Search

Purpose: The purpose of this study was to synthesize evidence and propose a technique for estimation of stretched penile length (SPL) applicable to children. MATERIALS AND METHODS: This review has been conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. PubMed, Embase, and Scopus databases were queried on penile length (PL) measurement techniques in humans published from 1990 onward. The devices and the techniques used for PL measurement, state of the penis, the habitus of the participants, proximal and distal landmarks for measurement, handling the foreskin and pubic pad of fat, optimal stretching of the penis, and other factors (including the environment) which should be accounted for in the technique were identified from the study cohort (90895 participants across 145 included studies). Results: PL has been represented through flaccid (33.79%), stretched (81.3%), and erect (12.41%) PLs as well as the greatest corporeal length (1.4%). Following devices have been used to measure the PL in the study cohort: rulers [54.68%], calipers [9.7%], measuring tapes [14.5%], coloured measuring strips [2.06%], spatulas/tongue depressors [11.03%], FitKit, syringe [1.4%], cotton swab (and ruler), titan cylinders, slide gauge and ultrasonography [1.37%]. The factors relevant to SPL measurement have been incorporated into the proposed SPL INdicator Technique (SPLINT) which is essentially a holistic extension of the “Conventional PL Measurement” technique. Conclusions: There is a wide range of heterogeneity in the technique for estimation of PL across the study cohort; the underlying factors have been identified along with the respective variables, and the SPLINT for SPL has been described.

During face mask ventilation, invariably, some air enters the esophagus rather than the airways; this results in gastric insufflation while the esophagus is intact or loss of tidal volume in patients with a cervical esophagostomy (Cx-esophagostomy). OBJECTIVE: The objective of the study was to report the indigenous use of an electrocardiography (ECG) electrode in successfully occluding the Cx-esophagostomy to prevent inadvertent loss of tidal volume. MATERIALS AND METHODS: Twenty-nine observations were recorded on 27 patients (mean age: 10.9 months; male:female = 2.6:1). The oral cavity, pharynx, and Cx-esophagostomy were cleared of saliva. Peristomal area was cleaned with dry gauze and dried with alcohol. Latex-free, 50 mm, ECG electrode was pasted symmetrically over the Cx-esophagostomy. The efficacy of the electrode was assessed using a five-point algorithm: (i) collapse of reservoir bag, (ii) chest expansion, (iii) ballooning of electrode, (iv) cotton-wisp test, and (v) change in compliance with manual compression of the electrode. Subgroup analysis was conducted for laterality and health of Cx-esophagostomy. Results: Study cohort: Cx-esophagostomy was located on the left in 58.26% (n = 17/29) patients. The health of Cx-esophagostomies was graded from I to IV (n = 9, 16, 3, and 1, respectively). The collapse of the reservoir bag and chest rise indicated successful ventilation. Ballooning of the electrode with each breath was observed in 79% (23/29) patients. Partial separation of the electrode from the skin (exaggerated with each breath) was observed in 10.3% (3/29) patients (Group I: n = 1, Group III: n = 1, and Group IV: n = 1). This was related to poor local preparation or pooling of saliva (n = 1; Group I: resolved with procedural re-application of a fresh electrode) and underlying skin condition (n = 2; Groups III and IV: resolved only temporarily with re-application). The cotton-wisp test was positive in two additional patients (1 each in Groups II and III) and was related to the pooling of saliva. No change in compliance was observed with manual compression of the electrode. No difference in success was observed between left and right Cx-esophagostomies. Overall success with this technique was 82.8% with a potential for 100% in those with peristomal health graded I–III. Conclusions: The ECG electrode is a technically simple, cost-effective, and widely available device, instrumental in addressing the problem of air leak through Cx-esophagostomy during face mask ventilation before intubation.

Chemical acaricides, viz. amitraz, cypermethrin, and ivermectin have been in use for control of ectoparasites (particularly ticks) in domestic animals over the past two decades. The present study aimed to appraise the acaricidal effects of ivermectin (IVM), amitraz, and cypermethrin against brown dog tick Rhipicephalus sanguineus sensulato (s.l.), by in-vitro bioassay based susceptibility tests, viz. larval immersion test and larval packet test. Lethal concentrations (LC50 and LC95) values of acaricides were ascertained by applying regression equation analysis to the probit transformed data of mortality and resistance factors (RF) were determined. LC50 values of 11.39, 22.51, and 10.75 ppm, and LC95 values of 57.06, 78.74, and 50.28 ppm were estimated for amitraz, cypermethrin, and ivermectin, respectively. The susceptible status against amitraz and ivermectin whereas, the resistance of level I against cypermethrin was recorded in the study. The present study is the only report of resistance to cypermethrin in R. sanguineus (s.l.), ticks from this region.

This comprehensive review explores furfural production from agricultural residues, focusing on its significance as a low-volume, high-value asset crucial for environmental sustainability. It covers diverse production technologies, recent advancements, and applications in agriculture, evaluating furfural's potential to enhance crop resilience and yield. Showing its role in a circular economy, the review discusses how furfural can replace conventional petrochemical processes, thereby reducing environmental impact. Case studies, such as successful implementations with cotton biomass byproducts, illustrate furfural's practical applications and environmental benefits. The study underscores the need for ongoing research, supportive policies, and furfural's growing role in sustainable agriculture and industry. It is focused on furfural's essential contribution to promoting environmental stewardship and sustainable practices. By examining furfural's role as a value-added product from agricultural residues, this review provides insights into its economic viability and potential challenges.

Sprouts are the low processed food, having the high nutritional value and health promoting components. Various studies reported that the bioactive composition of various sprouts enhanced by elicitation with different elicitors. In the present investigation, the protein profiling by SDS-PAGE of different sprouts (mungbean, chickpea, broccoli and knolkhol) which were elicited with different elicitor viz salicylic acid (SA), methyl salicylate (MeSA) and neem leaf extract (NE) were performed. Results of the study showed that in all the sprouting seeds variety of bands were obsereved ranging from 8.31 to 112 kDa. The significant increase in intensity of protein bands was observed in 1% MeSA and 20 mM SA treatments in mung bean and chickpea sprouts, whereas, in the case of broccoli and knolkhol sprouts, only SA (200 µM) treated sprouts showed increased protein band intensity. This quantitative increase may be due to an increase in the synthesis of some proteins during elicitation. Elicitation can enhance the polyphenolic such as phenolic, flavanoids, vitamins, amino acids and glucosinolates content in sprouts by regulating the expression level of gene which are responsible for the synthesis of various enzymes which are required for the production of secondary metabolites. Moreover, our previous studies also reported that elicitation with different elicitors effectively increases the biological activities of sprouts. Therefore, from this study it may be concluded that the elicitation is an effective approach for the enhancement of nutritional and bioactive composition of seed.

