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This article explores the benefits of using intra-operative ultrasound during revision neck dissections for thyroid cancer recurrence. The ultrasound technology allows for precise identification of metastases, leading to targeted surgery and smaller incisions. It can detect even small nodes and locate metastases in challenging areas. The study conducted in a thyroid surgery unit demonstrates that intra-operative ultrasound improves diagnostic accuracy, surgical precision, and reduces complications. The findings suggest that this technique can effectively identify and remove thyroid cancer lymph node metastases, including small ones, with real-time confirmation. [Extracted from the article]

Seven cucumber (Cucumissativus L.) genotypes (3 lines and 4 testers) were crossed in a line X tester mating design. The resultant 12 hybrids and their parents were evaluated using Randomised Block Design with two replications during Kharif 2018. Sufficient genetic variability was observed for all the characters under study. In this study, the parents L2 (Koradacherry local), T2 (Orathanadu local) and T3 (Aipatti local) exhibited high positive GCA (General Combining Ability) effects for yield related traits and high negative GCA effects for earliness characters. The parent T2 identified in this study may be used in multiple crossing programme to isolate high yielding varieties. Among the hybrid combinations, L2xT3, L1xT2 and L3xT4 expressed the maximum positive significant SCA (Specific Combining Ability) effects for yield and yield associated characters. In the above cross combinations one parent was a good combiner and the other was an average/poor combiner; hence the hybrids can be exploited for transgressive selection. [ABSTRACT FROM AUTHOR]

In this investigation, soot particles were doped with glass fibre and its characteristic and mechanical properties were examined. The glass fibres with soot particles composite were prepared via compression mould method and the effect of glass fibre on the mechanical properties of the composites was studied. The various wt. % of soot particles as 0%, 0.1%, 0.5% and 1.0% were added into epoxy. Tensile, flexural and impact tests were conducted. The addition of more than 0.1%wt. of soot particles with glass fibre has resulted in high mechanical properties compared to other weight ratios. [ABSTRACT FROM AUTHOR]

Due to environmental concerns, the use of alternative fuel is rapidly expanding around the world, making it imperative to fully understand the impacts of diesel on pollutant formation. The aim of this work is to increase the engine performance with reduced emissions using diesel blends from different feed stocks and to compare that with the diesel. In the Indian context linseed can play an important role in the production of alternative fuel using diesel. The climatic and soil conditions of India are convenient for the production of linseed crop. The blend is prepared from diesel, linseed oil and Leishman's solution by stirring process. The performance study of a diesel engine with these diesel blends were carried out at different compression ratios and loads. The combustion performance parameters like Mechanical, Volumetric, Brake thermal efficiencies and Specific Fuel Consumption are all noted. By applying Grey Relation Analysis, the best running condition for the engine within the chosen range are decided. The sample containing 95% diesel with 3%linseed oil and 2% solution gives better performance at a compression ratio of 18 during high load conditions. [ABSTRACT FROM AUTHOR]

Every manufacturing or production unit should concern about the quality of the product. Apart from quality, there exists other criterion, called productivity which is directly proportional to the profit level. Every manufacturing industry aims at producing a large number of products in relatively lesser time. In any machining process, it is most important to determine the optimal settings of machining parameters aiming at reduction of production costs and achieving the desired product quality. If the problem is related to a single quality attribute then it is called single objective optimization. If more than one attribute comes into consideration it is very difficult to select the optimal setting which can achieve all quality requirements simultaneously. . In this work, EN-24 alloy steel work pieces were turned on Computer Numerical Controlled (CNC) lathe by using Cemented carbide tool (coated). The influence of four cutting parameters, cutting speed, feed rate, depth of cut, and tool nose radius on minuscule surface roughness and material removal rate (MRR) were analyzed on the basis of Response Surface Methodology approach. The experimental results were collected by following the Taguchi's L16 mixed Orthogonal Array design. [ABSTRACT FROM AUTHOR]

