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Introduction: Oral examination (viva voce) is one of the common assessment methods for medical students. Literature shows that Conventional Oral Examination (COE), is a widely adopted method and uses a consolidated scoring system. There came an alternative method, Structured Oral Examination (SOE) that uses the recommended rating scale (prevalidated questions and markings). The emergence of a new method raised the research question of whether the conventional or structured oral examination is effective in assessing medical students. Aim: To evaluate the effectiveness of traditional and structured vivavoce examination across the specialties in medical education. Materials and Methods: A systematic review was conducted on 18 peer-reviewed articles about conventional and structured oral examination among medical students. Medical Education Research Study Quality Instrument (MERSQI) was used to assess the quality of evidence. Results: The level of evidence was moderate where the MERSQI score ranges from 7.5 to 15.5 for the 18 articles included in the review process. SOE overcomes COE by assessing students' cognitive skills, communication skills, behaviour, and attitude whereas COE principally assesses the recall knowledge. Analytical and reasoning power remains the predominant domain in SOE. With psychometric properties like good reliability, sensitivity, and acceptability, SOE remains the best strategy for the evaluation of medical students. Pooled results in the forest plot showed no difference in the viva voce marks between COE and SOE with a mean difference of 0.46 (p=0.53). Conclusion: The review analysis revealed that there is no difference in the mean marks scored by COE and SOE. However, a SOE will allow examiners to assess the medical students' learning achievement with no partiality, stress, and anxiety compared to COE. [ABSTRACT FROM AUTHOR]

Palatogingival groove also known as radicularlingual groove is a developmental anomaly involving the lingual surface of the maxillary incisors. They are inconspicuous, funnel-shaped, extend for varying distances on root surface and occur due to infolding of the hertwigs epithelial root sheath. This encourages adherence of microorganisms and plaque to levels significant for pathological changes resulting in endodontic and periodontal lesions. The variations in anatomy of the tooth as a cause of pulp necrosis in teeth of anterior maxillary segment should be considered by the clinician when other etiological factors are ruled out. Recognition of palatogingival groove is critical, especially because of its diagnostic complexity and the problems that may arise if it is not properly interpreted and treated. Regeneration is a new emerging approach in endodontics. Choukroun et al. were among the pioneers for using platelet-rich fibrin (PRF) to improve bone healing. PRF is rich in platelet cytokines and growth factors. Numerous techniques have been used to eliminate or seal the groove and regenerate endodontic and periodontal tissues. In this case report of two cases, a novel combination therapy involving ultrasonics, blend of PRF with bone graft, guided tissue regeneration membrane was used in the treatment of a palatogingival groove with an endoperio lesion to ensure arrest of disease progression and promote regeneration. The groove was cleaned and prepared ultrasonically and sealed with a bioactive dentin substitute. [ABSTRACT FROM AUTHOR]

Periapical lesions of endodontic origin are common pathological conditions affecting periradicular tissues. Microbial infection of pulpal tissues is primarily responsible for initiation and progression of apical periodontitis. The primary objective of endodontic therapy should be to restore involved teeth to a state of normalcy nonsurgically. Different nonsurgical management techniques, namely, conservative root canal therapy, decompression technique, method using calcium hydroxide, aspiration-irrigation technique, lesion sterilization and tissue repair therapy, active nonsurgical decompression technique, and the apexum procedure have been advocated. New techniques which use drug-loaded injectable scaffolds, simvastatin, and epigallocatechin-3-gallate have been tried. Surgical option should be considered when intra- or extra-radicular infections are persistent. Incidence of nonendodontic periapical lesions has also been reported. An accurate diagnosis of the periapical lesion whether it is of endodontic or nonendodontic origin has to be made. Surgical methods have many disadvantages, and hence should be considered as an option only in the case of failure of nonsurgical techniques. Assessment of healing of periapical lesions has to be done periodically which necessitates a long-term follow-up. Even large periapical lesions and retreatment cases where the lesion is of endodontic origin have been successfully managed nonsurgically with orthograde endodontic therapy. [ABSTRACT FROM AUTHOR]

Aim: This study aims to analyze root canal configuration of human permanent mandibular first molars of an indo-Dravidian population based in southern India. Materials and Methods: A total of 1147 mandibular first permanent molars were collected, cleansed, and stored. The number of roots was recorded, access preparations made, pattern of orifices recorded after pulpal floor debridement, dye injected into the canals using apical negative pressure and subjected to a clearing technique. They were then analyzed using a stereo microscope and the canal configurations recorded (Vertucci). The number of roots, the pattern of orifices and canal configuration were recorded. Results: The pattern of orifices was triangular (87.9%), rectangular (8.5%), C-shaped (3.0%), and two orifice pattern (0.6%). About 95.6% of teeth had two roots, and 4.4% had three roots. The most common canal system configuration in mesial root was Vertucci type IV (52.3%), followed by type II (35%). Root canal configuration of the distal root revealed type I configuration in 62.7%, followed by types II (14.5%) and IV (12.4%). The distolingual root had a type I configuration. Conclusion: Awareness of canal configuration, adequate clinical skills, use of specialized techniques of diagnosis, debridement and obturation will pave the way for successful treatment outcomes. [ABSTRACT FROM AUTHOR]

Aim: This study aims to compare the smear layer removal efficacy of 2% chitosan (low molecular weight) (C-LMV), 4% chitosan citrate (CC), and 10% citric acid (CA) when used in specific irrigant protocols. Materials and Methods: A total of 60 single-rooted maxillary incisors and canines were decoronated, standardized to a root length of 15 mm, and prepared with rotary files up to protaper F3 size. Sodium hypochlorite was used as initial rinse [8 ml]. The samples were divided into experimental (Group III, IV, V, and VI) (n = 10) and control groups (I - 17% EDTA, II - normal saline) (n = 5) based on the type of final rinse solution (5 ml) used, that is, 2% C-LMV, 4% C-citrate, 10% CA, and 1% acetic acid. Samples were dehydrated, split buccolingually, gold sputter coated, and examined in field emission scanning electron microscope. Results: Overall, the Group IV, V, and III presented the least amounts of smear, debris, and erosion among the experimental groups at the apical, middle, and coronal one-thirds of the root canal with a mean value of 1.53 ± 0.42, 1.33 ± 0.42, and 1.60 ± 0.46, respectively, and there was no statistically significant difference (P > 0.05). Conclusion: The use of CC as final rinse solution during biomechanical preparation seems promising. [ABSTRACT FROM AUTHOR]