Objective: Circulating exosome-enriched extracellular vesicles (EVs) have drawn considerable importance in obesity-related insulin-resistance (IR). We sought to compare the proteomics profile of serum exosomes from normal individuals and those with obesity and IR. Methods: We isolated serum exosomes from male subjects with obesity and insulin resistance (Ob-IR, HOMA-IR > 2.0) and lean/overweight insulin-sensitive (Normal (N), HOMA-IR < 2.0) individuals. The differential protein expression between the two groups was detected by a label-free quantitative mass spectrometry analysis followed by GO annotation and ingenuity pathway analysis (IPA). Results: We identified 23 upregulated and 46 downregulated proteins between Ob-IR and N groups. Some of these proteins are involved in altering insulin signaling (VPS13C, TBC1D32, TTR, and ADIPOQ), inflammation (NFκB and CRP), and B-cell proliferation/activation (IGLV4-69, IGKV1D-13, and IGHV4-28). GO analysis revealed that the differentially expressed proteins (DEPs) are mainly involved in regulating immune cell activation and are located in extracellular space. IPA analysis showed that top molecules mediating IR, inflammation and B-cell activation were upregulated in Ob-IR subjects compared to N subjects. Conclusions: Serum exosomal proteins can be used as biomarkers to identify the future risk of diabetes and a therapeutic target to prevent or slow down the progression of diabetes in high-risk individuals.

Introduction Tuberculosis is a disease of diversified presentation. It affects almost all organs in the body, and otorhinolaryngological, head and neck involvement is not an exception.

Interactions between the novel hypomethylating agent (HMA) thio-deoxycytidine (T-dCyd) and the BCL-2 antagonist ABT-199 (venetoclax) have been examined in human myelodysplastic syndrome (MDS) cells. The cells were exposed to agents alone or in combination, after which apoptosis was assessed, and a Western blot analysis was performed. Co-administration of T-dCyd and ABT-199 was associated with the down-regulation of DNA methyltransferase 1 (DNMT1) and synergistic interactions documented by a Median Dose Effect analysis in multiple MDS-derived lines (e.g., MOLM-13, SKM-1, and F-36P). Inducible BCL-2 knock-down significantly increased T-dCyd’s lethality in MOLM-13 cells. Similar interactions were observed in the primary MDS cells, but not in the normal cord blood CD34+ cells. Enhanced killing by the T-dCyd/ABT-199 regimen was associated with increased reactive oxygen species (ROS) generation and the down-regulation of the anti-oxidant proteins Nrf2 and HO-1, as well as BCL-2. Moreover, ROS scavengers (e.g., NAC) reduced lethality. Collectively, these data suggest that combining T-dCyd with ABT-199 kills MDS cells through an ROS-dependent mechanism, and we argue that this strategy warrants consideration in MDS therapy.

Background: Disorders of sexual development (DSD) encompass a group of congenital conditions characterized by diverse genotypic and phenotypic variations. Ovotesticular (OT) DSD is a distinctive subtype within this spectrum. Among the array of DSD, OT-DSD stands as one of the most infrequent anomalies, with reported prevalence rates as scarce as 1 in 83,000. This study aims to elucidate the clinical, hormonal, cytogenetic, surgical, and histopathological characteristics of OT disorder of sex development (OT-DSD) within a tertiary center in North India. Methodology: A retrospective analysis was conducted, involving a comprehensive review of records pertaining to OT-DSD patients from the years 2018 to 2022, all of whom were incorporated into the study. Results: The mean age of presentation in this study was 10 years, spanning from 6 to 15 years. Predominantly, the affected individuals were male, with a solitary patient representing the female category. Clinical manifestations displayed a spectrum encompassing genital ambiguity, inguinal swelling, and primary amenorrhea. The karyotypes observed were 46,XX in four patients and 46,XY in one patient. A holistic assessment, inclusive of clinical evaluation, hormonal assays, pelvic ultrasonography, and surgical intervention when necessary, was administered to all patients. Among these cases, three patients were reared as males, their gender assignment driven by external genital appearance and sociocultural influences. Notably, none of the patients manifested gonadal tumors during the course of the study. Conclusion: In cases of ambiguous genitalia, the consideration of OT-DSD should be integral to the differential diagnosis, underscoring the significance of heightened clinical awareness and informed decision-making.

Abstract Background Neuromyelitis optica (NMO), or neuromyelitis optica spectrum disorder (NMOSD), is an autoimmune CNS condition which often has a complex clinical course. Longitudinally extensive transverse myelitis (LETM) is an important and sensitive MRI finding but is not very specific to NMOSD and is seen in other causes of myelitis. Case presentations We report 11 NMO cases, all seen in women from 25 to 75 years at the time of diagnosis, with most above 65 years of age. All patients were seropositive for AQP4–IgG antibodies, and none had anti-MOG antibodies. Clinical presentations were diverse, the most common being paralytic and visual changes. In this study, 5 of the 11 seropositive NMO patients (45%) had bright spotty lesion (BSLs) on their MRI spine, as opposed to none (0%) in the control group. BSLs were defined as hyperintense foci of signal abnormality on T2-weighted images compared to the surrounding CSF. Treatment included symptomatic management and immunotherapy; timely management led to improvement in all the cases, with partial recovery seen in most (91%) and complete recovery seen only in one. Conclusions BSLs are a newly defined spinal MRI finding with high specificity, but low sensitivity for NMOSD. The absence of BSLs in the control group establishes its prolific role in distinguishing NMO from MS, ITM, MOGAD and other forms of myelitis. The main aim of this retrospective case–control study was to determine the diagnostic importance and specificity of bright spotty lesions (BSLs) in NMOSD and its ability to discriminate NMOSD from other causes of LETM.

Energy-efficient resource-optimization for multiple application scenarios requires appropriate clustering-based network-fractioning that skillfully removes unbalanced network connectivity, which is a stimulating bottleneck in WSN-performance. This paper proposes a new Uniform Connectivity-based clustering Protocol, called Lines-of-Uniformity based Enhanced-Threshold (LUET) to provide energy-efficient coverage in three-tier heterogeneous WSN. This protocol considers the node’s remnant-energy and its proximity from either of the lines of uniformity for lowering down average isolated node count in WSN. This paper also proposes a rotation epoch-based LUET variant, (LUET|R) that incorporates static epoch for initial clustering rounds until First-Node-Death to overcome the rapid fall after the death of the first node. The simulation model demonstrates the superiority of LUET and its variants over other established clustering protocols in terms of network-lifetime, power-efficiency, net death-rate, average isolated-nodes, throughput.

