Morpho-physiological studies of sandalwood-host interaction under individual and interactive water and salt stress.

To find out the possibilities of growing white sandalwood in sub-tropical regions of India where farmers facing the problem of water deficit and salinity stress, a RBD experiment was conducted. Sandalwood grown alone and with five selected hosts (Alternanthera sp., Neem, Shisham, Dek and Agarwood) on the basis of prior study under water deficit, salinity stress and combined water deficit and salinity stress. Sandalwood plants were harvested after 180 days of imposing stress treatments. Morphological traits (plant height, collar diameter, shoot fresh and dry biomass) showed significant reduction under water deficit and salinity stress, which were further aggravated under combined water deficit and salinity stress. Studied plant water traits, ionic balance and gas exchange attributes were also reduced by these stresses. While among studied host, Shisham and Dek identified as the best host species under water deficit, salinity and interactive stress by maintaining ion homeostasis, osmotic adjustments and plant water regulation. Results depicted that sandalwood plants cultivated alone were not able to survive under salinity and combined stress conditions and showed poor growth under water deficit and control conditions. Different indices were also calculated based on morpho-physiological and ionic traits and also indicated that sandalwood grown with Dalbergia sissoo and Melia dubia showed higher drought, salt and stress tolerance potential, which made sandalwood adaptable under these stresses. Therefore, the present study signifies the importance of host especially D. sissoo and M. dubia which might be excellent long-term host species for sandalwood cultivation under sub-tropical conditions to thrive under changing environments.

Delineating the role of host plants in regulating the water and salinity stress induced changes in sandalwood roots.

The interaction of root hemi-parasite (sandalwood) with its hosts is crucial for establishing successful plantations under abiotic stresses. In the present study, we explored the best possible host for sandalwood along with its effect on sandalwood physiology in terms of water and nutrients. Interactive effects of host species (Alternanthera sp., Azadirachta indica, Dalbergia sissoo, Melia dubia, and Aquilaria malaccensis) with sandalwood were observed under eight treatments {100% best available water (BAW); 100% BAW + nutrient medium; 50% water deficit; 50% water deficit + nutrient medium; 100% saline water (ECiw 8ds/m); 100% saline water (ECiw 8ds/m) + nutrient medium; 50% water deficit + saline water (ECiw 8ds/m); and 50% water deficit + saline water (ECiw 8ds/m) + nutrient medium}. A significant change in morpho-physiological traits of sandalwood roots was observed under different stress conditions, which were slightly improved through external supply of nutrient medium. Dalbergia sissoo (Shisham) and Melia dubia (Dek) seemed to be the best host plants providing better environment for sandalwood growth and development, i.e., higher plant height (59.7 and 53.68 cm) and collar diameter (3.24 and 3.07 mm) under stresses by maintaining water and ionic balance. Root length is an important parameter that was reduced by 27.58%, 19.22%, and 36.3% under water deficit, salinity, and combined stress of water deficit and salinity. Sandalwood grown with D. sissoo and M. dubia maintained the lowest Ψw (- 1.38 MPa) and Ψs (- 1.47 and - 1.48 MPa), respectively. In addition, sandalwood cultivated with D. sissoo and A. indica had higher accumulation of soluble proteins (0.48 and 0.42 mg/g) and soluble sugars (98.56 and 91.04 mg/g) in their roots. Results also showed that sandalwood roots had higher K+/Na+ with compatible host, i.e., with A. indica (1.85) and D. sissoo (1.83) than other studied hosts. It was also observed that sandalwood plants could not grow and survive alone under stress conditions even with application of nutrient medium. Based on the morphological traits, it was observed that sandalwood grown with hosts, Dalbergia sissoo and Melia dubia, was able to tolerate stress conditions better than other studied hosts. We can further recommend growing sandalwood with D. sissoo and M. dubia as a viable option to endure adverse environmental conditions.

Host Plant Modulated Physio-Biochemical Process Enhances Adaptive Response of Sandalwood (Santalum album L.) under Salinity Stress.

Salinity is one of the most significant abiotic stress that affects the growth and development of high-value tree species, including sandalwood, which can also be managed effectively on saline soils with the help of suitable host species. Therefore, the current investigation was conducted to understand the physiological processes and antioxidant mechanisms in sandalwood along the different salinity gradients to explore the host species that could support sandalwood growth in salt-affected agro-ecosystems. Sandalwood seedlings were grown with ten diverse host species with saline water irrigation gradients (ECiw~3, 6, and 9 dS m-1) and control (ECiw~0.82 dS m-1). Experimental findings indicate a decline in the chlorophyll content (13-33%), relative water content (3-23%), photosynthetic (27-61%) and transpiration rate (23-66%), water and osmotic potential (up to 137%), and ion dynamics (up to 61%) with increasing salinity levels. Conversely, the carotenoid content (23-43%), antioxidant activity (up to 285%), and membrane injury (82-205%) were enhanced with increasing salinity stress. Specifically, among the hosts, Dalbergia sissoo and Melia dubia showed a minimum reduction in chlorophyll content, relative water content, and plant water relation and gas exchange parameters of sandalwood plants. Surprisingly, most of the host tree species maintained K+/Na+ of sandalwood up to moderate water salinity of ECiw~6 dS m-1; however, a further increase in water salinity decreased the K+/Na+ ratio of sandalwood by many-fold. Salinity stress also enhanced the antioxidative enzyme activity, although the maximum increase was noted with host plants M. dubia, followed by D. sissoo and Azadirachta indica. Overall, the investigation concluded that sandalwood with the host D. sissoo can be successfully grown in nurseries using saline irrigation water and, with the host M. dubia, it can be grown using good quality irrigation water.