Anterior tooth fracture as a result of traumatic injuries, is frequently encountered in endodontic practice. Proper reconstruction of extensively damaged teeth can be achieved through the fragment reattachment procedure known as "biological restoration." This case report refers to the esthetics and functional recovery of extensively damaged maxillary central incisor through the preparation and adhesive cementation of "biological post" in a young patient. Biological post obtained through extracted teeth from another individual-represent a low-cost option and alternative technique for the morphofunctional recovery of extensively damaged anterior teeth. [ABSTRACT FROM AUTHOR]

Invasive cervical resorption is often not diagnosed properly, leading to improper treatment or unnecessary loss of the tooth structure. Early diagnosis and appropriate treatment are the keys to a successful outcome of therapy. Invasive cervical resorption is often seen in the cervical area of the tooth, but because it is initiated apical to the epithelial attachment, it can present anywhere in the root. In the early stages, it may be symmetrical, but larger lesions have the tendency to be asymmetrical. It can expand apically or coronally. [ABSTRACT FROM AUTHOR]

The primary objective of endodontic therapy is to achieve a three-dimensional obturation of the root canal space after adequate preparation of the canal space to remove the tissue debris, microorganisms, and their byproducts. Anatomical variations have frequently been encountered in endodontic practice and have to be adequately managed by the clinician. Missed roots and canals are a major reason for failure of therapy. Technological advances have given the clinician ample opportunity to identify and treat these aberrations successfully. The present report describes a left mandibular second permanent molar requiring root canal treatment, found to have three separate canals in the mesial root. This case demonstrates a rare anatomical configuration and emphasizes the need for the clinician to be aware of and look out for such variations and use adequate diagnostic methodologies prior to and during therapy to detect such variations. The possibility of additional canals, whenever in doubt, should be explored with the assistance of technologies such as those of magnification and illumination and various diagnostic aids. Operator experience has also shown to be a key factor in negotiation and management of these aberrant canal configurations. [ABSTRACT FROM AUTHOR]

Aim: The action of irrigant solutions on intra-radicular dentinal surface were evaluated in an in vitro setting using a scanning electron microscope (SEM) and it was observed that sodium hypochlorite and MTAD produced the cleanest surface and that none of the irrigants were able to produce an ideal preparation of the dentinal surface when used individually. The primary objective of endodontic therapy is to achieve a clean, optimal environment in root canals to avoid unsuccessful treatment outcomes. The complexities of the root canal system necessitate the use of irrigating solutions which act on radicular dentin surface, modifying it. The action of irrigants can be beneficial, and yet at the same time, as they modify the surface structure of dentin, they can have an adverse impact on the properties of dentin. The present study was undertaken to assess the effect of various irrigants on the dentinal surface using an SEM. Materials and Methods: Forty-five roots were randomly divided into nine groups (n=5) and prepared by sectioning at the level of cemento-enamel junction (CEJ) and 10 mm from the CEJ and split longitudinally. The dentin surface was prepared and the cemental surfaces were coated with double layer of varnish. The irrigants tested were normal saline, de-ionized water, 17% ethylenediaminetetraacetic acid (EDTA), 5% sodium hypochlorite (NaOCl), 5% NaOCl with ultrasonic agitation, 3% hydrogen peroxide, 2% chlorhexidine (CHX), MTAD, and MTAD with ultrasonic agitation. The prepared samples were placed in the irrigant solution for 3 min, subsequently dehydrated, sputter coated, and observed under SEM. The images were subsequently analyzed for dentinal surface changes. Results: 17% EDTA and MTAD produced the cleanest dentinal surface. Ultrasonic agitation enhanced the effect of irrigants. 5% NaOCl and 3% hydrogen peroxide were efficient at removal of organic debris, but were unable to remove the smear layer. De-ionized water, normal saline, and 2% chlorhexidine were not effective at removing the debris or the smear layer. Conclusion: None of the irrigants individually were able to achieve conditions of an ideal dentinal surface preparation. [ABSTRACT FROM AUTHOR]

Context: Influence of luting agent, design of tooth preparation for cast posts on tooth resistance to fracture. Aim: To evaluate fracture resistance of teeth restored with cast posts and cores with or without cervical ferrule and cemented with zinc phosphate, glass ionomer, or resin cement. Materials and Methods: Sixty single-rooted maxillary first premolars of similar sizes were selected. Biomechanical preparation and post space preparation for cast post was done for all samples and then they were divided into two groups (n=30). Cervical ferrule preparation was done for Group A, and Group B was prepared without any cervical ferrule. Both groups were further divided into three subgroups (1, 2, and 3; n=10) Cast posts for subgroups 1, 2, and 3 were cemented with zinc phosphate, glass ionomer, and resin cement, respectively. A shearing load was applied to indented buccal cusp of specimens at an angle of 45° in universal testing machine at a cross-head speed of 1 mm/min until fracture. Results: Specimens with ferrule (Group A) had significantly higher shear bond strength values (mean 1503.37 N) than specimens without ferrule (Group B) (mean 1052.09 N). Conclusion: Inclusion of ferrule in tooth preparations for posts increased the fracture resistance regardless of the luting agent. [ABSTRACT FROM AUTHOR]

Congenital double-lumen aortic arch resulting from persistence of the fifth aortic arterial arch (PFAA) is a rare congenital anomaly. It appears as a vascular structure running inferior and parallel to the “real” aortic arch from the innominate artery to the left subclavian artery. We report a case of persistent fifth aortic arch (systemic-to-systemic arterial connection) with pentalogy of Fallot in a patient who underwent successful intracardiac repair with a transannular patch with very proximal aortic cannulation for cardiopulmonary bypass (CPB). [ABSTRACT FROM AUTHOR]