Sensitive Health Information (SHI) is a developing patient-centric model of medical data exchange, which is frequently outsourced to be stored at third party servers. Though, there have been various privacy issues as SHI could be disclosed to the unauthorised and third parties. This is a promising method to encrypt the SHI before outsourcing to assure the patients’ control over access to their own SHI. However, challenges like scalability in key management and flexible access have remained the most significant issues toward achieving fine-grained, cryptographically data access control. In this paper, the authors proposed a novel patient-centric system model for access control to SHIs stored in semi-honest servers. For fine-grained and scalable access control for SHIs, authors have proposed an encryption technique which is an improvement over RSA techniques to encrypt every patient’s SHI file. To different from previous works in secure data transmission, the authors focus on the data owner and divide users into several domains in SHI, which greatly decrease the key management complexity for data owners and users. Comprehensive analytical and experimental results are presented which reflect the efficiency of the proposed approach.

Abstract Context Treatment-related toxicities in DLBCL (diffuse large B cell lymphoma) patients are higher in the initial phase of treatment (first cycle effect). Implementation of pre-phase treatment before definitive chemotherapy had been shown to alleviate some of these side-effects in a non-randomized study conducted earlier in our institute (Lakshmaiah et. al., Eur J Haematol 100:644-8, 2018). Aims This study was aimed at validating the role of pre-phase treatment in newly diagnosed DLBCL patients. Settings and design All newly diagnosed patients with DLBCL above the age of 18 years were evaluated for eligibility and prospectively enrolled. A single-arm prospective study was conducted at the Department of Medical Oncology, in our institute from July 2015 to December 2019. Methods and material Patients received vincristine and prednisolone as pre-phase treatment for 7 days after which definitive chemotherapy was instituted on day 1. They were followed up for 30 days post-first cycle chemotherapy. Statistical analysis used Paired Student’s t tests and Wilcoxon signed-ranks test were used for comparison of various clinical variables as appropriate. P value of less than 0.05 was considered significant. Results Among the 180 patients who were included in study, performance status improvement was noted in significant number of patients (p < 0.001). 38.4% achieved an ECOG (Eastern Cooperative Oncology Group) performance status of 0 post-pre-phase therapy. Febrile neutropenia was observed in 12.8% in the present cohort as compared to the historical non-pre-phase cohort (34%). Conclusions Pre-phase therapy significantly improves the performance status and diminishes neutropenia rates in DLBCL patients.

Gabapentin (GBP), a GABA analogue, is primarily used as an anticonvulsant for the treatment of partial seizures and neuropathic pain. Whereas a majority of the side effects are associated with the nervous system, emerging evidence suggests there is a high risk of heart diseases in patients taking GBP. In the present study, we first used a preclinical model of rats to investigate, firstly, the acute cardiovascular responses to GBP (bolus i.v. injection, 50 mg/kg) and secondly the effects of chronic GBP treatment (i.p. 100 mg/kg/day × 7 days) on cardiovascular function and the myocardial proteome. Under isoflurane anesthesia, rat blood pressure (BP), heart rate (HR), and left ventricular (LV) hemodynamics were measured using Millar pressure transducers. The LV myocardium and brain cortex were analyzed by proteomics, bioinformatics, and western blot to explore the molecular mechanisms underlying GBP-induced cardiac dysfunction. In the first experiment, we found that i.v. GBP significantly decreased BP, HR, maximal LV pressure, and maximal and minimal dP/dt, whereas it increased IRP-AdP/dt, Tau, systolic, diastolic, and cycle durations (* p < 0.05 and ** p < 0.01 vs. baseline; n = 4). In the second experiment, we found that chronic GBP treatment resulted in hypotension, bradycardia, and LV systolic dysfunction, with no change in plasma norepinephrine. In the myocardium, we identified 109 differentially expressed proteins involved in calcium pathways, cholesterol metabolism, and galactose metabolism. Notably, we found that calmodulin, a key protein of intracellular calcium signaling, was significantly upregulated by GBP in the heart but not in the brain. In summary, we found that acute and chronic GBP treatments suppressed cardiovascular function in rats, which is attributed to abnormal calcium signaling in cardiomyocytes. These data reveal a novel side effect of GBP independent of the nervous system, providing important translational evidence to suggest that GBP can evoke adverse cardiovascular events by depression of myocardial function.

Background: Oral submucous fibrosis (OSMF) is a potentially malignant disorder associated with habit of chewing betel quid containing arecanut. Morphological features of OSMF especially fibrosis suggests a possibility of the hypoxic environment in diseased tissues. The adaptation of cells to hypoxia appears to be mediated via hypoxia inducible factor-1α (HIF-1α) which is also said to be associated with malignant transformation of epithelial cells in various other carcinomas like prostate and cervical carcinoma. Therefore, the main objective of this study was to investigate the role of HIF-1α in progression and malignant transformation of OSMF. Materials and Methods: The study group consisted of histo-pathologically diagnosed 30 cases of oral submucous fibrosis and 10 cases of OSCC were taken as control. The immunohistochemistry was carried out on neutral buffered formalin-fixed paraffin-embedded tissue sections by using the monoclonal antibody of HIF-1α. Statistical analysis was done using SPSS software version 2.0. Results: A gradual and significant rise in the expression of HIF-1α was observed in various grades of OSMF and OSCC cases. HIF 1α expression was increased in cases showing hylanization and constricted blood vessels. A cut off value of 39.6% of HIF-1α positive cells was determined statistically to categorize the cases into high risk and low risk group for malignant transformation. Conclusion: Overexpression of HIF-1α may contribute to the progression and malignant transformation of OSMF. Cases expressing more than 40% of HIF-1α positive cells are at a greater risk for malignant transformation.

Background: Neonatal sepsis term is an infection of newborns

The present study is carried out to ascertain the effect of different physical factors (sunlight, temperature, pH) and storage conditions on the antimicrobial efficacy of Lawsonia inermis leaf extracts and bio-formulation against the Alternaria alternata. In addition, the phytotoxic potential of 100% alcoholic crude extract as well as the acetone fraction of young leaves of Lawsonia inermis was also checked on seed germination of chilli (Capsicum annuum). Results showed that there was no adverse effect of wet heat (50–100 °C) and dry heat (40–90 °C) on extract and bio-formulation efficacy. Storage for 6 and 12 months had no adverse effect on extract and bio-formulation efficacy and the antifungal activity was observed similar to freshly prepared extract. We have used concentrations of 5,10, 15, 20 and 25 mg/ml to perform a phytotoxicity assay. The measurement of phytotoxicity was done by using the Standard blotter method and the result revealed that 5, 10 and 15 mg/ml concentration of the extract was non phytotoxic and were further used for in vivo experiments. These plant extracts and bio-formulations have extensive antimicrobial potential to be explored for application in sustainable agriculture.

Mucinous tubular and spindle cell renal cell carcinoma (MTSC-RCC) is a rare but favorable variant of renal cell carcinoma, predominantly found in adults. Complete surgical excision is the treatment of choice. We are reporting an intriguing case of bilateral MTSC-RCC in a 13-year-old-boy with rapid disease progression, leading to metastatic disease and subsequent demise of the child.

