Laser-Assisted Frenectomy Followed by Post-Operative Tongue Exercises in Ankyloglossia: A Report of Two Cases.

Ankyloglossia, commonly known as tongue-tie, is a developmental abnormality that may interfere in speech and articulation of lingual and sibilant sounds, due to the abnormal lingual frenal attachment. Lingual frenectomy severs the tie, however in adolescents and young adults, kinesthetic awareness, that is, the senses of position and movement of the tongue, needs to be increased. In such a scenario, tongue exercises lend a helping hand. Here, we discuss the benefits of this combined treatment modality in two cases diagnosed with ankyloglossia.

Formulation and Evaluation of Isradipine Nanosuspension and Exploring its Role as a Potential Anticancer Drug by Computational Approach.

BACKGROUND: T-type calcium channels are aberrantly expressed in different human cancers and regulate cell cycle progression, proliferation, migration, and survival. FAK-1 can promote tumor protein degradation (p53) through ubiquitination, leading to cancer cell growth and proliferation. Similar findings are obtained regarding protease inhibitors' effect on cytokine-induced neutrophil activation that suppresses Granulocyte-macrophage colony-stimulatingfactor (GM-CSF) TNF-α-induced O2 release and adherence in human neutrophils without affecting phosphorylation of Extracellular signal-regulated kinase (ERK) and p38. Nanosuspensions are carrier-free, submicron colloidal dispersions, which consist of pure drugs and stabilizers. Incorporating drug loaded in nanosuspensions offer a great advantages of passive drug targeting with improved solubility, stability, and bioavailability, as well as lower systemic toxicity. OBJECTIVE: The present investigation objective was to establish a molecular association of Protease and Focal Adhesion Kinase 1 as cancer targets for isradipine, a calcium channel blocker (CCB). Furthermore, the study also aimed to formulate its optimized nanosuspension and how the physical, morphological, and dissolution properties of isradipine impact nanosuspension stability. METHODS: Five different molecular targets, namely Cysteine Proteases (Cathepsin B), Serine Proteases (Matriptase), Aspartate Proteases, Matrix Metalloproteases (MMP), and FAK-1 were obtained from RCSB-PDB, which has some potential associations with inhibition in cancer pathogenesis. Molecular interactions of these targets with CCB isradipine were identified and established by molecular simulation docking studies. Isradipine-loaded nanosuspension was prepared by precipitation technique by employing a 23 factorial design. PVP K-30, poloxamer 188, and sodium lauryl sulfate (SLS) were used as polymer, co-polymer, and surfactant, respectively. The nanosuspension particles were assessed for particle size, zeta potential, viscosity, polydispersity index (PDI), Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), In-vitro drug release kinetics, and short-term stability study. RESULTS: Considerable interactions were found with Cysteine, Serine, Aspartate, Threonine, and Matrix metalloproteases with binding energies of -3.91, -6.7, -3.48, -8.42, respectively. Furthermore, the interaction of isradipine with FAK-1 was compared with 7 native ligands and was found to show significant interaction with binding energies of - 8.62, -7.27, -7.69, -5.67, -5.41, -7.44, -8.21, respectively. The optimized nanosuspension was evaluated and exhibited a particle size of 754.9 nm, zeta potential of 32.5 mV, viscosity of 1.287 cp, and PDI of 1.000. The In-vitro dissolution of the optimized formulation (F8) was found to be higher (96.57%) as compared to other formulations. CONCLUSION: Isradipine could act as a potential inhibitor of different proteases and FAK-1 associated with tumor growth initiation, progression, and metastasis. Furthermore, isradipine-loaded nanosuspension with optimized release could be utilized to deliver the anticancer drug in a more targeted way as emerging cancer nanotechnology.

Correlation of arterial PaCO2 to end tidal CO2 in children undergoing laparoscopic abdominal surgery: An observational study.