Introduction White spot lesions (WSLs) are opacities formed due to decalcification occurring in the enamel's subsurface layer. These lesions are most commonly seen in patients during and after fixed orthodontic treatment due to undisturbed accumulation of plaque. Other factors that can predispose to WSLs are enamel hypomineralization, hypomaturation, hypoplasia, and disruption in the levels of salivary calcium, phosphate, bicarbonate, and fluoride. Though these lesions produce aesthetic mishaps, they go unattended because of the lack of clinical knowledge in interpretation and diagnosis. Aim This study aimed to determine the knowledge, attitude, and practice of dental professionals regarding the management of WSLs. Materials and methods Participants in a cross-sectional questionnaire-based survey included undergraduate practitioners, postgraduates, and specialists. Formulated in English, the questionnaire comprised 21 structured questions circulated through online media across India. Results The assessment of knowledge and awareness highlighted participants' understanding of WSL, underscoring fundamental knowledge shared across dental professionals. The attitudes toward WSL treatment showed a similar belief among participants, including undergraduate practitioners and specialists, regarding the necessity of treating WSL. Furthermore, the analysis of practice patterns revealed consistent diagnostic methods among dental professionals, with specialists showing slightly higher adherence to drying techniques for enhanced visibility. Statistical analysis Data analysis was conducted using IBM SPSS Statistics software, version 23 (IBM Corp., Armonk, NY), with descriptive statistics presented in frequencies, percentages, and means. Comparisons were made across different categories of dental professionals to examine variations in responses and practices. Conclusion Because untreated WSL can progress into cavities, a thorough understanding of the etiology, clinical picture, and early diagnosis is crucial in planning the treatment and managing patients' aesthetic demands and the tooth's function., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Chettinad Academy of Research and Education's Institutional Human Ethics Committee of the Faculty Research (CARE IHEC -II) issued approval (IHEC-II/0287/22). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Parthasarathy et al.)

Dengue is an emerging, mosquito-borne viral disease of international public health concern. Dengue is endemic in more than 100 countries across the world. However, there are no clinically approved antivirals for its cure. Drug repurposing proves to be an efficient alternative to conventional drug discovery approaches in this regard, as approved drugs with an established safety profile are tested for new indications, which circumvents several time-consuming experiments. In the present study, eight approved RNA-dependent RNA polymerase inhibitors of Hepatitis C virus were virtually screened against the Dengue virus polymerase protein, and their antiviral activity was assessed in vitro. Schrödinger software was used for in silico screening, where the compounds were passed through several hierarchical filters. Among the eight compounds, dasabuvir was finally selected for in vitro cytotoxicity and antiviral screening. Cytotoxicity profiling of dasabuvir in Vero cells revealed changes in cellular morphology, cell aggregation, and detachment at 50 μM. Based on these results, four noncytotoxic concentrations of dasabuvir (0.1, 0.25, 0.5, and 1 µM) were selected for antiviral screening against DENV-2 under three experimental conditions: pre-infection, co-infection, and post-infection treatment, by plaque reduction assay. Viral plaques were reduced significantly (p < 0.05) in the co-infection and post-infection treatment regimens; however, no reduction was observed in the pretreatment group. This indicated a possible interference of dasabuvir with NS5 RdRp, as seen from in silico interaction studies, translating into a reduction in virus plaques. Such studies reiterate the usefulness of drug repurposing as a viable strategy in antiviral drug discovery., Competing Interests: Declarations. Competing interests: The authors have no competing interests to declare that are relevant to the content of this article., (© 2023. The Author(s).)

Matrix metalloproteinases (MMPs) have been identified as agents that disintegrate the collagen structures of dental hybrid layers, resulting in reduced restorative bond strength. Multiple MMP inhibitors (MMPIs) are known to counteract this degenerative mechanism, thereby preserving bond strength and promoting the longevity of resin-based restorations. Additionally, literature suggests that certain MMPI materials possess antimicrobial/anticariogenic properties, potentially reducing the risk of secondary caries development. Therefore, this review article aims to narrate on the integration of matrix metalloproteinase inhibitors into adhesive systems and their impact on bond strength., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Conservative Dentistry and Endodontics.)

Objective: Treatment for Chiari malformation type I (CM-I) often includes surgical intervention in both pediatric and adult patients. The authors sought to investigate fundamental differences between these populations by analyzing data from pediatric and adult patients who required CM-I decompression., Methods: To better understand the presentation and surgical outcomes of both groups of patients, retrospective data from 170 adults and 153 pediatric patients (2000-2019) at six institutions were analyzed., Results: The adult CM-I patient population requiring surgical intervention had a greater proportion of female patients than the pediatric population (p < 0.0001). Radiographic findings at initial clinical presentation showed a significantly greater incidence of syringomyelia (p < 0.0001) and scoliosis (p < 0.0001) in pediatric patients compared with adult patients with CM-I. However, presenting signs and symptoms such as headaches (p < 0.0001), ocular findings (p = 0.0147), and bulbar symptoms (p = 0.0057) were more common in the adult group. After suboccipital decompression procedures, 94.4% of pediatric patients reported symptomatic relief compared with 75% of adults with CM-I (p < 0.0001)., Conclusions: Here, the authors present the first retrospective evaluation comparing adult and pediatric patients who underwent CM-I decompression. Their analysis reveals that pediatric and adult patients significantly differ in terms of demographics, radiographic findings, presentation of symptoms, surgical indications, and outcomes. These findings may indicate different clinical conditions or a distinct progression of the natural history of this complex disease process within each population, which will require prospective studies to better elucidate.

Background This study aimed to evaluate the effect of various surface treatments on the push-out bond strength of fiber posts to root dentin. Methodology A total of 96 single-rooted premolars were decoronated and obturated and post spaces were prepared for 9 mm. The canals were irrigated with 17% ethylenediaminetetraacetic acid followed by distilled water. The samples were divided into the two following groups based on the type of fiber posts used: Group I - glass fiber post (Reforpost size 1) and Group II: quartz fiber post (Quartzix Added Posts number 1). Further, each group was divided into four subgroups based on the surface treatments (A: no treatment (control); B: silanization; C: 4% titanium tetrafluoride (four minutes) followed by silanization; D: sandblasting followed by silanization). After surface treatments, posts were cemented using self-adhesive resin cement (RelyX U200). Three 2 mm thick slices were obtained and push-out tests were done. Failure modes were analyzed under a stereomicroscope. The surface morphology of the posts was analyzed with a scanning electron microscope. Data were analyzed using a one-way analysis of variance. Results Treating the posts with airborne particle abrasion (sandblasting) followed by silanization showed the highest bond strength. The coronal level of the root showed the highest bond strength compared to the middle and apical levels. Adhesive failures between the resin cement and dentin were found to be the highest. Conclusions Sandblasting followed by silanization produced the highest bond strength. The coronal level of the root showed the highest bond strength. Adhesive failures were the highest followed by mixed failures., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Karunakaran et al.)

