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Due to rising water quality-related issues, a periodic and continuous monitoring system is mandatory for inland water bodies. Water quality estimation is essential for water resource management and the sustainability of riverine ecosystems. Existing in-situ, field-based, and wet laboratory estimations, although precise and accurate, account for the lack of spatial and temporal variability and represent point sampled assessment. With a high temporal resolution and fine spatial resolved scaling, remote sensing data, including the Landsat-8,9 series, and Sentinel-2 series, consecutively provide high-spatio-temporal resolution observations for real-time analysis. The Google server and cloud-based Google Earth Engine (GEE) platform support image collections, atmospherically-radiometrically corrected imagery, and large-data processing. Taking the inland waterbodies of Delhi as the study area, this study is carried out in GEE to (i) design, inquire and pre-process all Landsat and Sentinel series observations that coincide with in situ measurements; (ii) extract the spectra to develop empirical models for water quality parameters and (iii) visualize the results graphically using geospatial distribution maps, time-series charts, and create a web-application. Water quality parametric analyses were conducted for Optically Active constituents (OAC), i.e., chlorophyll-a, suspended solids, and turbidity. Validation with an independent site location is the next area of study for estimating the predicted and observed values. Spectral characteristics show correlation and similarity with the field data and active optical constituents. Besides visualizing long-term spatial and temporal variabilities through thematic maps and time-series charts, anomalies such as eutrophication at specific sites can also identify using the models developed. An online application is in progress to allow users to explore and analyze water quality trends using the latest Landsat-9 dataset. Integrating remotely-sensed images, in situ measurements, and cloud computing can offer new opportunities to implement effective monitoring programs and understand water quality dynamics.

Backgrounds/Aims Hepaticojejunostomy (HJ) for bilioenteric continuity is generally performed with interrupted sutures. This study compares the safety, economics, short- and long-term outcomes of continuous suture hepaticojejunostomy (CSHJ) and interrupted suture hepaticojejunostomy (ISHJ). Methods A retrospective cohort analysis involving all HJs between January 2014 and December 2018 was conducted. Patients with type IV or V biliary strictures, duct diameter < 8 mm and/or associated vascular injury, and liver transplant recipients were excluded. Patient demographics, preoperative parameters including diagnosis, intra-operative parameters including type and number of sutures, suture time, and postoperative morbidity (based on Clavien-Dindo classification) were recorded. Patients were followed up to 60 months. McDonald’s Grade A and B outcomes were considered favorable. Cost according to suture type and number (polydioxanone 3-0/5-0 mean cost, US$ 9.26/length; polyglactin 3-0/4-0 mean cost, US$ 6.56/length), and operation room charge (US$ 67.47/hour) were compared between the two techniques. Statistical analysis was performed using IBM SPSS ver. 22 software. Results A total of 556 eligible patients (468 patients undergoing ISHJ and 88 undergoing CSHJ; 47% [n = 261] with malignant and 53% [n = 295] with benign pathology) were analyzed. The two groups were similar. Number of sutures, cost, time, and postoperative bile leak were significantly higher in the ISHJ group. Bile leak occurred in 54 patients (6 CSHJ, 48 ISHJ). Septic shock-induced death occurred in 16 cases (3 CSHJ, 13 ISHJ). Morbidity and the anastomotic stricture rates were comparable in both groups. Conclusions CSHJ is a safe, economical, and worthy of routine use.

Machine Learning is quickly becoming an impending game changer for transforming big data thrust from the bioprocessing industry into actionable output. However, the complex data set from bioprocess, lagging cyber-integrated sensor system, and issues with storage scalability limit machine learning real-time application. Hence, it is imperative to know the state of technology to address prevailing issues. This review first gives an insight into the basic understanding of the machine learning domain and discusses its complexities for more comprehensive applications. Followed by an outline of how relevant machine learning models are for statistical and logical analysis of the enormous datasets generated to control bioprocess operations. Then this review critically discusses the current knowledge, its limitations, and future aspects in different subfields of the bioprocessing industry. Further, this review discusses the prospects of adopting a hybrid method to dovetail different modeling strategies, cyber-networking, and integrated sensors to develop new digital biotechnologies.