The P. longifolia mediated silver (PL-AgNPs) nanoparticles are very stable and efficient. UV–Vis spectroscopy, dynamic light scattering (DLS), X-ray diffraction (XRD), transmission electron microscope (TEM), scanning electron microscope (SEM), and energy dispersive X-ray spectroscopy (EDX) were used to characterize the produced AgNPs. UV–Vis analysis showed a characteristic peak at 435 nm corresponding to surface plasmon resonance. The synthesis process was spectrophotometrically optimized for various parameters. After optimization, highly stable AgNPs were prepared using 3.0 ml of P. longifolia leaf extract, pH 7.0, 1.0 mM AgNO3, and 60 °C. The zeta potential was measured by DLS, which showed −20.8 mV and the PDI value was 5.42. TEM and SEM analysis shows a spherical shape of the synthesized nanoparticles, and the size was measured between 10 and 40 nm. EDX analysis showed intense peaks from silver and oxygen and small peaks from various metal atoms such as Na, P, S and Al indicating their presence in trace amounts. The average size of the PL-AgNPs was 14 nm. The phytochemical analysis shows that the presence of alkaloids, essential oils and saponins seems to be responsible for the synthesis of nanoparticles. PL-AgNPs were further investigated for their antifungal activity against Alternaria alternata. The minimum inhibitory concentration (MIC), minimum fungicidal concentration (MFC) and effect of nanoparticles on cytomorphology of A. alternata have also been reported. Biosynthesized nanoparticles have proven to be inexpensive, environmentally friendly, stable, easily reproducible, and highly effective against plant-pathogenic fungi.

Objective: Tuberculosis (TB) is a deadly infectious ailment causing mortality and morbidity globally. The study objectives were to investigate the effect and possible mechanisms of metformin as adjuvant therapy in the management of tuberculosis. Methods: TB patients attending HAHC hospital, New Delhi (India) and had T2DM (Type-2 diabetes mellitus) comorbidity were enrolled. Study participants were categorized into metformin non-users and metformin users depending on the presence of metformin in their prescription. Whole blood was used for immunophenotyping of total T-Cells (CD45+CD3+), Helper T-Cells (Th) (CD45+CD3+ CD4+) and Cytotoxic T Cells (Tc) (CD45+CD3+CD8+) through flow cytometry. BD FACS Verse and BD LSR II were used for sample acquisition. Results: Estimation of T-Cells (CD45+CD3+), Helper T-Cells (Th) (CD45+CD3+ CD4+) and Cytotoxic T Cells (Tc) (CD45+CD3+CD8+) levels at 2nd visit showed a larger T-Cells (CD45+CD3+) (p

Plant extract possess various secondary metabolites which are antifungal in nature and can be used as a safer alternative to the synthetic fungicides. As we all know that the chemical fungicides are harmful not only for humans but also for animals, other vegetation and for complete ecosystem. To overcome this problem, we have to focused on another alternative which are biologically libel and nonhazardous also. In the present study, herbal formulation was prepared in various combination ratios with Thevetia peruviana leaf extracts, cow dung and neem oil cake. The major aim of this short study is to check the stability of the said plant extracts and prepared herbal formulation on various physical factors like heat, temperature, pH, sunlight and storage etc. The extracts and herbal formulations were exposed to varying conditions of the parameters selected for a precise time period, and then observing the effect as a function of change in the crude extract activity, herbal formulation activity and change minimum inhibitory concentration of plant extract against the Alternaria solani. Control set of MIC, and extract free medium were maintained for comparison in each set of experiment against Alternaria solani. Results suggested that efficacy of leaf extracts and different formulations was not affected by wet heat up to 100 °C while slight reduction in antifungal activity of the plant extract and herbal formulations were observed with dry heat at 100 °C. In addition, slight reduction in activity of extract and herbal formulations was observed with change in pH. However antifungal activity of plant extract as well as herbal formulations, remain unaffected at alkaline pH (pH 9) and neutral pH (pH7). Storage for 6 and 12 months had no negative effect on extract and herbal formulation efficacy and the antifungal activity was observed similar to freshly prepared extract activity. The present study concluded that the plant disease or plant pathogens can be controlled by plant extract and plant based bioformulations by increasing the shelf life with some little changes in the physical parameters such as light, temperature, pH and storage.

Abstract Background Appendicitis following trauma is a well-documented sequela of blunt trauma to the abdomen, while appendiceal transection following trauma is extremely rare. Literature reports have documented appendicitis and appendiceal transection as the presenting pathology in a trauma setting. This is first report of auto-amputation of the appendix as a delayed presentation with peritonitis, which was detected during the second surgery in a child with blunt abdominal trauma. Case presentation A 11-year-old Asian boy presented to our center with a 2-day history of blunt abdominal trauma and chief complaint of severe abdominal pain. On evaluation, a computed tomography scan showed gross pneumoperitoneum. The child underwent emergency laparotomy, where a jejunal perforation was noted, which was repaired. The rest of the bowel and solid organs were healthy. The child was managed in the intensive care unit postoperatively, when he developed a burst abdomen. During the second surgery, pyoperitoneum and free-floating appendix were found in the left paracolic gutter. After peritoneal wash, the bowel was noted to be healthy and the previous jejunal repair was intact. The child was allowed oral intake of food and discharged on postoperative days 4 and 8, respectively. At the 1-year follow-up, he remained asymptomatic. Conclusions This case report is unique as it describes auto-amputation of the appendix as a delayed event in the course of treatment for blunt trauma of the abdomen. Although a remote event, the possibility of amputation of the appendix should be retained as a differential diagnosis and unusual complication in cases of delayed peritonitis.

Calocybe indica, generally referred as milky mushroom, is one of the edible mushroom species suitable for cultivation in the tropical and sub-tropical regions of the world. However, lack of potential high yielding strains has limited its wider adaptability. To overcome this limitation, in this study, the germplasms of C. indica from different geographical regions of India were characterized based on their morphological, molecular and agronomical attributes. Internal transcribed spacers (ITS1 and ITS4)-based PCR amplification, sequencing and nucleotide analysis confirmed the identity of all the studied strains as C. indica. Further, evaluation of these strains for morphological and yield parameters led to the identification of eight high yielding strains in comparison to the control (DMRO-302). Moreover, genetic diversity analysis of these thirty-three strains was performed using ten sequence-related amplified polymorphism (SRAP) markers/combinations. The Unweighted Pair-group Method with Arithmetic Averages (UPGMA)-based phylogenetic analysis categorized the thirty-three strains along with the control into three clusters. Cluster I possesses the maximum number of strains. Among the high yielding strains, high antioxidant activity and phenol content was recorded in DMRO-54, while maximum protein content was observed in DMRO-202 and DMRO-299 as compared with the control strain. The outcome of this study will help the mushroom breeders and growers in commercializing C. indica.