Aim This study aimed to assess and compare the mechanical properties, including compressive strength, diametral tensile strength, flexural strength, fracture resistance, microhardness, and microleakage, between Cention N (Ivoclar Vivadent, Gurugram, India) and Cention N enriched with titanium dioxide (TiO 2 ) nanoparticles. Methodology A total of 120 samples were involved in the study, which were split into two experimental groups. For evaluation of each mechanical property, 20 samples were included, of which 10 samples were used for evaluating the properties of Cention N and 10 samples were used for TiO 2  nanoparticles-enriched Cention N. Samples, formed using Teflon molds, were filled with Cention N and TiO 2 -enriched Cention N powders mixed per the manufacturer's instructions. The universal testing machine (UTM) was used to assess compressive, flexural, diametral tensile strength, and fracture resistance. Microhardness was evaluated using a diamond indenter, while microleakage was examined utilizing a stereomicroscope. Results The nanotitania-enriched Cention N showed significantly increased mechanical properties and increased microhardness with the least microleakage. Conclusion The inclusion of TiO 2 in Cention N has proved to yield promising results., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Irudayaraj et al.)

Purpose: Very few reports elaborate on the changes in P wave following superior septal approach to the mitral valve. We aimed to describe the changes in the P wave axis and other electrocardiographic changes following this approach among patients preoperatively in sinus rhythm., Methods: We did a retrospective review of medical records among all our patients undergoing superior septal approach for mitral valve surgery from September 2014 to September 2019. Electrocardiograms during hospital stay and until 6-month follow-up were analyzed. A deviation in P wave axis from the normal range of + 30 to + 60° was classified as ectopic atrial rhythm., Results: In the study population of 47 patients (age 16-75 years, 51.3 ± 13.6 years; M:F ratio 3.7:1), who were in normal sinus rhythm preoperatively, 34 patients (72.3%) had a visible P wave on electrocardiogram (ECG) at discharge. Among them, the P wave axes of 17 patients (36.2%) were within normal range (normal sinus rhythm), whereas 17 patients (36.2%) had ectopic atrial rhythm at discharge. The most frequent abnormal P wave axis was between 0 and - 30° (12 patients). At 6 months, 8 patients (17.0%) had a persistent ectopic atrial rhythm. These patients underwent a Holter test at 6 months and were followed up for symptomatic bradycardia for 3 years. None of the patients with ectopic atrial rhythm required pacemaker insertion., Conclusion: Persistence of ectopic atrial rhythm at 6 months is common (17%) after superior septal approach. Documentation of P wave axis after this approach will help avoid missing it. These patients may be kept on follow-up to look for symptomatic bradycardia., Competing Interests: Conflict of interestThe authors have no competing interests to declare that are relevant to the contents of this article., (© Indian Association of Cardiovascular-Thoracic Surgeons 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Objective: To study the extent of left ventricular (LV) mass regression in aortic stenosis after aortic valve replacement with the TTK Chitra™ tilting disc valve., Methods and Materials: This study included patients with severe isolated aortic stenosis (AS), admitted in our department. They had aortic valve replacement (AVR) with the TTK Chitra™ tilting disc valve, between January 2008 and December 2010. Data were collected from consecutive forty-eight patients. LV mass and diametric and functional parameters were recorded preoperatively and compared with echocardiography after 3 months, 6 months, then yearly, up to 3 years., Results: 70.8% of the patients were males and 29.2% were females. The mean duration of illness was 37.92 ± 25.87 months. The mean LV ejection fraction increased 3 months after surgery (61.56 ± 10.10% to 69.31 ± 9.34%) with a sustained increase for the next 3 years. The mean LV end-diastolic diameter decreased (50.16 ± 6.05 mm to 45.69 ± 5.93 mm) after 3 months of surgery, with a sustained decrease for the next 3 years. The mean LV end-systolic diameter decreased (32.84 ± 6.96 mm to 29.41 ± 5.86 mm) after 3 months of surgery and then showed a sustained decrease for the next 3 years. The LV mass assessed with echocardiography regressed from 324.65 ± 97.77 g before surgery to 252.64 ± 71.12 g after 3 months and then showed a sustained decrease over the next 3 years., Conclusion: Significant LV mass regression occurred after AVR with the TTK Chitra™ valve. The maximum reversal was found to be within the first 3 months after surgery with sustained beneficial improvement for the next 3 years., Competing Interests: Conflict of interestNil., (© Indian Association of Cardiovascular-Thoracic Surgeons 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Introduction: Type A acute aortic dissection (AAD) remains a challenging cardiac emergency despite the availability of various management strategies. This study compared the outcomes of supracoronary ascending aortic replacement (SCAAR) with aortic valve (AV) resuspension with those of modified Bentall's operation for type A AAD and the progression of aortic regurgitation (AR), long-term dilatation of aortic root and proximal arch, and long-term mortality in SCAAR patients., Methods: Sixty patients underwent surgery for type A AAD (January 2005 to December 2015). Forty-three patients underwent SCAAR with AV resuspension and 17 underwent modified Bentall's operation. All patients were followed up., Results: Upon follow-up of SCAAR patients (n=40), there was significant reduction in aortic root size (preoperative 39.3 mm [9.4] vs. postoperative 33.1 mm [9.1]; P<0.001). Three of these patients worsened to severe AR while others had similar or lesser degree of AR. On comparison between preoperative and postoperative dimensions of all patients (n=53), there was no significant difference in distal ascending aorta size (35.7 mm [8.1] vs. 34.4 mm [8.9]; P=0.52). However, an increase in descending thoracic aorta size (28.8 mm [7.8] vs. 33.7 mm [9.9]; P<0.001) was observed. In-hospital and late mortalities for SCAAR vs. modified Bentall's procedure were 11.7% (seven patients) (7% [3] vs. 23.5% [4]) and 28% (15 patients) (15% [6] vs. 69% [9]), respectively., Conclusion: SCAAR with AV resuspension is a safe surgical option for type A AAD. Preservation of AV is associated with better long-term outcomes and reduced mortality. Modified Bentall's operation may be associated with long-term mortality.

