Sporadic Form of Glomerulocystic Kidney Disease in a Child: A Case Report.

Glomerulocystic kidney disease (GCKD) is a rare form of cystic renal disease. We report a four-week-old baby girl born to non-consanguineous parents; their antenatal third-trimester ultrasound showed severe oligohydramnios that required amnioinfusion. Post-natal ultrasound examination showed few tiny cysts (2-3mm) involving the cortices in bilateral kidneys. Kidney biopsy showed dilatation of Bowman's space and cystically dilated glomeruli, suggestive of GCKD. Whole exome sequencing revealed no pathogenic or likely pathogenic variant.

Unresectable Metastatic Solid Pseudopapillary Pancreatic Neoplasm Treated With Liver Transplantation.

We present a 49-year-old woman requiring living donor liver transplantation after liver metastasis from a pancreatic solid pseudopapillary tumor. After identifying a pancreatic mass and liver lesions, she underwent extensive surgical resection. Pathology revealed a solid pseudopapillary neoplasm of the head and body of the pancreas, extending into the peripancreatic soft tissues and confirmed to have spread to the liver. Subsequently, she underwent adjuvant chemotherapy and radiofrequency ablations of the new liver lesions. Despite immunotherapy and chemotherapy, there was a progression of the lesions. With interval growth of liver lesions, without evidence of extrahepatic disease, she underwent living donor liver transplantation.

5-Phenyl valeric acid attenuates α-synuclein aggregation and endoplasmic reticulum stress in rotenone-induced Parkinson's disease rats: A molecular mechanistic study.

The abnormal accumulation of fibrillar α-synuclein in the substantia nigra contributes to Parkinson's disease (PD). Chemical chaperones like 4-phenyl butyric acid (4PBA) show neuroprotective potential, but high doses are required. A derivative, 5-phenyl valeric acid (5PVA), has reported therapeutic potential for PD by reducing Pael-R expression. This study assessed 5PVA's efficacy in PD animals and its molecular mechanism. In vitro studies revealed 5PVA's anti-aggregation ability against alpha-synuclein and neuroprotective effects on SHSY5Y neuroblastoma cells exposed to rotenone. PD-like symptoms were induced in SD rats with rotenone, followed by 5PVA treatment at 100 mg/kg and 130 mg/kg. Behavioral analysis showed significant improvement in memory and motor activity with 5PVA administration. Histopathological studies demonstrated normal neuronal histoarchitecture in mid-brain tissue sections of 5PVA-treated animals compared to the PD group. mRNA studies revealed significant suppression in the expression of various protein folding and heat-shock protein markers in the 5PVA-treated group. In conclusion, 5PVA, with its anti-aggregation ability against alpha-synuclein, acts as a chemical chaperone, showing potential as a therapeutic candidate for PD treatment.

Composites of sodium alginate based - Functional materials towards sustainable adsorption of benzene phenol derivatives - Bisphenol A/Triclosan.

The present study evaluates the adsorption efficiency of low-cost carbonaceous adsorbents as fly ash (FA), saw dust biochar (SDB) (untreated and alkali - treated), live/dead pulverized white rot fungus Hypocrea lixii biomass encapsulated in sodium alginate (SA) against the commercially available activated carbon (AC) and graphene oxide (GO) SA beads for removal of benzene phenol derivatives - Bisphenol A (BPA)/triclosan (TCS). Amongst bi - and tri - composites SA beads, tri-composite beads comprising of untreated flyash - dead fungal biomass - sodium alginate (UFA - DB - SA) showed at par results with commercial composite beads. The tri - composite beads with point zero charge (Ppzc) of 6.2 was characterized using FTIR, XRD, surface area BET and SEM-EDX. The batch adsorption using tri - composite beads revealed removal of 93% BPA with adsorption capacity of 16.6 mg/g (pH 6) and 83.72% TCS with adsorption capacity of 14.23 mg/g (pH 5), respectively at 50 ppm initial concentration with 6 % adsorbent dose in 5 h. Freundlich isotherm favoring multilayered adsorption provided a better fit with r2 of 0.9674 for BPA and 0.9605 for TCS respectively. Intraparticle diffusion model showed adsorption of BPA/TCS molecules to follow pseudo - second order kinetics with boundary layer diffusion governed by first step of fast adsorption and intraparticle diffusion within pores by second slow adsorption step. Thermodynamic parameters (ΔH°, ΔS°, ΔG°) revealed adsorption process as exothermic, orderly and spontaneous. Methanol showed better desorbing efficiency leading to five cycles reusability. The phytotoxicity assay revealed increased germination rate of mung bean (Vigna radiata) seeds, sprinkled with post adsorbed treated water (0 h, 5 h and 7 h) initially spiked with 50 ppm BPA/TCS. Overall, UFA - DB - SA tri - composite beads provides a cost effective and eco - friendly matrix for effective removal of hydrophobic recalcitrant compounds.