Abstract Background Microbial origin polysaccharides have gained popularity due to lesser toxicity, better degradability and selectivity as compared to their synthetic counterparts and can be used as emulsifier, stabilizer, thickener, texturizer, flocculating and gelling agent. Here main emphasis on exopolysaccharide production from potential lactic acid bacteria that has GRAS status. Results This work was aimed at isolating, purifying and characterizing an extracellular polysaccharide (EPS) produced by a foodgrade lactic acid bacteria Lactobacillus paraplantarum KM1. L. paraplantarum KM1 was isolated from human milk and identified by conventional and molecular techniques. The 16S rRNA sequence of the isolate was registered in National Centre for Biotechnology Information (NCBI) under accession number KX671558. L. paraplantarum KM1 was found to produce EPSs in lactose containing MRS medium, and the maximum yield (47.4 mg/ml) was achieved after 32-h incubation. As evident from TLC and HPLC analyses, the polysaccharide was found to be a heteropolymer-containing glucose, galactose and mannose as main sugars. Different oligosaccharides namely hexoses were obtained after partial hydrolysis of the polymer using MALDI-ToF-MS. The total molecular weight of all polysaccharides present was 348.7 kDa with 100 °C thermal stability as well as water soluble in nature. Cell cytotoxicity revealed that the purified EPS was safe for consumption; thus, it can be used in various food industries as emulsifying and texture agent. Conclusions The present study highlighted that exopolysaccharides could be harnessed to improve food products in terms of texture, emulsifying agents, pharmaceutical industry (antioxidants, antitumour, anti-inflammatory and antiviral agents) and as safety purposes.

Introduction: The emergence of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pandemic has been troublesome particularly for developing countries that lack infrastructure and capacities to produce the kits locally. Simplification of the method can increase diagnostic efficiency which can benefit patients and help in infection control, consequently saving time and lives. Aim: To evaluate the diagnostic value of four methods (that omit extraction step) for detection of SARS-CoV-2 against the traditional extraction method. Materials and Methods: This was a cross-sectional analysis for evaluating diagnostic accuracy of four methods for detection of SARS-CoV-2 by real-time Reverse Transcriptase Polymerase Chain Reaction (rRT-PCR), conducted in the Department of Microbiology, SMS Medical College, Jaipur, Rajasthan, India, in October 2020. Ninety four SARS-CoV-2 RT-PCR positive samples and 20 negative samples were taken for this study. Automated extraction system was used for Ribonucleic Acid (RNA) extraction and four different approaches were compared to the traditional extraction method for detection of SARS-CoV-2 by RT-PCR. Data was entered and analysed using Statistical Package for the Social Sciences (SPSS) statistical software version 24.0. Results: The automated RNA extraction method was compared to the method of direct addition of samples with (Heat processed Direct Viral transport medium Sample (HDVS)) and without heating (Direct Viral transport medium Sample (DVS)), directs addition of diluted (1:5) sample with (Heat processed diluted VTM sample (HdVS)) and without heating (Diluted VTM sample (dVS)) as well as after addition of Proteinse K (PK) to the diluted samples that came either negative/invalid. Out of four methods, the HdVS method gave the best results, considering extraction with Perkin Elmer as standard, this method showed sensitivity of 96.74%, specificity of 100%. Conclusion: In current pandemic, molecular testing is critically challenged by the limited supplies of reagents of nucleic acid extraction alternative method like diluting and heating of Viral Transport Media (VTM) samples and using them directly as elutes serve as an easy, fast and inexpensive alternative.

Ectopic scrotum is a rare form of congenital scrotal anomaly that is rarely encountered in pediatric surgical practice. Herein, we report an infant with a unilateral ectopic suprainguinal scrotum associated with undescended testis and multicystic dysplastic kidney. The case is reported in view of rarity of this anomaly in the general pediatric population.

Pleurotus (Oyster mushroom) is an important cultivated edible mushroom across the world. It has several therapeutic effects as it contains various useful bio-molecules. The cultivation and crop management of these basidiomycete fungi depends on many extrinsic and intrinsic factors such as substrate composition, growing environment, enzymatic properties, and the genetic makeup, etc. Moreover, for efficient crop production, a comprehensive understanding of the fundamental properties viz. intrinsic–extrinsic factors and genotype-environment interaction analysis is required. The present study explores the basidiocarp formation biology in Pleurotus mushroom using an in silico response to the environmental factors and involvement of the major regulatory genes. The predictive model developed in this study indicates involvement of the key regulatory pathways in the pinhead to fruit body development process. Notably, the major regulatory pathways involved in the conversion of mycelium aggregation to pinhead formation and White Collar protein (PoWC1) binding flavin-chromophore (FAD) to activate respiratory enzymes. Overall, cell differentiation and higher expression of respiratory enzymes are the two important steps for basidiocarp formation. PoWC1 and pofst genes were participate in the structural changes process. Besides this, the PoWC1 gene is also involved in the respiratory requirement, while the OLYA6 gene is the triggering point of fruiting. The findings of the present study could be utilized to understand the detailed mechanism associated with the basidiocarp formation and to cultivate mushrooms at a sustainable level.

Background: Gastric transposition (GT) is a well-established procedure of esophageal re­placement (ER) for children with esophageal atresia. ER in the neonatal period is sparsely reported. We report characteristics of children who have undergone neonatal GT and have completed ten years of follow-up. Methods: The cross-sectional study was conducted which included all children who under­went neonatal GT at the institute and have completed a follow-up of at least 10-years. An­thropometry, oral contrast study, Hepatobiliary Scintigraphy, Gastroesophageal reflux study, Gastric emptying test, spirometry, and blood investigations were done for all the children. Results: Four children (three male and one female) were included in the study. The mean age at ER was 5.3 ±2.2 days with a mean birth-weight of 2.43 ±0.13 kg. Two children had prima­ry GT, while the other two had GT following a leak in primary anastomosis. During the mean follow-up of 180.25 ±43.5 months, none of the children required esophageal dilatation or other surgical intervention or procedures. All children were below 3rd centile for weight-for-age while all except one were below 50th centile for height-for-age. There was no stricture on oral contrast study, however, one child had grade III reflux on GER scan. Persistent duode­nogastric reflux on HIDA scan was seen in one child. Three children had restrictive parame­ters on spirometry. Symptomatically, all reported poor weight gain, one had left vocal cord palsy with hoarseness, and one had chest-wall protuberance. Conclusions: Neonatal gastric transposition is a feasible alternative to delayed esophageal replacement for neonates with esophageal atresia with limited complications.