Background and Aims: The reliability of end tidal carbon dioxide (ETCO2) as a measure of arterial carbon dioxide (PaCO2) in pediatric laparoscopy is unclear. We evaluated the correlation of arterial to end tidal P(a-ET) CO2 during pediatric laparoscopy at two hours of pneumoperitoneum as the primary objective. We also compared P(a-ET) CO2 and alveolar to arterial oxygen gradient P(A-a) O2 and haemodynamics at fixed time points during surgery. Material and Methods: A cross-sectional study was conducted in 25 children undergoing laparoscopic abdominal surgery. Arterial blood gases were drawn at T0, baseline, T10: ten minutes, T1h: 1 hour, T2h: 2 hours of pnuemoperitoneum and T 10d: 10 mins after deflation. The P(a-ET) CO2, P(A-a) O2, were measured from the blood gas and ETCO2 and FiO2 values on the monitor. The Pearson's correlation coefficient, the Wilcoxon rank test and Chi square test were used for statistical analysis. Results: At T2h moderate correlation of P(a-ET) CO2 (r = 0.605, P = 0.001) with 40% children documenting accurate P(a-ET) CO2, -1 to +1 mm Hg was seen. Moderate correlation was also seen at T0, T10, T 10d but poor correlation at T 1h. The P(A-a) O2 increased progressively with surgery and did not correlate with P(a-ET) CO2. Heart rate was stable, but systolic blood pressures at T 10 and diastolic at T10, T 1h, T 2h were higher than baseline. Conclusion: Moderate correlation was seen between PaCO2 and ETCO2 at 2 h of pnuemoperitoneum and at T0, T 10, and T 10d. P(A-a) O2 increased with surgery but did not correlate with P(a-ET) CO2.

Pan-Asian adaptation of the EHNS-ESMO-ESTRO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with squamous cell carcinoma of the head and neck.

The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of squamous cell carcinoma (SCC) of the oral cavity, larynx, oropharynx and hypopharynx was published in 2020. It was therefore decided by both the ESMO and the Korean Society of Medical Oncology (KSMO) to convene a special, virtual guidelines meeting in July 2021 to adapt the ESMO 2020 guidelines to consider the potential ethnic differences associated with the treatment of SCCs of the head and neck (SCCHN) in Asian patients. These guidelines represent the consensus opinions reached by experts in the treatment of patients with SCCHN (excluding nasopharyngeal carcinomas) representing the oncological societies of Korea (KSMO), China (CSCO), India (ISMPO), Japan (JSMO), Malaysia (MOS), Singapore (SSO) and Taiwan (TOS). The voting was based on scientific evidence and was independent of the current treatment practices and drug access restrictions in the different Asian countries. The latter was discussed when appropriate. This manuscript provides a series of expert recommendations (Clinical Practice Guidelines) which can be used to provide guidance to health care providers and clinicians for the optimisation of the diagnosis, treatment and management of patients with SCC of the oral cavity, larynx, oropharynx and hypopharynx across Asia.

Utility of Chitra-HASi Granules in Cystic Defects of the Maxillofacial Region: A Pilot Study.

BACKGROUND: Cystic defects that are critical sized or larger require bone replacement strategies. However, due to inherent disadvantages of the various types of grafts, none of the available materials are best suited for these defects. Among the alloplastic materials, hydroxyapatite (HA)-based grafts are the most popular, due to their osteoconductive nature and resemblance to mineral bone. The aim of the study was to assess the utility of the novel material "Chitra-HASi" as a bone substitute in the maxillofacial region. MATERIALS AND METHODS: In a single-arm, prospective study, patients with radicular and dentigerous cysts were included and the minimum defect size was standardized at 20 × 20 mm or above. The Chitra-HASi material was developed by a wet precipitation technique and adopted for use following multiple in vitro and in vivo studies, confirming its safety and biocompatibility profile. All cysts underwent enucleation, followed by peripheral ostectomy and apicectomy of the teeth involved. The HASi graft was packed inside the cystic defect in a granular form and covered with a mucoperiosteal flap. Panoramic radiographs were taken preoperatively and at 3, 6, and 12 months postoperatively. RESULTS: Twenty-three patients were included in the study, of which only 10 patients could be followed up for 12 months after graft placement. The mean preoperative bone density was found to be 14.9% ± 4.97 (standard deviation), whereas the postoperative 3-month, 6-month, and 12-month densities had a mean difference of -11.3%, -22.9%, and -37.3%, respectively, and the differences were statistically significant. Minor complications such as sinus formation (n = 7) and extrusion of granules (n = 4) were noted, which were managed conservatively. Only two patients required graft removal secondary to infection, leading to a persistent sinus tract. CONCLUSION: The results of the study suggest that Chitra-HASi granules show potential as an alternative to other bone substitutes. The addition of silica to the porous HA material offers superior strength characteristics and needs long-term evaluation to assess its stability in large cystic defects.

Surface modified polymer-magnetic-algae nanocomposite for the removal of chromium- equilibrium and mechanism studies.