Background: Surgical revascularization by coronary artery bypass grafting (CABG) is the gold standard treatment for coronary artery disease. But, in patients with severe left ventricular dysfunction (ischemic cardiomyopathy), the result of CABG is different from those with normal left ventricular function. The coronary artery disease pattern in the Indian subconti-nent is different from the western world, due to the diffuse nature of coronary involvement, the smaller size of native vessels, increased prevalence of diabetes mellitus and other risk factors, and more prevalence of severe left ventricular dysfunction. Most of the studies regarding the surgical outcomes in ischemic cardiomyopathy come from western countries. This study attempts to assess the outcomes of surgical management of ischemic cardiomyopathy in the Indian subcontinent., Methods: A single-center retrospective cohort study was conducted at Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram. The data of CAD pa-tients, who underwent surgical coronary revascularization for severe LV dysfunction from January 2010 to December 2014, were collected from the hospital records and through tele-phonic interviews in a structured study proforma. A total of 146 patients satisfied the criteria and were followed up for a period of 5 years., Results: The mean age of the study population was 55.6 (8.8) years. Male preponderance was observed (94.52%; N = 138). CABG alone was done in 62.3% (N = 91) of the study partici-pants. CABG with linear plication was done in 23.3% (N = 34), CABG with MV repair in 7.5% (N = 11), and CABG with DORS in 6.8% (N = 10). The majority of patients (N = 54, 37%) received 4 grafts. Thirty-day mortality observed in the study population was 11 (7.5%). The causes documented were cardiac causes in 9 (82%), cerebrovascular events in one (9%), and septicemia in one (9%). The mean of 5-year survival of the study population was 94.2 (3.5) months with 95% CI 87.32, 101.13. There was a substantial improvement in the degree of mitral regurgitation. Ejection fraction (EF) also showed improvement. The mean preoperative EF was 29.51 (4.84%) and that of post-op was 39.92 (9.0%)., Conclusion: Despite the challenges of diffusely diseased coronary arteries, severe LV dysfunction, addressing associated significant MR and ventricular aneurysms, the outcome of surgical management of CAD with severe LV dysfunction, in the Indian population can be done with acceptable results. Randomized control studies in this subset can provide more solid evidence in this regard.

Objective: Heart diseases are common in offspring of gestational diabetic mother (ODM). Defects in mitochondrial metabolism and autophagy may be one of the basic reasons behind the abnormal structural and functional behaviour of offspring's heart. So the main objective of the present study was to explore the cardiac mitochondrial respiration and autophagy in male and female offspring of diabetic pregnancy at two different developmental stages of life., Methods: High-resolution respirometry was used to measure substrate-mediated mitochondrial respiration in isolated mitochondria from ventricular tissues of offspring of streptozotocin-induced diabetic mother rats. To find the expression of proteins involved in autophagic process and oxidative stress, western blotting and densitometric analysis were done., Results: Mitochondrial complex I and complex II respiration was found to be decreased in adult male offspring while it was unaltered or less affected in weaning male and female offspring. Elevated autophagy was shown by adult male, while there was no change observed in adult female. Also absence of elevated expression of oxidative stress markers was observed in all groups., Concusion: The present study reports altered cardiac mitochondrial respiration and autophagy in male offspring of diabetic mothers than the control ones. The study also analysed the expression of various candidates of cardiac autophagic process in male and female offspring of diabetic pregnancy at two time points of development., (This article is protected by copyright. All rights reserved.)

Introduction: Double valve replacement (DVR) with a mechanical prosthesis is associated with a higher risk of mortality. We planned to study the survival rate, early and late mortality and major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing DVR for rheumatic heart disease, with various generations of prosthetic valves ranging from ball in cage to bileaflet prosthesis and tilting disc valves., Materials and Methodology: We followed up 277 patients with rheumatic heart disease who underwent DVR between August 1999 and November 2009, retrospectively, at Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram. Two hundred and fifty-nine patients were followed up for a minimum period of 10 years, and the follow-up period varied between 10 and 20 years. Eighteen patients were lost to follow-up after the surgery and could not be contacted. Their data was included till the time they appeared for follow-up last, for survival analysis. Survival analysis was carried out using the life table method to calculate the freedom from reoperation, survival rates and freedom from MACCE at 1 year, 5 years and 10 years post-DVR., Results: The median duration of hospital stay was 8 days. The number of patients with stroke was 11 (4.26%), 21 (8.7%) and 29 (12%) at the end of 1 year, 5 years, and 10 years, respectively. A total of 5 (2%) patients underwent reoperation by the end of 10 years. Seven patients died either in hospital or in the first 30 days following operation, making the early mortality 2.5%. At the end of 1 year, a total of 16 patients (5.8%) died. The mortality at the end of 5 years was 6.8% (19 patients), and at the end of 10 years, it was 7.2% (20 patients). The survival rate of the study population was 94.9%, 93.02% and 93.02% at the completion of 1 year, 5 years and 10 years, respectively. The freedom from MACCE was 93.8%, 88.6% and 85% at 1 year, 5 years and 10 years, respectively. The freedom from re-operation was 98% at 10 years. Kaplan-Meier analysis showed an overall survival time of 226.3 months in the entire study population. The mean survival time in males was 227.5 months and in females was 206.3 months, with no statistically significant difference between the two. Univariate logistic regression analysis revealed an association with mortality when DVR was combined with concomitant tricuspid valve repair procedures, with an odds ratio of 4.5 ( p value 0.005). Multivariate logistic regression analysis also showed an association with mortality when tricuspid valve procedures were combined with DVR with an odds ratio of 5.25 ( p value 0.003)., Conclusion: The operative mortality and morbidity for DVR have been significantly reduced with advancements in operative techniques, myocardial preservation and postoperative care. Patients can have an improved functional status following surgery, with good rates of freedom from re-operation and MACCE., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interests., (© Indian Association of Cardiovascular-Thoracic Surgeons 2020.)

Diels-Alder reaction of tetraarylcyclopentadienones with benzo[b]thiophene dioxides in xylenes at reflux led to the formation of tetra aryl-substituted dibenzothiophene as well as penta aryl-substituted benzene analogues depending on the influence of aryl substituents present on cyclopentadienones. The intermediate dihydrodibenzothiophene-dioxides underwent aromatization either through de-oxygenation or extrusion of sulfur dioxide to furnish substituted dibenzothiophenes or benzenes.

