP score improved (median 9, range 5–12, P < 0.01). In the GCSF group, 16 patients died and 10 patients were lost to follow up while 17 patients died and 19 patients were lost to follow up in standard medical therapy group.According to intention to treat analysis, mortality was significantly higher in standard medical therapy group (P = 0.02). There is no significant change in CTP or MELD score at 6 months from baseline in standard medical therapy group. Conclusion: A 5-day course of GCSF in the dose of 5 mg/kg b.i.d. leads to an effective mobilization of CD34+ cells into the peripheral blood and improvement in survival at 6 months follow up.