The present work explains the sorption ability of a novel nano-composite, Polypyrrole -iron oxide-seaweed (PPy - Fe3O4 - SW), for Cr(VI) removal. The influence of operating parameters, namely pH, contact time, nanocomposite dosage, initial Chromium concentration and operating temperature, on the hexavalent chromium removal was studied. The novel nano-composite was analyzed using FTIR, SEM and EDS to confirm the sorption of Cr(VI) and to understand the mechanism of sorption. PPy - Fe3O4- SW nano-composite removed 96.36% of Cr(VI) at the optimized conditions of pH = 2, temperature = 30 °C, initial Cr(VI) concentration = 50 mg/L, nanocomposite dosage = 100 mg and contact time = 30min. PPy-Fe3O4-SW nanocomposite has a maximum sorption capacity of 144.93 mg/g. The kinetic studies revealed that the metal adsorption obeys pseudo second order (PSO) model and the sorption was found to be monolayer in nature as confirmed by Langmuir isotherm (R2 > 0.9985). Electrostatic interaction and ion-exchange are identified as the fundamental mechanisms for Cr(VI) sorption on PPy-Fe3O4-SW composite.

A new strategy for craniospinal axis localization and adaptive dosimetric evaluation using cone beam CT.

BACKGROUND AND AIM: Computational complexities encountered in craniospinal irradiation (CSI) have been widely investigated with different planning strategies. However, localization of the entire craniospinal axis (CSA) and evaluation of adaptive treatment plans have traditionally been ignored in CSI treatment. In this study, a new strategy for CSI with comprehensive CSA localization and adaptive plan evaluation has been demonstrated using cone beam CT with extended longitudinal field-of-view (CBCTeLFOV). MATERIALS AND METHODS: Multi-scan CBCT images were acquired with fixed longitudinal table translations (with 1 cm cone-beam overlap) and then fused into a single DICOM-set using the custom software coded in MatLab™. A novel approach for validation of CBCTeLFOV was demonstrated by combined geometry of Catphan-504 and Catphan-604 phantoms. To simulate actual treatment scenarios, at first, the end-to-end workflow of CSI with VMAT was investigated using an anthropomorphic phantom and then applied for two patients (based on random selection). RESULTS: The fused CBCTeLFOV images were in excellent agreement with planning CT (pCT). The custom developed software effectively manages spatial misalignments arising out of the uncertainties in treatment/setup geometry. Although the structures mapped from pCT to CBCTeLFOV showed minimal variations, a maximum spatial displacement of up to 1.2 cm (and the mean of 0.8 ± 0.3 cm) was recorded in phantom study. Adaptive plan evaluation of patient paradigms showed the likelihood of under-dosing the craniospinal target. CONCLUSION: Our protocol serves as a guide for precise localization of entire CSA and to ensure adequate dose to the large and complex targets. It can also be adapted for other complex treatment techniques such as total-marrow-irradiation and total-lymphoid-irradiation.

Black carbon aerosol quantification over north-west Himalayas: Seasonal heterogeneity, source apportionment and radiative forcing.

Continuous measurements of Black Carbon (BC) aerosol mass concentrations were carried at Dehradun (30.33°N, 78.04°E, 700 m amsl), a semi-urban site in the foothills of north-westHimalayas, India during January 2011-December 2017. We reported both the BC seasonal variations as well as mass concentrations from fossil fuel combustion (BCff) and biomass burning (BCbb) sources. Annual mean BC exhibited a strong seasonal variability with maxima during winter (4.86 ±â€¯0.78 µg m-3) followed by autumn (4.18 ±â€¯0.54 µg m-3), spring (3.93 ±â€¯0.75 µg m-3) and minima during summer (2.41 ±â€¯0.66 µg m-3). Annual averaged BC mass concentrations were 3.85 ±â€¯1.16 µg m-3 varying from 3.29 to 4.37 µg m-3 whereas BCff and BCbb ranged from 0.11 to 7.12 µg m-3 and 0.13-3.6 µg m-3. The percentage contributions from BCff and BCbb to total BC are 66% and 34% respectively, indicating relatively higher contribution from biomass burning as compared to other locations in India. This is explained using potential source contribution function (PSCF) and concentration weighted trajectories (CWT) analysis which reveals the potential sources of BC originating from the north-west and eastern parts of IGP and the western part of the Himalayas that are mostly crop residue burning and forest fire regions in India. The annual mean ARF at top-of-atmosphere (TOA), at surface (SUR), and within the atmosphere (ATM) were found to be -14.84 Wm-2, -43.41 Wm-2, and +28.57 Wm-2 respectively. To understand the impact of columnar aerosol burden on ARF, the radiative forcing efficiency (ARFE) was estimated and averaged values were -31.81, -91.63 and 59.82 Wm-2 τ-1 for TOA, SUR and ATM respectively. The high ARFE within the atmosphere indicates the dominance of absorbing aerosol (BC and dust) over Northwest Himalayas.