Benign to Malignant Hepatic Lesion Transformation in Abernethy Malformation.

Abernethy malformation or congenital extrahepatic portosystemic shunt is an extremely rare condition whereby the portomesenteric blood drains into a systemic vein and bypasses the liver through a complete or partial shunt. Severe complications include hyperammonemia and encephalopathy, benign and malignant liver tumors, and hepatopulmonary syndrome. We describe a case where a female adult diagnosed with congenital extrahepatic portosystemic shunt subsequently developed focal nodular hyperplasia and then hepatocellular carcinoma.

Impact of Medicaid Expansion on Surgical Care and Outcomes for Hepatobiliary Malignancies.

BACKGROUND: As part of the Patient Protection and Affordable Care Act, some states expanded Medicaid eligibility to adults with incomes below 138% of the federal poverty line. While this resulted in an increased proportion of insured residents, its impact on the diagnosis and treatment of hepatopancreaticobiliary (HPB) cancers has not been studied. STUDY DESIGN: The National Cancer Database (NCDB) from 2010 to 2017 was used. Patients diagnosed with HPB malignancies in states which expanded in 2014 were compared to patients in non-expansion states. Subset analyses of patients who underwent surgery and those in high-risk socioeconomic groups were performed. Outcomes studied included initiation of treatment within 30 days of diagnosis, stage at diagnosis, care at high volume or academic center, perioperative outcomes, and overall survival. Adjusted difference-in-differences analysis was performed. RESULTS: A total of 345,684 patients were included, of whom 55% resided in non-expansion states and 54% were diagnosed with pancreatic cancer. Overall survival was higher in states with Medicaid expansion (HR .90, 95% CI [.88-.92], P < .01). There were also better postoperative outcomes including 30-day mortality (.67 [.57-.80], P < .01) and 30-day readmissions (.87 [.78-.97], P = .02) as well as increased likelihood of having surgery in a high-volume center (1.42 [1.32-1.53], P < .01). However, there were lower odds of initiating care within 30 days of diagnosis (.77 [.75-.80], P < .01) and higher likelihood of diagnosis with stage IV disease (1.09 [1.06-1.12], P < .01) in expansion states. CONCLUSION: While operative outcomes and overall survival from HPB cancers were better in states with Medicaid expansion, there was no improvement in timeliness of initiating care or stage at diagnosis.

Multifaceted Carbon Dots: toward pH-Responsive Delivery of 5-Fluorouracil for In Vitro Antiproliferative Activity.

The synthesis of smart hybrid material to assimilate diagnosis and treatment is crucial in nanomedicine. Herein, we present a simple and facile method to synthesize multitalented blue-emissive nitrogen-doped carbon dots N@PEGCDs. The as-prepared carbon dots N@PEGCDs show enhanced biocompatibility, small size, high fluorescence, and high quantum yield. The N@PEGCDs are used as a drug carrier for 5-fluorouracil (5-FU) with more release at acidic pH. Furthermore, the mode of action of drug-loaded CD (5FU-N@PEGCDs) has also been explored by performing wound healing assay, DCFDA assay for ROS generation, and Hoechst staining. The drug loaded with carbon dots showed less toxicity to normal cells compared to cancer cells, making it a perfect candidate to be studied for designing next-generation drug delivery systems.

To evaluate eosinophilia (tissue eosinophilia, blood eosinophilia and tissue eosinophilia/blood eosinophilia ratio) in increasing grades/ severity of oral neoplastic lesions.