Objective: In this study, we aimed at a comparative quantitative estimation of the difference in LIMA blood flow between LIMAs treated with topical papaverine alone and LIMAs treated with a combination of topical papaverine plus an intraluminal cocktail of papaverine, nitroglycerine, and milrinone., Methods: Nearly 50 consecutive patients with similar demographics undergoing elective on-pump CABG were recruited for the study. After pedicled LIMA harvest, topical papaverine was sprayed on the pedicle and kept enveloped in papaverine soaked gauze. LIMA flow was then estimated. Later, intraluminal vasodilator solution of papaverine, NTG, milrinone, and heparinized blood were instilled in LIMA, and LIMA flows were estimated., Results: The mean LIMA flows with topical papaverine alone was 47.19 mL/min whereas the mean LIMA flows with topical papaverine plus intraluminal cocktail was 104 mL/min. There was a significant difference between the two flows as their mean was 56.815 mL/min and the paired t-test for significance had a P value of 0.0001., Conclusion: There was a significant difference in the LIMA flow when the LIMA had been treated with the intraluminal instillation of the vasodilator cocktail in addition to the topical application of papaverine solution. Therefore, intraluminal vasodilator cocktail of milrinone, NTG, and papaverine mixed with heparinized blood in addition to topical papaverine is a simple and effective method for LIMA preparation in CABG., Competing Interests: None

Introduction: Hemodynamic stability and fluid responsiveness (FR) assume importance in perioperative management of patients undergoing major surgery. Passive leg raising (PLR) is validated in assessing FR in intensive care unit patients. Very few studies have examined FR to PLR in intraoperative scenario. We prospectively studied FR to PLR using transesophageal echocardiography (TEE), in patients with no coronary artery disease (CAD) undergoing major neurosurgery and those with CAD undergoing coronary artery bypass grafting (CABG)., Methods: We enrolled 29 adult consenting patients undergoing major neurosurgery with TEE monitoring and 25 patients undergoing CABG. After induction of anesthesia, baseline hemodynamic parameters were obtained which was followed by PLR using automated adjustment of the operating table. Clinical and TEE-derived hemodynamic parameters were recorded at 1 and 10 min after PLR following which patients were returned to supine position., Results: A total of 162 TEE and clinical examinations were done across baseline, 1 and 10 min after PLR; and paired comparison was done at data intervals of baseline versus 1 min PLR, baseline versus 10 min PLR, and 1 min versus 10 min PLR. There was no significant change in hemodynamic variables at any of the paired comparison intervals in patients undergoing neurosurgery. CABG cases had significant hemodynamic improvement 1 min after PLR, partially sustained at 10 min., Conclusion: Patients undergoing CABG had significant hemodynamic response to PLR, whereas non-CAD patients undergoing neurosurgery did not. A blood pressure-left ventricular end-diastolic volume combination represented strong correlation in response prediction (Pearson's coefficient 0.641; P < 0.01)., Competing Interests: None

Pulmonary atresia with ventricular septal defect and coronary-dependent pulmonary circulation arising from both major coronary arteries is rare. Dependence of pulmonary blood flow on the coronaries and the risk of early development of pulmonary vascular obstructive disease warrant early surgical repair in these patients. We report a case of a ten-month-old infant with pulmonary atresia with ventricular septal defect and coronary artery-to-main pulmonary artery connections who was successfully managed with ligation of the coronary fistulas and intracardiac repair.

Background: The cardiovascular complications associated with type 2 diabetes mellitus could be attributed to changes in myocardial mitochondrial metabolism. Though it is a known fact that permeabilized cardiac muscle fibers and isolated mitochondria are metabolically compromised in the Caucasian population, studies of Asian Indian myocardial mitochondrial function are lacking. Thus, the objective of the present study is to analyze if there is altered cardiac mitochondrial substrate utilization in diabetic Asian Indians., Methods: Mitochondrial substrate utilization was measured using high-resolution respirometry in isolated mitochondria prepared from right atrial appendage tissues of diabetic and nondiabetic subjects undergoing coronary artery bypass graft surgery. Western blotting and densitometric analysis were also done to compare the levels of proteins involved in fatty acid metabolism and regulation., Results: The mitochondrial oxygen consumption rate for fatty acid substrate was shown to be decreased in diabetic subjects compared to nondiabetic subjects along with an unvaried mitochondrial DNA copy number and uniform levels of electron transport chain complex proteins and proteins involved in fatty acid metabolism and regulation. Decreased glutamate but unchanged pyruvate-mediated state 3 respiration were also observed in diabetic subjects., Conclusion: The current study reports deranged cardiac mitochondrial fatty acid-mediated complex I respiration in type 2 diabetic Asian Indians with comparable levels of regulators of fatty acid oxidation to that of nondiabetic myocardium. Altered glutamate-mediated mitochondrial respiration also points toward possible alterations in mitochondrial complex I activity. When compared with previous reports on other ethnic populations, the current study suggests that Asian Indian population too have altered cardiac mitochondrial substrate utilization., (© 2020 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.)

Background: Longstanding ostium secundum atrial septal defects lead to functional tricuspid regurgitation. Significant functional tricuspid regurgitation associated with left heart valve disease is addressed at the time of primary left heart valve surgery. In contrast, there is no global recommendation for tricuspid regurgitation associated with atrial septal defects. This study assesses changes in tricuspid regurgitation after isolated atrial septal defect closure., Methods: Retrospectively, records were examined of 100 patients who underwent isolated ostium secundum atrial septal defect closure without tricuspid valve repair. Echocardiograms were done preoperatively and 3 days, 3 months, and 1 year after surgery. Data on tricuspid regurgitation status, right ventricle dimensions, and pulmonary artery hypertension status were collected and analyzed., Results: After surgical closure, echocardiography showed a regression of tricuspid regurgitation to mild or less in 76% of patients at 3 days, 89% at 3 months, and 93% at 1 year. Severe pulmonary artery hypertension (32% patients preoperatively) showed statistically significant regression: 14% at 3 days, 10% at 3 months, and 2% at 1 year. Preoperatively, the mean right ventricular internal diameter was 37.9 mm, which decreased to 34 ± 5.5 mm (mean ± standard deviation) at 3 days, 32.3 ± 5.3 mm at 3 months, and 31.3 ± 5.4 mm at 1 year. It was also noted that regression favored patients who were <25 years old., Conclusion: Tricuspid valve repair may not be required in patients with ostium secundum atrial septal defect with functional tricuspid regurgitation., (2020 Forum Multimedia Publishing, LLC)