Introduction: ElaTION is a large multi-centre pragmatic randomised controlled trial, performed in 18 secondary/tertiary hospitals across England, comparing elastography ultrasound-guided fine needle aspiration cytology (EUS-FNAC) with ultrasound-guided FNAC (US-FNAC) alone in the diagnostic assessment of thyroid nodules. Secondary trial outcomes, reported here, assessed the accuracy of ultrasound-alone (US) compared with US-guided FNAC to inform and update current practice guidelines., Methods: Adults with single or multiple thyroid nodules who had not undergone previous FNAC were eligible. Radiologists assessed all thyroid nodules using US alone, thereby enabling assessment of its accuracy (sensitivity and specificity) versus US-FNAC., Results: Of the 982 participants, a final definitive diagnosis was obtained in 688, who were included in the final analyses. The sensitivity of US-alone was the same as US-FNAC (0.91, [95% CI 0.85, 0.97] vs 0.87 [95%CI 0.80-0.95], p=0.37). US alone had statistically significant lower specificity than US-FNAC alone (0.48 vs 0.67 respectively, p<0.0001). The malignancy rate on histology in a nodule classified as benign on ultrasound (U2) was 9/263 (3.42%) and on cytology (Thy2) was 15/353 (4.25%), whereas the malignancy rate in a nodule that was benign on both (U2, Thy2) was 3/210 (1.43%). Malignancy risk for U3, U4, and U5 nodules was 68/304 (22.4%), 43/83 (51.8%), and 29/38 (76.3%) respectively (p<0.0001). Yet 80/982 (8%) patients were discharged despite having U3-U5 scans with Thy1 (non-diagnostic) FNAC and no definitive diagnosis.Malignancy risk was higher in smaller nodules: <10mm 23/60 (38.3%), 10-20mm 46/162 (28.4 %), and >20mm 80/466 (17.2%) (p<0.0001). Nodules with indeterminate cytology with atypical features (Thy3a) carried a similar malignancy risk to those with indeterminate cytology (Thy3/3f): 27/95 (28.4%) versus 42/113 (37.2%) respectively (p=0.18)., Conclusion: Ultrasound alone appears to be an effective diagnostic modality in thyroid nodules, confirming the recommendations of recent guidelines and the BTA classification. However, findings also suggest caution regarding existing recommendations for conservative management of non-diagnostic (Thy1/Bethesda I) and atypical (Thy3a/Bethesda III) nodules. In those cases, ultrasound (U3-5) features may help identify high-risk subgroups for more proactive management., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)

Background There is variable evidence and no randomized trials on the benefit of US elastography-guided fine-needle aspiration cytology (FNAC) over conventional US-guided FNAC alone for thyroid nodules. Purpose To compare the efficacy of US elastography-guided FNAC versus US-guided FNAC in reducing nondiagnostic rates for thyroid nodules. Materials and Methods A pragmatic, multicenter randomized controlled trial was performed at 18 secondary and tertiary hospitals across England between February 2015 and September 2018. Eligible adults with single or multiple thyroid nodules who had not previously undergone FNAC were randomized (1:1 ratio) to US elastography FNAC (intervention) or conventional US FNAC (control). The primary outcome was the proportion of patients who have a nondiagnostic cytologic Thy1 (British Thyroid Association system) result following the first FNAC. Results A total of 982 participants (mean age, 51.3 years ± 15 [SD] [IQR, 39-63]; male-to-female ratio, 1:4) were randomized. Of the 493 participants who underwent US elastography, 467 (94.7%) were examined with strain US elastography. There was no difference between the two arms in the nondiagnostic (Thy1) rate following the first FNAC (19% vs 16%; risk difference [RD], 0.03 [95% CI: -0.01, 0.07]; P = .11) or in the median time to reach the final definitive diagnosis (3.3 months [IQR, 1.5-6.4] for US elastography FNAC vs 3.4 months [IQR, 1.5-6.2] for US FNAC). All sensitivity analyses supported the primary analysis. Fewer participants in the US elastography FNAC arm underwent diagnostic hemithyroidectomy than in the US FNAC arm (183 of 493 [37%] vs 196 of 489 [40%]), but this was not statistically significant (adjusted RD, 0.02 [95% CI: -0.06, 0.01]; P = 0.15). There was no evidence of a difference in malignancy rates between the two arms: 70 of 493 (14%) in US elastography FNAC arm versus 79 of 489 (16%) in US FNAC arm ( P = .39). There was also no difference in the rate of benign histologic findings between the groups (RD, -0.01 [95% CI: -0.04, 0.03]; P = .7). Conclusion Strain US elastography does not appear to have additional benefit over conventional US FNAC in the diagnosis of malignancy in thyroid nodules. Clinical trial registration no. ISRCTN18261857 Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Isikbay and Harwin in this issue.

Introduction: Complications due to small bowel non-Meckel's diverticulosis is an uncommon clinical scenario encountered in clinical practice. A diverticulum in the ileum is rare among the locations of the diverticulum in the small intestine. We describe an unusual case of ileal diverticular perforation presenting as an acute abdomen., Case Presentation and Management: A 74-year-old male presented with septic shock and localized peritonitis in right lower abdomen. Preoperative imaging and intraoperative findings were consistent with terminal ileal diverticular perforation for which right hemicolectomy was done., Conclusion: Small bowel diverticulosis was usually asymptomatic, though it can rarely present with acute abdominal emergencies. Computed tomogram of the abdomen, Barium meal follow-through, capsule endoscopy, CT enteroclysis can be used to diagnose small bowel diverticulosis. Although the incidence of small bowel diverticulosis is low, small bowel diverticulitis should be included in the differential diagnosis if an inflammatory mass involving the small bowel is demonstrated on CT. Patients with localized and self-limited inflammation without free perforation in imaging can be treated conservatively with parenteral antibiotics and close monitoring approach. Surgical intervention is usually required for complicated acute presentations and those with refractory symptoms. A high index of suspicion of complicated small bowel diverticulosis should be in the clinician's mind when dealing with acute small bowel emergencies especially in elderly patients., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

An efficient synthesis of dihydro-4H-benzo[4,5]imidazo[2,1-b]pyrano[2,3-d]thiazole by a multicomponent route starting from 2-((1H-benzo[d]imidazol-2-yl)thio)-1-phenylethan-1-one, an aromatic aldehyde and malononitrile is described. This protocol features a metal free approach with good substrate scope and decent yield. The heterocyclic skeleton obtained in this study may have interesting biological properties.