Oral squamous cell carcinoma (OSCC) is the most common cause of morbidity and mortality in India. Buccal mucosa is the most common site because of tobacco quid. Several parameters for the assessment of OSCC have been studied like lymph node metastasis, tumor stage, grade, and perineural invasion. Tumor-associated tissue eosinophilia is another parameter, on which several studies have been done because of its favorable and unfavorable prognosis. The aim of our study is to study quantitative and qualitative eosinophilia in premalignant and malignant lesions of squamous origin in oral cavity with respect to tumor-associated blood eosinophilia. A retrospective study was done at Tertiary care hospital between January 2016 and December 2016. A total of 150 cases of premalignant (oral leukoplakia and dysplasia) and malignant oral squamous cell carcinoma (of various grades) along with blood pictures were evaluated.

Tobacco Smoking among the Online Respondent Dental Students of a Dental College: A Descriptive Cross-sectional Study.

Introduction: Smoking tobacco is most common nowadays among dental students due to stress induced by practical workloads and exams. There is limited data regarding tobacco smoking among dental students. The aim of this study was to determine the prevalence of tobacco smoking among online respondent dental students of a dental college. Methods: This was a descriptive cross-sectional study conducted on dental students from 15 July 2021 to 15 August 2021. Ethical approval was obtained from the Institutional Review Committee of K.D. Dental College and Hospital (Reference number: KDDC/Admin/2021/9990A). Data was collected through a structured questionnaire and responses were gathered using an online Google form survey with informed consent. A convenience sampling method was used. Point estimate and 95% confidence interval were calculated. Results: Among 60 online respondents, the prevalence of tobacco smoking was found to be 11 (18.33%) (17.04-24.56, 95% Confidence Interval). The percentage of participants who wanted to stop smoking now was 11 (18.33%). Conclusions: The prevalence of tobacco smoking among the online dental respondents of a dental college was similar to the other studies done in similar settings. Keywords: dental students; smoking; tobacco cessation.

Pullulan in pharmaceutical and cosmeceutical formulations: A review.

Pullulan, an α-glucan polysaccharide, is colorless, odorless, non-toxic, non-carcinogenic, highly biocompatible, edible and biodegradable in nature. The long chains of glucopyranose rings in pullulan structure are linked together by α-(1 â†’ 4) and α-(1 â†’ 6) glycosidic linkages. The occurrence of both glycosidic linkages in the pullulan structure contributes to its distinctive properties. The unique structure of pullulan makes it a potent candidate for both pharmaceutical and cosmeceutical applications. In pharmaceuticals, it can be used as a drug carrier and in various dosage formulations. It has been widely used in drug targeting, implants, ocular dosage forms, topical formulations, oral dosage forms, and oral liquid formulations, etc. Pullulan can be used as a potential carrier of active ingredients and their site-specific delivery to skin layers for cosmeceutical applications. It has been extensively used in cosmeceutical formulations like creams, shampoo, lotions, sunscreen, facial packs, etc. The current review highlights applications of pullulan in pharmaceutical and cosmeceutical applications.

Sarcomatous Nodules Associated with Mucinous Neoplasms of Ovary: A Report of Two Cases.

Ovarian mucinous neoplasms (benign/borderline/malignant), one of the common surface epithelial tumours of ovary, at times can be associated with mural nodules. These mural nodules can either be sarcomatous, sarcoma like or anaplastic carcinomatous. The nodules can be single or multiple and appear solid, white to brown in color. Sarcomatous nodules tend to occur in older patients and microscopically are poorly circumscribed, comprising of a population of pleomorphic spindled cells. Two cases of sarcomatous nodules associated with ovarian mucinous neoplasm are being presented here.

Thiazolothiazole based donor-π-acceptor fluorophore: Protonation/deprotonation triggered molecular switch, sensing and bio-imaging applications.

Stimuli modulated photophysical properties of a new asymmetric multifunctional molecular probe, 2-(pyren-1-yl)-5-(pyridin-4-yl)thiazolo [5,4-d]thiazole (PYTZ-P) bearing electron-rich pyrene and electron-deficient pyridine units linked through a π-conjugated thiazolo [5,4-d]thiazole (TTz) bridge are reported. Its sensitivity towards protons (TFA) in solution is manifested in the form of bathochromically shifted emission that spreads all over the visible region, and is related to the increased acceptor strength of pyridine upon protonation and subsequent enhanced magnitude of intramolecular charge-transfer in the probe. Similar modulation of the luminescence behaviour of the probe was also observed in the solid state. These observations are well rationalised by the theoretical calculations. The applicability of the sensitivity of the probe towards TFA has been demonstrated by developing the ready-to-use portable paper strips. Furthermore, PYTZ-P showed different acid/base induced absorption/emission switching property. Interestingly, when the response of the probe was noted in the presence of several cations, modulation of the electronic properties was observed only in the presence of Hg2+ ions, with the lowest detection limit of 8.43 × 10-8 M. Additionally, the sensitivity of the probe towards TFA and Hg2+ ions in solution and solid states is convincingly mimicked in the fluorescence imaging of HeLa and A375 cancer cells.