Background: Left stellate ganglion blockade (LSGB) may have additive effect to topical administration of papaverine on prevention of vasospasm of left internal thoracic artery (LITA)., Aims: This study aims to compare LITA blood flow with topical application of papaverine alone or in combination with LSGB., Setting: Tertiary care hospital., Design: Prospective randomized controlled study., Materials and Methods: A total of 100 patients operated for coronary revascularization were randomly and equally allocated into two groups. In control Group-C, papaverine was applied topically during the dissection of LITA. In Group-S, the additional LSGB was performed. Blood flow was measured from cut end of the LITA for 15 s. Primary objectives of the evaluation were to observe differences in the LITA blood flow. Observing incidence of radial-femoral arterial pressure difference after cardiopulmonary bypass (CPB) was secondary objective., Statistical Analysis: Student's unpaired t-test and Fisher's exact test to find out a significant difference between the groups., Results: LITA flow in Group-S was insignificantly more (49.28 ± 7.88 ml/min) than Group-C (47.12 ± 7.24 ml/min), (P = 0.15). Radio-femoral arterial pressure difference remained low for 40 min after termination of CPB in the Group-S compared to the Group-C (-0.99 ± 1.85 vs. -1.92 ± 2.26)., Conclusion: Combining LSGB with papaverine does not increase the LITA blood flow compared to when the papaverine is used alone. However, ganglion blockade reduces radial-femoral arterial pressure difference after CPB. Blockade can be achieved successfully under the ultrasound guidance without any complications., Competing Interests: None

The title naphthalene derivative, C 24 H 20 O 2 , features 4-methy-oxy-substituted benzene rings in the 1 and 4 positions of the naphthalene ring system. There are two crystallographically independent mol-ecules ( A and B ) in asymmetric unit. The independent mol-ecules have very similar conformations in which the naphthalene ring systems are only slightly bent, exhibiting dihedral angles between the constituent benzene rings of 3.76 (15) and 3.39 (15)° for A and B , respectively. The pendent 4-methyoxybenzene rings are splayed out of the plane through the naphthalene ring system to which they are connected [range of dihedral angles = 59.63 (13) to 67.09 (13)°]. In the crystal, the mol-ecular packing is consolidated by inter-molecular C-H⋯π inter-actions, leading to supra-molecular chains along the b axis. The chains assemble without directional inter-actions between them., (© Manickam et al. 2020.)

A new series of 3,4-ethylenedioxythiophene (EDOT)-appended propenones were prepared by condensation reaction and their in vitro cytotoxicity effects were evaluated against five human cancer cell lines. Preliminary structure-activity relationships of EDOT-incorporated 2-propenone derivatives were also established. The EDOT-appended enones demonstrated significant cytotoxicity against human cancer cell lines. The most active analogue, (E)-3-(2,3-dihydrothieno[3,4-b][1,4]dioxin-5-yl)-1-(3,4,5-trimethoxyphenyl)prop-2-en-1-one (3 p, GI 50 =110 nm), severely inhibited the clonogenic potential of cancer cells, and induced cell-cycle arrest in the G2/M phase and caused an accumulation of HCT116 colon cancer cells with >4 N DNA content. Also, 3 p exhibited weak inhibition of the enzymatic activity of human topoisomerase I. Molecular docking studies indicated preferential binding of the compounds to the ATP-binding pocket of the human checkpoint 2 kinase (Chk2) catalytic domain, thus, identifying a novel diaryl 2-propenone chemotype for the development of potent inhibitors of Chk2., (© 2019 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Background: The incidence of rheumatic fever and rheumatic heart disease still remains high in the developing countries. Mitral stenosis is predominantly due to rheumatic origin and affects females more than males. Historically, closed mitral valvotomy (CMV) was the first effective intervention for mitral stenosis. We studied the immediate and early surgical outcomes of MVR in patients with history of CMV to see whether their disease behaves differently, when compared with patients without prior CMV undergoing MVR., Methods: This single center retrospective cohort study was conducted in Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India. Patients who underwent MVR from January 2008 to December 2012 at our institute were studied. The hospital records of 90 patients were analyzed both in the CMV cohort and also in the non-CMV cohort. Preoperative details, intraoperative parameters, immediate postsurgery echocardiography parameters, and follow-up echocardiography details at 1 year and 5 years were studied., Results: Both the cohorts were similar in age, height, weight, and BSA. In the CMV cohort, 67% were females and in the non-CMV cohort 48% were females. Most of the patients in both the cohorts presented with functional classes 2 and 3. The mean duration between onset of symptoms and MVR in the CMV cohort and the non-CMV cohort was 24.6 years and 6.25 years, respectively. Fifty-nine patients in the CMV cohort had preoperative atrial fibrillation, whereas 47 patients in the non-CMV cohort presented with atrial fibrillation. The mean left atrial (LA) size of patients with sinus rhythm and atrial fibrillation was 46.34 (SE, 0.852) and 55.21(SE, 0.808), respectively. Preoperative echocardiographic assessment revealed a mean ejection fraction of 62% and 63%, mean mitral stenosis gradient of 13 mm Hg and 14.7 mm Hg, mean LA size of 53.2 mm and 50.5 mm, and mean right ventricular systolic pressure of 47.5 mm Hg and 43.6 mm Hg in the post-CMV cohort and in the non-CMV cohort, respectively. The CMV cohort had a longer cardiopulmonary bypass time (111.5 minutes) in comparison with the non-CMV cohort (97 minutes). The aortic cross-clamp time remained similar in both the cohorts. Thirty-six percent of the post-CMV cohort patients had a valve size of 25, and 48% of patients belonging to the non-CMV cohort had a valve size of 27. The percent of moderate-to-severe subvalvar pathology was 88 in both the cohorts. Patients belonging to the post-CMV cohort had a median ventilation time of 16.35 hours, and the patients of the non-CMV cohort had a median ventilation time of 13.75 hours. The duration of ICU stay was 4.41 (SE, 0.188) days and 4.13 (SE, 0.153) days, and length of hospital stay was 8.93 (SE, 0.230) days and 9.13 (SE, 0.313) days in the CMV and the non-CMV cohorts, respectively. Inotropic requirement, measured by the vasoactive inotropic score, was higher in the post-CMV group (11.9), when compared to the other cohort (9.7). Right ventricular (RV) function and pulmonary arterial hypertension assessed in the immediate postoperative period, at 1 year, and at 5 years did not show any significant difference., Conclusion: The percentage of females in the CMV cohort is higher. Delaying the valve replacement by performing a surgical palliative procedure like CMV, is beneficial in female patients in the child-bearing age group so that they can complete the families. The disease process started earlier in the CMV cohort, and they had a longer duration of illness before undergoing MVR. Even with the longer duration of disease, the RV function, LA size, PA pressures, and mitral stenosis gradients were comparable. Therefore, CMV prevented progression of the disease in the CMV group. The mean LA size is significantly higher in patients with atrial fibrillation. The CMV cohort had a longer cardiopulmonary bypass time. The duration of ventilation, ICU stay, and hospital stay were similar in both cohorts. Inotrope requirement was higher in the post-CMV group. RV function and pulmonary arterial hypertension assessed in the immediate postoperative period, at 1 year, and at 5 years did not show any significant difference., (2019 Forum Multimedia Publishing, LLC)