Background: Gallbladder cancer (GBC) is an aggressive, uncommon malignancy, with variation in operative approaches adopted across centres and few large-scale studies to guide practice. We aimed to identify the extent of heterogeneity in GBC internationally to better inform the need for future multicentre studies. Methods: A 34-question online survey was disseminated to members of the European-African Hepatopancreatobiliary Association (EAHPBA), American Hepatopancreatobiliary Association (AHPBA) and Asia–Pacific Hepatopancreatobiliary Association (A-PHPBA) regarding practices around diagnostic workup, operative approach, utilization of neoadjuvant and adjuvant therapies and surveillance strategies. Results: Two hundred and three surgeons responded from 51 countries. High liver resection volume units (>50 resections/year) organised HPB multidisciplinary team discussion of GBCs more commonly than those with low volumes (p < 0.0001). Management practices exhibited areas of heterogeneity, particularly around operative extent. Contrary to consensus guidelines, anatomical liver resections were favoured over non-anatomical resections for T3 tumours and above, lymphadenectomy extent was lower than recommended, and a minority of respondents still routinely excised the common bile duct or port sites. Conclusion: Our findings suggest some similarities in the management of GBC internationally, but also specific areas of practice which differed from published guidelines. Transcontinental collaborative studies on GBC are necessary to establish evidence-based practice to minimise variation and optimise outcomes.

Background Carney’s triad is a rare syndrome comprising gastrointestinal stromal tumor, extra-adrenal paraganglioma, and pulmonary chondroma along with newer additions of adrenal adenoma and esophageal leiomyoma. The triad is completely manifest in only 25–30% cases, with most patients presenting with two out of three parts of the syndrome. Wild-type succinate-dehydrogenase-deficient gastric gastrointestinal stromal tumor forms the most common component of Carney’s triad and is usually multicentric and multifocal. It usually demonstrates indolent behavior and resistance to imatinib; hence, the management remains predominantly surgical. Pulmonary chondromas are commonly unilateral and multiple with slow-growing nature, which allows for conservative management. Adrenocortical adenomas are found in 20% of patients and are usually detected as incidentalomas. Case presentation A 49-year-old Asian male presented with upper gastrointestinal bleed and was diagnosed with multiple gastric succinate-dehydrogenase-deficient gastrointestinal stromal tumors. On evaluation, he was found to have left pulmonary chondroma and non-secretory adrenal adenoma, thus completing the Carney’s triad. He underwent surgery with sleeve gastrectomy and excision of the antral tumor nodule, while the adrenal and pulmonary tumors have been under close follow-up. Conclusion Literature regarding Carney’s triad is scarce, especially from the Indian setting. Our report aims to highlight the various manifestations of this syndrome with emphasis on management of wild-type succinate-dehydrogenase-deficient gastrointestinal stromal tumor. Radical gastric surgeries do not offer a survival advantage in this condition; hence, more conservative modalities of resection can be adopted.

Introduction Hepaticojejunostomy (HJ), a standard method of bilioenteric anastomosis, is done with interrupted sutures by most surgeons. This audit of a prospective database compares the safety, economics, short term and long term outcome of continuous suture HJ (CSHJ) and interrupted suture HJ (ISHJ). Methods An audit of a prospecrive database of all HJ performed between January 2014 and December 2018 after IEB approval. Patients with type IV or higher biliary strictures, duct diameter < 8 mm and/or associated vascular injury and liver transplant recipients were excluded. Patient demographics, diagnosis, pre-operative parameters, intra-operative findings, type and number of sutures, suturing time, and postoperative morbidity (Clavien Dindo) were recorded, and patients followed up to 60 months. McDonald's grade A and B were considered as good outcome. Cost of suture (polydioxanone) 3-0/5-0 mean cost - ₹686/length, polyglactin 3-0, 4-0 mean cost - ₹486/length), operating room time (₹5,000/hour) were considered for comparison of economics of both techniques. Statistical analysis done on SPSS 22 software. Results 556 eligible patients - 468 with ISHJ and 88 with CSHJ analyzed. 258 (54%) had benign and 300 (46%) had malignant pathology. The groups were similar. PDS sutures dominated in CSHJ. Number of sutures, cost, time, and postoperative bile leak was significantly more in ISHJ group. Fifty four patients had bile leak (6 CSHJ and 48 ISHJ). There were 16 mortalities (3 CSHJ, 13 ISHJ) due to septic shock. Morbidity was comparable according to Clavien Dindo grading. Anastomotic stricture rate was comparable. Conclusions CSHJ is safe, economic and worthy of routine practice.