Hitch suture assisted tuck in Tenon's Patch Graft for management of Corneal Perforations.

PURPOSE: To describe a novel modification of tuck-in Tenon's patch graft (TPG) using temporary horizontal mattress sutures and fibrin glue to hitch the graft in the management of corneal perforations. DESIGN: Ambispective interventional case series. METHODS: Modified technique of autologous TPG was used to seal corneal perforations measuring 3-5 mm, using horizontal mattress sutures to hitch the graft in a lamellar pocket, followed by application of fibrin glue. The horizontal mattress sutures were removed after the reformation of the anterior chamber. The primary outcome measure was a well formed anterior chamber in the post-operative period and the secondary outcome was epithelization time. RESULTS: The surgery was performed in 22 eyes. The mean age was 43.86 ± 16.02 (26-66) years, with 14 males and eight females. The etiologies of corneal perforation included dry eye (n = 10), neurotrophic keratitis (n = 6), trauma (n = 2), chemical injury (n = 2) and exposure (n = 2). The mean size of the perforation with the thinned-out area was 4.3 mm (range 3-5 mm). The mean duration of epithelialization was 14.31 ± 2.63 days (7-21 days). No intraoperative complications were observed. All eyes had a well-formed anterior chamber in the immediate postoperative period. Postoperatively, two eyes had graft pseudoectasia due to a thick graft and supra tenon haemorrhage each; one eye each had graft thinning with the formation of pseudopterygium and graft melting. CONCLUSION: Tenon's patch graft, along with the use of temporary horizontal mattress sutures and fibrin glue, is an effective modification of the technique for managing corneal perforations measuring 3-5 mm.

Telemedicine Experience of General Surgery Trainees: Impact on Patient Care and Education.

OBJECTIVE: The COVID-19 pandemic has had a significant impact on patient care, including the increased utilization of contact-free clinic visits using telemedicine. We looked to assess current utilization of, experience with, and opinions regarding telemedicine by general surgery residents at an academic university-based surgical training program. DESIGN: A response-anonymous 19-question survey was electronically distributed to all general surgery residents at a single academic university-based general surgery residency program. SETTING: University of Southern California (USC) general surgery residency participants: Voluntarily participating general surgery residents at the University of Southern California. RESULTS: The response rate from USC general surgery residents was 100%. A majority of residents (76%) had utilized either video- or telephone-based visits during their careers. No resident had undergone formal training to provide telemedicine, although most residents indicated a desire for training (57.1%) and acknowledged that telemedicine should be a part of surgical training (75.6%). A wide variety of opinions regarding the educational experience of residents participating in telemedicine visits was elicited. CONCLUSIONS: The COVID-19 pandemic brought telemedicine to the forefront as an integral part of future patient care, including for surgical patients. Additional investigations into nationwide telemedicine exposure and practice among United States general surgery residencies is imperative, and the impact of the implementation of telemedicine curricula on general surgery resident telemedicine utilization, comfort with telemedicine technology, and patient outcomes are further warranted. COMPETENCIES: Practice-based learning, systems-based practice, interpersonal and communication skills.

A fluorene based probe: Synthesis and "turn-on" water sensitivity of the in-situ formed Cu2+ complex: Application in bio-imaging.