Bioaccumulation and heavy metal concentration in tissues of some commercial fishes from the Meghna River Estuary in Bangladesh and human health implications.

Despite the beneficial aspect of aquatic food's consumption, bioaccumulation of toxic metals in fish can enhance the health risk for the consumers. Heavy metals were measured from editable tissues of some commercial fish species like Latis calcarifer, Silonia silondia, Clupisoma garua, Planiliza subviridis, Otolithoides pama, Tenulosa ilisa, Rhinomugil corsula, and Aila coila in the Meghna river estuary in Noakhali district. Heavy metals such as As, Pb, Cd, Cu, and Cr were detected by ICP-MS, which were significantly different (p ≤ 0.01), and the hierarchy of all mean concentrations were: Cu (5.14 mg/kg) > Pb (3.79 mg/kg) > As (1.08 mg/kg) > Cr (0.78 mg/kg) > Cd (0.12 mg/kg). The mean concentration of Cu (6.62 mg/kg) imparted to the maximum level in L. calcarifer, which slightly exceeded the Bangladesh food safety guideline. The mean BAFs of the contaminants were found as: Pb (1042.29) > Cr (1036.47) > As (934.84) > Cd (832.77) > Cu (772). Further, L. calcarifer, S. silondia, C. garua, and P. subviridis showed the bioaccumulative status. To assess the health risk effects, estimated daily intake (EDI), target hazard quotient (THQ) and carcinogenic risk (CR) were conducted. THQs for both adult and children consumers were <1, indicating that, consumers would not experience the non-carcinogenic health effects. Although children were more susceptible than adults, CR for all the consumers was found in the acceptable range (10-6 to 10-4).

Simultaneous antegrade and retrograde endoscopic surgery for benign prostatic hyperplasia with vesical calculi - A single-centre experience.

OBJECTIVE: To describe the effectiveness and safety of our novel technique of simultaneous percutaneous cystolithotripsy with transurethral resection of prostate (TURP) for patients with benign prostatic hyperplasia (BPH) complicated with large vesical calculi. PATIENTS AND METHODS: This was a retrospective analysis of 25 patients who underwent simultaneous percutaneous cystolithotripsy with TURP between January 2012 and January 2016. Technique: A 28-F Amplatz sheath was inserted percutaneously into the bladder after sequential dilatation under cystoscopic guidance. Percutaneous cystolithotripsy using a nephroscope and pneumatic lithoclast was then performed simultaneously along with monopolar TURP. Preoperative parameters reviewed included: patient's symptoms, International Prostate Symptom Score, uroflowmetry pattern, prostate volume, and stone burden on ultrasonography of the abdomen and pelvis. Postoperative parameters analysed included: duration of irrigation, time until catheter removal, length of hospital stay, and complications. RESULTS: The mean age of the patients was 67.8 years. The mean prostate size was 62.28 mL and the mean stone burden was 3.18 cm. The mean operating time was 54.2 min. The mean time until catheter removal was 3.2 days. CONCLUSION: Simultaneous percutaneous cystolithotripsy with TURP in patients with BPH with large bladder calculi is safe and feasible.

Radiation dose metrics in multidetector computed tomography examinations: A multicentre retrospective study from seven tertiary care hospitals in Kerala, South India.

BACKGROUND: Presently, computed tomography (CT) is the most important source of medical radiation exposure. CT radiation doses vary considerably across institutions depending on the protocol and make of equipment. India does not yet have national or region-specific CT diagnostic reference levels. AIM: To evaluate radiation doses of consecutive multidetector CT (MDCT) examinations based on anatomic region, performed in 1 month, collected simultaneously from seven tertiary care hospitals in Kerala. SETTINGS AND DESIGN: Descriptive study. MATERIALS AND METHODS: We collected the CT radiation dose data of examinations from the seven collaborating tertiary care hospitals in Kerala, performed with MDCT scanners of five different makes. The data included anatomic region, number of phases, CT dose index (CTDIvol), dose-length product (DLP), and effective dose (ED) of each examinations and patient demographic data. STATISTICAL ANALYSIS: We calculated the 25th, 50th, and 75th percentiles of the CTDIvol, DLP, and ED according to anatomic region. We made descriptive comparisons of these results with corresponding data from other countries. RESULTS: Of 3553 patients, head was the most frequently performed examination (60%), followed by abdomen (19%). For single-phase head examinations, 75th percentile of CTDIvol was 68.1 mGy, DLP 1120 mGy-cm, and ED 2.1 mSv. The 75th percentiles of CTDIvol, DLP, and ED for single-phase abdomen examinations were 10.6, 509.3, and 7.7, and multiphase examinations were 14.6, 2666.9, and 40.8; single-phase chest examinations were 23.4, 916.7, and 13.38, and multiphase examinations were 19.9, 1737.6, and 25.36; single-phase neck were 24.9, 733.6, and 3.814, and multiphase neck were 24.9, 2076, and 10.79, respectively. CONCLUSION: This summary CT radiation dose data of most frequently performed anatomical regions could provide a starting point for institutional analysis of CT radiation doses, which in turn leads to meaningful optimization of CT.