The COVID-19 pandemic was declared by World Health Organization (WHO) on 11 March 2020 and advised countries to take immediate and concerted action. The governments of India and Himachal Pradesh carried out preventive and precautionary steps to minimize the spread of coronavirus disease. In this study, the impact of a sudden halt in human activity on air quality was investigated by looking at changes in satellite imagery using a remote sensing approach. The concentrations of the gaseous contaminants studied (CO, SO2, NO2, and C6H6) show a significant decrease during the lockdown. The average particulate matter concentrations (PM10 and PM2.5) differed significantly from gaseous emissions, meaning that particulate matter significantly affects anthropogenic activities. NO2 concentrations and NOx emission variations were tracked for rural/town areas around Himachal Pradesh and major urban cities of India. Daily top-down NOx emissions were measured using the Tropospheric Monitoring Instrument (TROPOMI), which assisted in retrieving NO2 from the steady-state continuity equation. The emissions of NOx from rural, urban, and power plants were compared before and after the lockdown. The research accounted for our studies on the levels of (NO2, Ozone (O3), and sulfur dioxide (SO2) were monitored using Sentinel-5P imagery using the GEE platform.

Pancreatic cancer continues to be a life-threatening disease with poor long term outcomes despite various treatments. Progress has been slow, although results of surgery have improved, and mortality rates have fallen. Surgery is still the modality with the highest potential to cure pancreatic cancer. We examine some of the key issues relating to the treatment of pancreatic cancer, largely to the description of issues related to pancreatic head cancer.

Objective: There is a rising trend of Incidental Gall Bladder Cancer (IGBC) with increase in laparoscopic cholecystectomy. Objective of our study was to evaluate the efficacy of further management (completion surgery and adjuvant chemotherapy) in IGBC in terms of long-term survival (> 5 years). Material and Method: Clinic-pathological and survival data of 145 IGBC patients was analysed from a prospectively maintained database of GBC. Patients investigated with triple phase CT abdomen and if required PET-CT. Diagnostic laparoscopy with Completion extended cholecystectomy performed in patients amenable for resection. Adjuvant therapy consisted of gemcitabine and cisplatin. Patients followed up with OPD visits and telephonic enquiry. Results: 864 patients of GBC were treated during the period of January 1989 to December 2012. Out of these 145 patients were IGBC [113 women (77%), median age; 52 years)]. 96 patients were detected on histopathology while 49 were diagnosed intra-operatively. Open cholecystectomy was done in 88, laparoscopic in 45 while 12 underwent laparoscopic converted to open cholecystectomy. Commonest T stage was T3 (n=71). All patients were re-evaluated after diagnosis of IGBC. 80 patients (55%) were taken up for surgery of which, 50 (62.5%) underwent completion extended cholecystectomy (rest had metastases or locally advanced unresectable disease). Median time interval between index surgeries to re-exploration was 35 days (0-250). It was longer in patients who could not undergo completion extended cholecystectomy (70 days vs. 49 days). Overall 5-year survival in pT1b, pT2 and pT3 stage was 49.5%, 36.1% and 8.4% respectively, but was considerably better in patients who underwent completion extended cholecystectomy compared with those who did not undergo re-surgery [pT1; 62.5% vs. 29.1%, pT2; 52.2% vs. 15.9%, pT3; 22.6% vs. 7.2%, p Conclusion: Early recognition, early completion radical surgery and adjuvant therapy lends considerable survival benefit to patients of incidental carcinoma gall bladder. Residual disease and R1 resection portends a poorer survival. High index of suspicion should be kept in patients with thick walled GB to avoid missing a malignancy at index surgery. Citation Format: Saurabh Galodha, Puneet Mahajan. Incidental gallbladder cancer: Best step forward [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4874.