Summary: A primary goal of the US National Cancer Institute's Ras initiative at the Frederick National Laboratory for Cancer Research is to develop methods to quantify RAS signaling to facilitate development of novel cancer therapeutics. We use targeted proteomics technologies to develop a community resource consisting of 256 validated multiple reaction monitoring (MRM)-based, multiplexed assays for quantifying protein expression and phosphorylation through the receptor tyrosine kinase, MAPK, and AKT signaling networks. As proof of concept, we quantify the response of melanoma (A375 and SK-MEL-2) and colorectal cancer (HCT-116 and HT-29) cell lines to BRAF inhibition by PLX4720. These assays replace over 60 western blots with quantitative mass-spectrometry-based assays of high molecular specificity and quantitative precision, showing the value of these methods for pharmacodynamic measurements and mechanism-of-action studies. Methods, fit-for-purpose validation, and results are publicly available as a resource for the community at assays.cancer.gov. Motivation: A lack of quantitative, multiplexable assays for phosphosignaling limits comprehensive investigation of aberrant signaling in cancer and evaluation of novel treatments. To alleviate this limitation, we sought to develop assays by using targeted mass spectrometry for quantifying protein expression and phosphorylation through the receptor tyrosine kinase, MAPK, and AKT signaling networks. The resulting assays provide a resource for replacing over 60 western blots in examining cancer signaling and tumor biology with high molecular specificity and quantitative rigor.

Thymolipoma is a rare thymic mass usually incidentally diagnosed. We present the case of an 8-year old child who presented with breathlessness and cough. On evaluation, she had a giant anterior mediastinal mass involving bilateral hemithorax (right > left) which was diagnosed as thymolipoma. The child was started on steroids, to which she responded very well initially, but after few months the thymic mass gradually increased again and respiratory distress reccured. Subsequently total excision of mass was done followed by gradually tapering of steroids. The child had excellent recovery and is asymptomatic at 2.5 years follow up.

Herein, we report the development of a two-dimensional (2D) label-free matrix for cardiac biomarker detection. Tungsten trioxide nanosheets (WO3 NS) were synthesized by a facile, environmentally friendly hydrothermal method and subsequently functionalized chemically using 3-aminopropyletriethoxysilane (APTES). Thin film of APTES functionalized WO3 NS was deposited on indium tin oxide (ITO) substrate using electrophoretic deposition technique. The fabricated APTES/WO3 NS/ITO electrode endows with large surface area for high loading of cardiac troponin I antibodies (anti-cTnI), good stability and strong adsorption platform for the biomolecules immobilization. The selective and quantitative detection of cTnI biomarker was accomplished by immobilizing anti-cTnI on APTES/WO3 NS/ITO platform. The electrochemical sensing using anti-cTnI/APTES/WO3 NS/ITO immunoelectrode was studied as a label-free immunoassay format using EIS (electrochemical impedance spectroscopy) technique. The performance of the sensor as investigated with the measurement of charge transfer resistance (RCT) for variant concentrations of cTnI antigen demonstrated good sensitivity as 30.8 Ω mL ng−1 cm−2 for a linear detection range 0.1 to 100 ng mL−1 along with good stability up to 6 weeks. The competency of the biosensor was also tested by detecting cTnI antigen in spiked human serum samples.

The Mycobacterium tuberculosis kinase PknB regulates essential cell functions via interactions with muropeptides. Here the authors identify interaction sites in the extracytoplasmic PASTA domain and show that abrogation of ligand binding leads to a hyper-activated kinase, causing loss of homeostasis and cell death.

Abstract Background Mechanisms by which Smac mimetics (SMs) interact with proteasome inhibitors (e.g., bortezomib) are largely unknown, particularly in multiple myeloma (MM), a disease in which bortezomib represents a mainstay of therapy. Methods Interactions between the clinically relevant IAP (inhibitor of apoptosis protein) antagonist birinapant (TL32711) and the proteasome inhibitor bortezomib were investigated in multiple myeloma (MM) cell lines and primary cells, as well as in vivo models. Induction of apoptosis and changes in gene and protein expression were monitored using MM cell lines and confirmed in primary MM cell populations. Genetically modified cells (e.g., exhibiting shRNA knockdown or ectopic expression) were employed to evaluate the functional significance of birinapant/bortezomib-induced changes in protein levels. A MM xenograft model was used to evaluate the in vivo activity of the birinapant/bortezomib regimen. Results Birinapant and bortezomib synergistically induced apoptosis in diverse cell lines, including bortezomib-resistant cells (PS-R). The regimen robustly downregulated cIAP1/2 but not the canonical NF-κB pathway, reflected by p65 phosphorylation and nuclear accumulation. In contrast, the bortezomib/birinapant regimen upregulated TRAF3, downregulated TRAF2, and diminished p52 processing and BCL-XL expression, consistent with disruption of the non-canonical NF-κB pathway. TRAF3 knockdown, ectopic TRAF2, or BCL-XL expression significantly diminished birinapant/bortezomib toxicity. The regimen sharply increased extrinsic apoptotic pathway activation, and cells expressing dominant-negative FADD or caspase-8 displayed markedly reduced birinapant/bortezomib sensitivity. Primary CD138+ (n = 43) and primitive MM populations (CD138−/19+/20+/27+; n = 31) but not normal CD34+ cells exhibited significantly enhanced toxicity with combined treatment (P

Mitochondrial markers can be used to differentiate diverse mitotypes as well as cytoplasms in angiosperms. In cauliflower, cultivation of hybrids is pivotal in remunerative agriculture and cytoplasmic male sterile lines constitute an important component of the hybrid breeding. In diversifying the source of male sterility, it is essential to appropriately differentiate among the available male sterile cytoplasms in cauliflower. PCR polymorphism at the key mitochondrial genes associated with male sterility will be instrumental in analyzing, molecular characterization, and development of mitotype-specific markers for differentiation of different cytoplasmic sources. Presence of auto- and alloplasmic cytonuclear combinations result in complex floral abnormalities. In this context, the present investigation highlighted the utility of organelle genome-based markers in distinguishing cytoplasm types in Indian cauliflowers and unveils the epistatic effects of the cytonuclear interactions influencing floral phenotypes. In PCR-based analysis using a set of primers targeted to orf-138, 76 Indian cauliflower lines depicted the presence of Ogura cytoplasm albeit the amplicons generated exhibited polymorphism within the ofr-138 sequence. The polymorphic fragments were found to be spanning over 200–280 bp and 410–470 bp genomic regions of BnTR4 and orf125, respectively. Sequence analysis revealed that such cytoplasmic genetic variations could be attributed to single nucleotide polymorphisms and insertion or deletions of 31/51 nucleotides. The cytoplasmic effects on varying nuclear-genetic backgrounds rendered an array of floral abnormalities like reduction in flower size, fused flowers, splitted style with the exposed ovule, absence of nonfunctional stamens, and petaloid stamens. These floral malformations caused dysplasia of flower structure affecting female fertility with inefficient nectar production. The finding provides an important reference to ameliorate understanding of mechanism of cytonuclear interactions in floral organ development in Brassicas. The study paves the way for unraveling developmental biology of CMS phenotypes in eukaryotic organisms and intergenomic conflict in plant speciation.