Tuberculous lymphadenitis is associated with altered levels of circulating angiogenic factors.

BACKGROUND: Angiogenic factors are important in granuloma formation and serve as biomarkers in pulmonary tuberculosis (PTB). The relationship between these markers and tuberculous lymphadenitis (TBL) is not known. OBJECTIVE AND DESIGN: To examine the association of vascular endothelial growth factor (VEGF) and angiopoietin (Ang) family molecules in TBL, we measured systemic levels of VEGF-A, C, D, R1 (VEGF-receptor 1), R2, R3, Ang-1, Ang-2 and TIE2 (tyrosine kinase with immunoglobulin-like and epidermal growth factor-like domains 2) levels in TBL, latent tuberculous infection (LTBI) and lymph node culture supernatants (VEGF-A, C and Ang-2) of the same TBL patients. RESULTS: Circulating levels of VEGF-A and VEGF-C were significantly diminished, whereas VEGF-R2, R3, Ang-2 and TIE2 levels were significantly increased, in TBL. Likewise, VEGF-A, C and Ang-2 levels were significantly increased in lymph node supernatants compared with plasma in individuals with TBL. Receiver operating characteristic curve analysis showed that VEGF-C and VEGF-R2 markers clearly distinguished TBL from LTBI. Following treatment, VEGF-C and Ang-1 levels were significantly altered. No association was observed between angiogenic factors and culture grade or lymph node size, except for VEGF-A. VEGF-A was also significantly decreased in multiple lymph nodes compared with single lymph nodes. CONCLUSIONS: Our data suggest that altered levels of circulating angiogenic factors in TBL might reflect underlying vasculo-endothelial dysfunction. Reversal of angiogenic markers after anti-tuberculosis treatment suggests that these angiogenic markers may serve as biomarkers of disease severity or response to treatment in TBL.

Strontium Hydroxyapatite scaffolds engineered with stem cells aid osteointegration and osteogenesis in osteoporotic sheep model.

Osteoporotic fracture healing is an orthopaedic challenge due to excessive bone resorption and impaired osteogenesis. Majority of current treatment strategies focus on regulating bone resorption and the potential application of Mesenchymal Stem Cells (MSCs) in promoting osteogenesis has not been explored much. Furthermore, the present study has put forth a novel approach, wherein the synergistic action of Strontium (Sr) and MSCs in a single implant may facilitate osteoporotic bone healing. Strontium Hydroxyapatite (SrHA) synthesized by wet precipitation was fabricated into tissue engineered Strontium incorporated Hydroxyapatite (cSrHA) using sheep adipose tissue derived MSCs (ADMSCs). Porosity, radiopacity and cytocompatibility of SrHA scaffolds were found appropriate for orthopaedic applications. cSrHA scaffolds exhibited an in vitro Alkaline Phosphatase activity of 20 µmol pnp/30 min comparable to that of Hydroxyapatite (HA) - control scaffold, proving its osteogenic efficacy. Implantation studies in sheep osteoporotic model depicted enhanced osteogenic ability with mature lamellar bone formation in cSrHA implanted group, compared to bare HA, SrHA and tissue engineered HA implanted groups. Histomorphometry data substantiated improved osteogenesis on par with material resorption, as cSrHA implanted group exhibited highest regeneration ratio of 0.38 ±â€¯0.05. Density histograms from micro CT further signified the enhanced osteointegrative ability of cSrHA implants. Results of the study depicted the therapeutic potential of cSrHA in osteoporotic bone healing and proposes the use of allogenic ADMSCs for fabricating "Off the Shelf Tissue Engineered Products".