Background: Xanthogranulomatous cholecystitis (XGC) is an uncommon variant of chronic cholecystitis, characterized by a focal or diffuse destructive inflammatory process. The importance of XGC is that it mimics gall bladder carcinoma (GBC) both preoperatively and intra-operatively, as it can present with pericholecystic infiltration, hepatic involvement and lymphadenopathy. As a result of a misdiagnosis, which is not infrequent, the patient may undergo an unnecessary radical cholecystectomy rather than only a cholecystectomy, which is associated with a greater morbidity and mortality. The main aim of the study is to formulate a simple preoperative scoring system for diagnosis of XGC which might benefit patients by avoiding radical procedures., Methods: A retrospective study was done from all the patients who underwent gall bladder and gall bladder-related operations (benign and malignant), during a 5-year time period from 2010 to 2014 in a tertiary care centre were reviewed (n = 462)., Results: Initial analyses of all the clinical and imaging parameters were done. Patients with a long history of recurrent abdominal pain with leucocytosis and who on imaging are found to have a diffusely thickened gall bladder wall, cholelithiasis, choledocholithiasis and submucosal hypoattenuated nodules are likely to have XGC while those with anorexia, weight loss, focal thickening of the gall bladder wall on imaging and dense local organ infiltration are more likely to have GBC. The presence of lymph nodes on imaging and the loss of a fat plane interface between the liver and gall bladder are not differentiating factors. A scoring system was made by taking statistically significant features (n = 13) of clinical and imaging parameters in initial assessment to identify the features of XGC. The same scoring system was subsequently applied to the patients who underwent cholecystectomy to study the effectiveness and the results were reviewed., Conclusion: High value scores (≥11/13) helps in diagnosing XGC in preoperative setting. Hence, intra-operative frozen section analysis can be avoided in such cases to differentiate XGC and GBC. However in difficult cases with high suspicion of malignancy based on clinical experience, definitive diagnosis still remains a histopathological examination to avoid radical resection in patients who have a benign condition., (© 2016 Royal Australasian College of Surgeons.)

A pharyngocele is an uncommon condition, where pharyngeal mucosa herniates through the thyrohyoid membrane. It can be difficult to locate when the patient is at rest. To locate the pharyngocele intra-operatively, a bag valve mask was used to inflate the herniated mucosa. We describe a cost-effective and simple way to locate the pharyngocele intra-operatively.

Background: The incarceration of an appendix within an inguinal hernia sac is known as Amyand's hernia. Appendicitis in Amyand's hernia accounts for 0.1 % of the cases. An aggressive necrotizing infection of the genitalia and perineum, called Fournier's gangrene, can rapidly progress to sepsis and death. We describe a rare case of Fournier's gangrene complicating Amyand's inguinal hernia which has rarely been reported in the literature., Case Presentation: This case report describes the presentation and management of a 47-year-old Chinese man who presented with pus discharge from his right inguinoscrotal region and lower abdominal pain with clinical signs of Fournier's gangrene. On surgical exploration, a complicated Amyand's hernia (Losanoff and Basson classification type 4) was found to be the cause of his Fournier's gangrene., Conclusions: A perforated appendix within an inguinal hernia causing Fournier's gangrene is rarely seen in clinical practice. The diagnosis of this condition is almost always made intraoperatively. Early recognition and awareness of perforated appendicitis within an inguinal hernia sac as one of the causes of Fournier's gangrene and good surgical technique in such cases are the keys to success when dealing with this surgical issue. In complicated presentations of Amyand's hernia, an appendicectomy with anatomical repair is the best treatment. It is better to avoid meshplasty.

An efficient synthesis of 3-substituted-5-arylamino-1,2,4-thiadiazoles through intramolecular oxidative S-N bond formation of imidoyl thioureas by phenyliodine(III) bis(trifluoroacetate) is reported. The protocol features a metal-free approach, broad substrate scope, very short reaction times, good to excellent yields, and simple starting materials.

The reaction of α-azidochalcones with carboxylic acids has been investigated resulting in the formation of α-amido-1,3-diketones under microwave irradiation via in situ formation of 2H-azirine intermediates. An interesting reaction is described wherein, with trifluoroacetic acid at lower temperature, it affords highly substituted 2-(trifluoromethyl)oxazoles. These flexible transformations proceed under solvent free conditions in good to excellent yields without any catalyst.

The synthesis of highly substituted imidazole derivatives has been achieved from various α-azido chalcones, aryl aldehydes, and anilines. This multicomponent protocol employs erbium triflate as a catalyst resulting in excellent yield of the imidazoles.