A new fluorene based probe (FTH) has been evaluated for its photo-physical properties in solution as well as in the aggregated state/viscous environment. Addition of a poor solvent (water) to the solution of the probe in a good (acetonitrile) solvent significantly enhanced the otherwise weak emission due to aggregation induced emission (AIE). The emission enhancement is also related to the increase in viscosity of the solution, leading to the restricted intramolecular rotation of the peripheral (phenyl) groups. Interestingly, the emission behaviour of the non-emissive in-situ formed Cu2+ complex is drastically modulated in the presence of water. The solution of the putative Cu2+ complex of the probe turns highly emissive (yellow colour) upon addition of a small fraction of water (up to 7.6 wt %), but the yellow emission diminishes upon increasing higher water fraction. We propose that the initially formed Cu2+ complex undergoes hydrolysis in the presence of higher water content releasing the free amine possessing the diaryl amino rotors thus rendering the solution non-emissive. Thus the current probe being reported herein discloses its potential to generate trace water sensitive turn-on Cu2+ complex. Additionally, the bio-imaging potential of FTH for live cancer cells and its sensitivity towards intracellular presence of Cu2+ ions has been demonstrated.

Transfusion-free Retransplantation for Post-liver Transplantation Hepatic Artery Thrombosis: How Much Augmentation Is Too Much?

Liver transplantation presents unique challenges in patients who do not accept blood transfusions. The difficulty of balancing chemical augmentation and handling the technical difficulty of the surgery make transfusion-free liver transplantation an exception rather than the norm. However, at our center, we have performed 27 successful living donor liver transplants in transfusion-free patients. We describe a case of hepatic artery thrombosis (HAT) after living donor liver transplantation requiring retransplantation. This first report of safe retransplantation without blood products demonstrates that even graft-threatening complications can be safely managed in a transfusion-free setting. However, it remains unclear if the medical augmentation to meet hematologic and coagulation parameters before transfusion-free transplantation may increase the risk of postoperative HAT and other thrombotic complications. Although it is our center's experience that the thrombosis rate is comparable with the published rate in standard transfusion-eligible living donor liver transplantations and this case demonstrates that HAT can be safely managed in this setting, further study on the risks and benefits of hematopoietic stimulants as pretransplant optimization is warranted.

Recent advances in near infrared light responsive multi-functional nanostructures for phototheranostic applications.

Light-based theranostics have become indispensable tools in the field of cancer nanomedicine. Specifically, near infrared (NIR) light mediated imaging and therapy of deeply seated tumors using a single multi-functional nanoplatform have gained significant attention. To this end, several multi-functional nanomaterials have been utilized to tackle cancer and thereby achieve significant outcomes. The present review mainly focuses on the recent advances in the development of NIR light activatable multi-functional materials such as small molecules, quantum dots, and metallic nanostructures for the diagnosis and treatment of deeply seated tumors. The need for improved disease detection and enhanced treatment options, together with realistic considerations for clinically translatable nanomaterials will be the key driving factors for theranostic agent research in the near future. NIR-light mediated cancer imaging and therapeutic approaches offer several advantages in terms of minimal invasiveness, deeper tissue penetration, spatiotemporal resolution, and molecular specificities. Herein, we have reviewed the recent developments in NIR light responsive multi-functional nanostructures for phototheranostic applications in cancer therapy.

Impact of Morbid Obesity on Liver Transplant Candidacy and Outcomes: National and Regional Trends.

BACKGROUND: Body mass index (BMI) limits for liver transplant (LT) candidacy are controversial. In this study, we evaluate waitlist and post-LT outcomes, and prognostic factors and examine regional patterns of LT waitlist registration in patients with BMI ≥40 versus BMI 18-39. METHODS: United Network for Organ Sharing (UNOS) data were analyzed to assess waitlist dropout, post-LT survival, and prognostic factors for patient survival. The distribution of waitlisted patients with BMI ≥40 was compared with the Centers for Disease Control Behavioral Risk Factors Surveillance System data to explore the rates of morbid obesity in the general population of each UNOS region. RESULTS: Post-LT outcomes demonstrate a small but significantly lower 1- and 3-y overall survival for patients with BMI ≥45. Risk factors for post-LT mortality for patients with BMI ≥40 included age >60 y, prior surgery, and diabetes on multivariable analysis. Model for End-Stage Liver Disease >30 was significant on univariable analysis only, likely due to the limited number of patients with BMI ≥40; however, median Model for End-Stage Liver Disease scores in this BMI group were higher than those in patients with lower BMI across all UNOS regions. Patients with BMI ≥40 had a higher waitlist dropout in 4 regions. Comparison with BRFSS data illustrated that the proportion of waitlisted patients with BMI ≥40 was significantly lower than the observed rates of morbid obesity in the general population in 3 regions. CONCLUSIONS: While BMI ≥45 is associated with modestly lower patient survival, careful selection may equalize these numbers.