Alternaria solani, a plant pathogenic fungus causes significant economical losses of potato crop. The disease is controlled primarily through some traditional methods and most commonly via the application of chemical fungicides. Fungicides treatment is not protected as chemicals pollute environment, effect health vulnerability in humans and when these harmful chemicals enter into the food chain become hazardous to all living entities. Recent efforts have focused on developing environmentally safe, long-lasting, and effective biocontrol methods for the management of plant diseases. Present research focus on screening of crude and partially purified leaf extract of Thevetia peruviana for the presence of antifungal efficacy against Alternarai solani. It was observed that 100% alcoholic crude and alcoholic fraction of partially purified extract showed maximum inhibitory activity which is due to the presence of different secondary metabolites, revealed by phytochemical screening. Active column fraction (possess best antifungal activity against Alternaria solani) was subjected to Gas Chromatography-Mass Spectrometry (GS-MS) analysis. On the basis of peaks matching of GC-MS chromatogram with available data base showed the presence of benzoic acid and oxo-benzoate in active fraction of Thevetia peruviana leaf extract which is already known chemical among the phytochemicals described for antimicrobial activity. Further research on development of herbal formulation from the same would be very helpful environment friendly approach to manage concern crop disease.

Let h be a nonvanishing analytic function in the open unit disc with h0=1. Consider the class consisting of normalized analytic functions f whose ratios fz/gz, gz/zpz, and pz are each subordinate to h for some analytic functions g and p. The radius of starlikeness of order α is obtained for this class when h is chosen to be either hz=1+z or hz=ez. Further, starlikeness radii are also obtained for each of these two classes, which include the radius of Janowski starlikeness, and the radius of parabolic starlikeness.

Background: With 10 vaccines approved by the WHO and nearly 48% of people fully vaccinated worldwide, we have observed several individual case studies of neurological manifestations post-COVID-19 vaccination. Through this systematic review, we aim to discern these CNS and PNS manifestations following the COVID-19 vaccine to help produce methods to mitigate them. Methods: We conducted a thorough literature search of Google Scholar and PubMed from 1 December 2020 until 10 October 2021 and included all the case studies of COVID-19 vaccine-associated neurological side effects. The literature search and data analysis were performed by two independent reviewers according to prespecified inclusion and exclusion criteria using PRISMA. Results: The most common CNS manifestation was CVST (14.47%), found in females (64%) younger than 50 years (71%) after the first AstraZeneca dose (93%). Others included CNS demyelinating disorders (TM, ADEM, MS, NMOSD) (9.30%), encephalopathy/encephalitis (3.10%), and others (4.13%). The most common PNS manifestation was GBS (14.67%) found in males (71%) older than 50 years (79%), followed by Bell’s palsy (5.24%) and others (2.10%). Most occurred with the AstraZeneca (28.55%), Pfizer-BioNTech (9.18%), and Moderna (8.16%) vaccines. Nine (64%) out of the 14 patients with CVST died. However, most cases overall (42 out of 51) were non-fatal (82%). Conclusion: Several CNS and PNS adverse events have occurred post-COVID-19 vaccination, including CVST, GBS, and TM. High vigilance with early identification and treatment leads to better outcomes. Further studies with non-vaccinated controls might help in understanding the pathophysiologic mechanisms of these neurological manifestations following COVID-19 vaccination.

Continuous increase in global human population and depletion of natural resources of energy posing threat to environment needs, sustainable supply of food and energy. The most ecofriendly approach ‘green technology’ has been exploited for biofertilizer preparation. Cyanobacteria are the most successful and sustained prokaryotic organism during the course of evolution. They are considered as one of the primitive life forms found on our planet. Cyanobacteria are emerging candidates for efficiently conversion of radiant energy into chemical energy. This biological system produces oxygen as a by-product. Cyanobacterial biomass can also be used for the large scale production of food, energy, biofertilizers, secondary metabolites, cosmetics and medicines. Therefore, cyanobacteria are used in ecofriendly sustainable agricultural practice for production of biomass of very high value and decreasing the level of CO2. This review article describes the methods of mass production of cyanobacterial biofertilizers and their applications in agriculture and industrial level.

Plants have been used throughout the world for its medicinal powers since ancient time. The pharmacological properties of plants are based on their phytochemical components especially the secondary metabolites which are outstanding sources of value added bioactive compounds. Secondary metabolites have complex chemical composition and are produced in response to various forms of stress to perform different physiological tasks in plants. They are used in pharmaceutical industries, cosmetics, dietary supplements, fragrances, flavors, dyes, etc. Extended use of these metabolites in various industrial sectors has initiated a need to focus research on increasing the production by employing plant tissue culture (PTC) techniques and optimizing their large scale production using bioreactors. PTC techniques being independent of climatic and geographical conditions will provide an incessant, sustainable, economical and viable production of secondary metabolites. This review article intends to assess the advantages of using plant tissue culture, distribution of important secondary metabolites in plant families, strategies involved for optimal metabolite production and the industrial importance of selected secondary metabolites.

Introduction: Studies quantifying cortical metrics in brain tumor patients who present with seizures are limited. The current investigation assesses morphometric/volumetric differences across a wide range of anatomical regions, including temporal and extra-temporal, in patients with gliomas and intracranial metastases (IMs) presenting with seizures that could serve as a biomarker in the identification of seizure expression and serve as a neuronal target for mitigation.Methods: In a retrospective design, the MR sequences of ninety-two tumor patients [55% gliomas; 45% IM] and 34 controls were subjected to sophisticated morphometric and volumetric assessments using BrainSuite and MATLAB modules. We examined 103 regions of interests (ROIs) across eight distinct cortical categories of interests (COI) [gray matter, white matter; total volume, CSF; cortical areas: inner, mid, pial; cortical thickness]. The primary endpoint was quantifying and identifying ROIs with significant differences in z-scores based upon the presence of seizures. Feature selection employing neighborhood component analysis (NCA) determined the ROI within each COI having the highest significance/weight in the differentiation of seizure vs. non-seizure patients harboring brain tumor.Results: Overall, the mean age of the cohort was 58.0 ± 12.8 years, and 45% were women. The prevalence of seizures in tumor patients was 28%. Forty-two ROIs across the eight pre-defined COIs had significant differences in z-scores between tumor patients presenting with and without seizures. The NCA feature selection noted the volume of pars-orbitalis and right middle temporal gyrus to have the highest weight in differentiating tumor patients based on seizures for three distinct COIs [GM, total volume, and CSF volume] and white matter, respectively. Left-sided transverse temporal gyrus, left precuneus, left transverse temporal, and left supramarginal gyrus were associated with having the highest weight in the differentiation of seizure vs. non-seizure in tumor patients for morphometrics relating to cortical areas in the pial, inner and mid regions and cortical thickness, respectively.Conclusion: Our study elucidates potential biomarkers for seizure targeting in patients with gliomas and IMs based upon morphometric and volumetric assessments. Amongst the widespread brain regions examined in our cohort, pars orbitalis, supramarginal and temporal gyrus (middle, transverse), and the pre-cuneus contribute a maximal potential for differentiation of seizure patients from non-seizure.