The Significance of ERG and Androgen Receptor Expression in Adenocarcinoma Prostate.

Background Fusions of transmembrane protease, serine 2 (TMPRSS2) with erythroblast transformation specific transcription factors have been found in prostate cancer. The v-etserythroblastosis virus E26 oncogene homologue (ERG) is a proto-oncogene of the erythroblast transformation specific transcription factor family. TMPRSS2-ERG fusion is the most common molecular alteration present in about 50% of prostatic adenocarcinomas. Androgen receptor (AR) plays a key role in prostate development and is involved in the progression of prostate cancer. Objective To evaluate the significance of combined ERG and AR expression in cases of prostatic adenocarcinoma. Method The study was conducted at Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. Formalin fixed-paraffin embedded archival prostatic tissue specimens were obtained. A total of 10 cases of prostatic adenocarcinoma were included in the study. Immunohistochemistry for Androgen receptor was done by the standard protocol. Multiplex immunohistochemical staining was done for ERG+CK5 using a primary antibody cocktail of mouse and rabbit antibodies. Result Specific AR immunostaining was exclusively nuclear and was present in all 10 cases in varying intensity. Specific ERG immunostaining was nuclear and was present in seven cases (70%) and absent in three cases (30%). The three cases that were negative for ERG had a Gleason score of ≤ 6 and the AR staining was strong and present in about 90% of the cells. Gleason score was directly related to the ERG staining while AR staining was inversely related to the ERG staining. Conclusion The prognostic value of combined ERG and AR over-expression, its associated genes should be further investigated as potential therapeutic targets in prostate cancer progression. Preliminary data is being presented. Larger prospective studies with survival analysis are essential for prognostic significance.

Long-Term Effects of Neonatal Hyperoxia in Adult Mice.

The outcomes of premature infants have improved greatly; however, the health risks in adulthood are still relatively unclear. Bronchopulmonary dysplasia (BPD) in premature infants is a major risk factor for alteration in lung function and predisposition to respiratory morbidity, and is associated with hyperoxia. The study explores the effect of neonatal hyperoxia on organ systems in adult mice. Newborn mouse litters were randomized to 85%O2 or room air (RA) on P3 for 12 days; mice were sacrificed at P3, P7, P15, 3 months and 9 months. Lungs were assessed by histopathology, radial alveolar count, mean linear intercept, and α-Smooth muscle actin immunohistochemistry. Aortic assessment included histology, wall thickness, elastin, and collagen content. Glomerular histology and nephron number were assessed in the kidneys. Hyperoxia-exposed mice had progressive alveolar simplification and poor weight gain over time. Greater thickness of pulmonary arterioles by 3 months and a higher Fulton index by 9 months suggest worsening pulmonary hypertension. Aortic wall thickness to lumen ratio was greater with a lower aortic elastin-to-collagen ratio suggesting long-term effects of neonatal hyperoxia. Hyperoxia-exposed mice at 9 months had smaller glomeruli as indicated by glomerular diameter and volume. Prolonged neonatal hyperoxia during the critical period of development induces irreversible lung damage, pulmonary hypertension and structural changes in the kidneys and aorta in adult mice. This could have implications for chronic adult diseases following exposure to high levels of oxygen in the newborn period. Anat Rec, 301:717-726, 2018. © 2017 Wiley Periodicals, Inc.

Xanthogranulomatous Pyelonephritis: Intrahepatic and Intrathoracic Extension.

A 32-year-old female presented to us with worsening cough and expectoration, low-grade fever, and malaise for 3 months. She gave a history of pregnancy loss secondary to urinary tract infection (UTI) a year back. At that time, she was told to have an obstructive right renal calculus. She also had a history of recurrent UTI in the past 1 year. She had no other comorbidities. Her clinical evaluation revealed an enlarged right kidney and reduced air entry in the right hemithorax. Radiological investigations revealed a large right kidney invading into the inferior surface of the right lobe of the liver and the right pleural space. A clinical diagnosis of xanthogranulomatous pyelonephritis was made, and she was advised nephrectomy. Intraoperatively, the right kidney was found to invade both the right lobe of the liver and the right pleural cavity through a right diaphragmatic defect. Histopathology of the kidney revealed the presence of foamy histiocytes suggestive of xanthogranulomatous pyelonephritis. Invasive xanthogranulomatous pyelonephritis is known, however, invasion into the extra-abdominal structures has not been reported in the literature. Our case is a rare manifestation of a rare clinical entity - xanthogranulomatous pyelonephritis.