Introduction: Patient prosthesis mismatch is known to alter post-operative remodeling of left ventricle adversely in aortic stenosis patients. An indexed orifice area of 0.85 is considered as conventional cutoff for patient prosthesis mismatch based on hemodynamic principles. Many patients have smaller annulus and annulus enlargement techniques may be required to avoid this benchmark which complicates the surgery., Aims and Objectives: To determine incidence of patient prosthesis mismatch (PPM) in our population, to assess left ventricle (LV) regression and impact of indexed effective orifice area on LV regression, and to determine a minimum acceptable cut off indexed orifice area that will result in LV regression., Materials and Methods: A single-center retrospective observational study of all patients who underwent aortic valve replacement surgery for severe aortic stenosis between July 2015 and December 2015 was conducted. Patients who underwent concomitant revascularization or other valve surgery were excluded. Data regarding conventional risk factors for PPM, valve type, and indexed orifice area as well as pre-operative and late post-operative LV mass were collected., Observations: Thirty-seven of the 91 patients satisfied inclusion criteria. All patients had significant regression in LV mass. The incidence of PPM was 68%. Regression of indexed left ventricular mass showed a positive correlation of with indexed effective orifice area of the prosthetic valve. The correlation coefficient is + 0.48 (95% CI 0.18-0.698). Left ventricular mass regression was significantly higher in patients with indexed effective orifice area more than 0.75 (68.89 ± 29 vs 122.55 ± 58.84, p  = 0.028). Relative left ventricular regression also was significantly higher in patients with an indexed effective orifice area more than 0.75 (39.53 ± 13.13 vs 49.73 ± 15.56, p  = 0.022). There is a positive correlation between left ventricular regression and the reduction in mean gradient achieved by valve replacement. The correlation coefficient was + 0.35 (95% CI 0.03-0.61)., Conclusions: The incidence of PPM was found to be comparable to literature. There is a positive correlation between left ventricular regression and indexed effective orifice area of the prosthetic valve. Left ventricular regression was significantly higher in patients with an indexed effective area more than 0.75. This can be considered as criteria for significant PPM in study population., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Indian Association of Cardiovascular-Thoracic Surgeons 2018.)

In the title compound, C 25 H 22 O, the two rings of the naphthalene system are inclined to each other by 3.06 (15)°. The mean plane of the naphthalene ring system makes a dihedral angle of 65.24 (12)° with the di-methyl-phenyl ring and 55.82 (12)° with the meth-oxy-phenyl ring. The di-methyl-phenyl ring is inclined to the meth-oxy-phenyl ring by 59.28 (14)°. In the crystal, adjacent mol-ecules are linked via C-H⋯π inter-actions, forming chains along [100]. Using Hirshfeld surface and two-dimensional fingerprint plots, the presence of short inter-molecular inter-actions in the crystal structure were analysed. The inter-molecular inter-action energies were also calculated and their distribution over the crystal structure was visualized graphically using energy frameworks.

Submitral aneurysms are rare clinical entities occurring predominantly in young adults of African descent. A host of etiologies have been proposed for this entity. We present a unique case of submitral aneurysm which developed after pulmonary artery banding in a three-year-old girl with complex congenital heart disease. The aneurysmal sac was burrowing into the interatrial septum.

Diels-Alder reaction of 1,3-diarylbenzo[c]furan/cyclopentadienone with TTF followed by triflic acid mediated cleavage of the resulting adducts led to the formation of the respective 1,4-diaryl substituted naphthalenes, fluoranthenes, and fluorenones. The photophysical properties of representative diaryl-substituted hydrocarbons are also reported.

In the title compound, C 26 H 20 O 5 , a 1,2-di-hydro-naphthalene derivative, the cyclo-hexa-1,3-diene ring of the 1,2-di-hydro-naphthalene ring system adopts a half-chair conformation. The mean plane of the 1,2-di-hydro-napthalene ring system makes dihedral angles of 86.23 (6) and 64.80 (7)° with two phenyl rings. The carbonyl O atom attached to the di-hydro-naphthalene ring system deviates from the mean plane of the 1,2-di-hydro-naphthalene ring system by 0.618 (1) Å. In the crystal, the mol-ecules are linked into layers parallel to the bc plane via two kinds of C-H⋯O inter-actions, one of which forms a C (10) chain motif running along the c- axis direction and the other forms an R 2 2 (6) ring motif. Adjacent layers are further connected by C-H⋯π and offset π-π inter-actions [centroid-centroid distance = 3.6318 (9) Å].

A straightforward and general method for the synthesis of annulated thiophene, dibenzothiophene, and carbazoles analogues has been achieved involving alkylation of 2-bromo-1-(phenylsulfonylmethyl)arene/heteroarene with arylmethyl bromides/heteroarylmethyl bromides using t-BuOK as a base in DMF, followed by Pd(0)-mediated intramolecular Heck coupling in the presence of K 2 CO 3 in DMF at 80-140 °C. The attractive feature of this protocol is that a wide variety of π-conjugated heterocycles could be readily accessed by an appropriate choice of arylmethylsulfones and benzylic bromides.