Objectives: Comparison of two fractionation schedules of intensity modulated radiotherapy (IMRT) for locally advanced head and neck cancer – simultaneous integrated boost (SIB-IMRT) and simultaneous modulated accelerated radiotherapy (SMART) boost in terms of toxicity and survival end-point measures. Patients and methods: Sixty patients with locally advanced head and neck cancer were randomized in two treatment arms (SIB-IMRT [control arm] and SMART boost arm [study arm]). In the control arm, patients received 70, 63 and 56 Gy in 35 fractions to clinical target volumes (CTV) 1, 2 and 3, respectively. In the study arm, patients received 60 and 50 Gy to CTV 1 and CTV 3, respectively. Toxicities, progression free survival (PFS) and overall survival (OS) were compared between both arms. Results: Baseline patient-related characteristics were comparable between the arms except for primary site of tumour. No significant differences were noted in acute toxicities between the arms except for fatigue which was statistically higher for control arm. No significant differences in 2-year late toxicities were observed. The median follow-up duration was 25.5 (range, 1.8–39.9) months. The 2-year PFS was 53.3% and 80.0% (p = 0.028) for control and study arm, respectively. The 2-year OS was 60.0% and 86.7% (p = 0.020) in control and study arms, respectively. Multivariate analysis showed clinical stage and site to be significant predictors for OS and PFS, respectively. Conclusions: The SMART boost technique can be a feasible alternative fractionation schedule that reduces the overall treatment time, maintaining comparable toxicity and survival compared with SIB-IMRT. Keywords: Radiotherapy, Intensity-modulated, Dose fractionation, Oral cancer, Head and neck neoplasms, Simultaneous integrated boost (SIB), Simultaneous modulated accelerated radiotherapy (SMART)

Abstract Background A retained surgical sponge remains a dreaded complication of modern surgery. Despite the increasing focus on patient safety instances of “a sponge being left in the abdomen”, are all too common in popular media. In this article we report the rare phenomenon of transmigration of a retained surgical sponge in a patient who underwent laparoscopic sterilization. Case presentation A 30-year-old female presented with progressive abdominal pain for about one month and vomiting with obstipation for 2 days. The patient had undergone laparoscopic sterilization 7 years back and then underwent re-canalization one year back. She underwent an exploratory laparotomy for suspected adhesive small bowel obstruction. During surgery, an intra-luminal surgical sponge was recovered from the distal small bowel. The patient recovered and was discharged in good health. Conclusion Despite numerous advances in terms of technology and the ever-growing emphasis on patient safety, the problem of a retained surgical sponge remains a dreaded potential complication. All clinicians and health care professionals should be aware of this entity and its various presentations.

The platinum‐based DNA damaging agent cisplatin is used as a standard therapy for locally advanced head and neck squamous cell carcinoma (HNSCC). However, the mechanisms underpinning the cytotoxic effects of this compound are not entirely elucidated. Cisplatin produces anticancer effects primarily via activation of the DNA damage response, followed by inducing BCL‐2 family dependent mitochondrial apoptosis. We have previously demonstrated that cisplatin induces the expression of proapoptotic BCL‐2 family protein, Noxa, that can bind to the prosurvival BCL‐2 family protein, MCL‐1, to inactivate its function and induce cell death. Here, we show that the upregulation of Noxa is critical for cisplatin‐induced apoptosis in p53‐null HNSCC cells. This induction is regulated at the transcriptional level. With a series of Noxa promoter‐luciferase reporter assays, we find that the CRE (cAMP response element) in the promoter is critical for the Noxa induction by cisplatin treatment. Among the CREB/ATF transcription factors, ATF3 and ATF4 are induced by cisplatin, and downregulation of ATF3 or ATF4 reduced cisplatin‐induced Noxa. ATF3 and ATF4 bind to and cooperatively activate the Noxa promoter. Furthermore, ERK1 is involved in cisplatin‐induced ATF4 and Noxa induction. In conclusion, ATF3 and ATF4 are important regulators that induce Noxa by cisplatin treatment in a p53‐independent manner.

This is a case report of a 60-year-old diabetic, hypertensive male with a good performance status and a history of bilateral interstitial lung disease with a left upper lobe lung mass diagnosed to be a Stage IIB mixed small-cell/squamous cell carcinoma which was refractory to carboplatin- and etoposide-based chemotherapy. The patient was then taken up for adaptive intensity-modulated radiotherapy with tighter margin under image guidance with a mid-treatment replanning done at 25#. Acute toxicities were assessed weekly and showed no Grade 3 or more reactions. Pulmonary function test showed no detrimental changes during or after radiation. Response assessment at 12 and 20 weeks showed a partial response with decrease in metabolic activity on serial scans.

A search on PubMed and Web of Science revealed scarcity of the literature on anomalies of hepatic artery or portal vein and the presence of arterioportal fistula in biliary atresia; although, it has long-lasting implications for both the patient and the surgeon, including hepato-pancreato-biliary surgeons, pediatric surgeons (who perform Kasai's portoenterostomy), liver transplant surgeons, and interventional radiologists. We report a case of extrahepatic biliary atresia with multiple anomalies involving the hepatic arteries, portal vein, cystic artery, arterioportal fistula and shunting, intrahepatic portal vein radicals, kidney, and external genitalia. The merits of the case from various standpoints including its implications for etiopathogenesis, caution during surgical anesthesia or postoperative management, and enrichment of the literature have been discussed.

Mucosal Schwann cell hamartoma (M-SCH) of the intestinal mucosa is a rare entity and incidental finding in histological examination. Histological characteristics are Schwannonian cell proliferation in lamina propria with S100-positivity. M-SCH-like lesion in the gall bladder is even rarer and is a recently reported entity. We report this extremely rare lesion in a cholecystectomy specimen of a 4-year-old boy, which makes it the youngest patient to be having M-SCH-like lesion in the gall bladder.

The rarity, diverse clinical presentation, relatively featureless sonography, and diagnostic dilemma associated with pilomatrixomas may trigger anxiety and call for unwarranted investigations. The authors have shared their experience in two consecutive cases to generate awareness for such lesions.