Geospatial technology in agroforestry: status, prospects, and constraints.

Agroforestry has an indispensable role in food and livelihood security in addition to its capacity to combat the detrimental effects of climate change. However, agroforestry has not been properly promoted and exploited due to lack of precise extent, geographical distribution, and carbon sequestration (CS) assessment. The recent advent of geospatial technologies, as well as free availability of spatial data and software, can provide new insights into agroforestry resources assessment, decision-making, and policy development despite agroforestry's small spatial extent, isolated nature, and higher structural and functional complexity of agroforestry. In this review, the existing application of geospatial technologies together with its constraints and limitations as well as the potential future application for agroforestry has been discussed. The review reveals that the application of optical remote sensing in agroforestry includes spatial extent mapping, production of tree species spectral signature, CS assessment, and suitability mapping. Simultaneously, the recent surge in the use of synthetic aperture radar in conjunction with algorithms based on vegetation photosynthesis and optical data enables a more accurate estimation of gross primary productivity at different scales. However, unmanned aerial vehicles equipped with sensors, such as multispectral, LiDAR, hyperspectral, and thermal, offer a considerably higher potential and accuracy than satellite-based datasets. In the future, the health monitoring of agroforestry systems can be a key concern that may be addressed by utilizing hyperspectral and thermal datasets to analyze plant biochemistry, chlorophyll fluorescence, and water stress. Additionally, current (GEDI, ECOSTRESS) and future space agency missions (BIOMASS, FLEX, NISAR, TRISHNA) have enormous potential to shed fresh light on agroforestry systems.

Local recurrence with intersphincteric resection in adverse histology rectal cancers. A retrospective study with competing risk analysis.

BACKGROUND: The safety of inter-sphincteric resection (ISR) for low rectal cancer with adverse histologic subtypes has been incompletely studied. The present study aims at determining the risk of local recurrence with this procedure in poorly differentiated and signet ring cell (PDSR) adenocarcinoma. METHODS: Retrospective analysis from a single tertiary cancer centre of non-metastatic primary rectal cancer <6 cm from the anal verge that underwent ISR. Competing risk analysis and sub-distribution hazard ratios for local recurrence free survivals were calculated to determine factors that influenced local recurrence with the competing risk of death from any cause to overcome the exceeding risk of distant metastasis associated with adverse histologic types. RESULTS: One hundred forty-two patients underwent ISR and 22.6% has PDSR histology. At a median follow up of 61 months, 15.6% of the PDSR cohort developed local recurrence (five patients) compared to 11.7% in the non-PDSR group. PDSR histology influenced overall and disease free survival but not local recurrence on cox regression. On competing risk analysis, only ypT stage ≥3 predicted worse local recurrence free survival and not histology. CONCLUSIONS: The presence of PDSR histology did not increase the risk of local recurrence after ISR in this retrospective competing risk analysis.

Outcomes of exenteration in cT4 and fixed cT3 stage primary rectal adenocarcinoma: a subgroup analysis of consolidation chemotherapy following neoadjuvant concurrent chemoradiotherapy.

PURPOSE: The aim was to evaluate the oncological outcomes and the prognostic factors following pelvic exenteration (PE) in cT4 and fixed cT3 stage primary rectal adenocarcinoma and to study the impact of consolidation chemotherapy following neoadjuvant concurrent chemoradiotherapy (NACRT). METHODS: A retrospective analysis of a prospectively maintained database of PE from 2013 to 2018. RESULTS: Out of 2900 colorectal resections, there were 131 pelvic exenterations that were performed, and 100 of these patients had undergone exenteration for primary rectal adenocarcinoma. Of these 100 patients, there were 81 patients who had received NACRT followed by surgery, 50 of whom who had received consolidation chemotherapy and 31 who had undergone surgery without consolidation chemotherapy. R0 resection was achieved in 90% cases. At a median follow-up of 32 months, 2-year disease free survival was 61.8% and estimated 5-year overall survival was 62%. The incidence of distant metastases was 44% vs. 19% (p = 0.023), and the 2-year distant recurrence-free survival was 58% vs. 89% (p = 0.025), respectively, in the 'consolidation chemotherapy group' and the 'no chemotherapy group'. The poorly differentiated grade of tumours, presence of lympho-vascular-invasion, consolidation chemotherapy, and disease recurrence were all found to affect the survival. CONCLUSION: PE with R0 resection achieves excellent survival rates in cT4 and fixed cT3 stage primary rectal adenocarcinoma. The distant recurrence rate may not be altered by consolidation chemotherapy in the subset of high-risk patients. However, further research on consolidation chemotherapy following NACRT in cT4 and fixed cT3 stage primary rectal adenocarcinoma will give a definite answer in the future.

Minimally Invasive Surgery for Pelvic Exenteration in Primary Colorectal Cancer.

BACKGROUND: Minimally invasive surgery (MIS) for pelvic exenteration is not a well-established technique. The aim was to assess the safety and feasibility of MIS for pelvic exenteration in locally advanced primary colorectal cancer and to compare the perioperative outcomes with open surgery. METHODS: This is a retrospective analysis of patients, who had undergone pelvic exenteration for primary colorectal adenocarcinoma from May 2013 to July 2018. The short-term outcomes like perioperative details and histopathological characteristics were compared between the two groups. RESULTS: MIS was performed in 23 patients and open pelvic exenteration was carried out in 72 patients. The mean operative time was significantly more in the MIS group (640 vs. 432 min, p = 0.00). The intraoperative blood loss (900 vs. 1550 ml, p = 0.00) and the requirement for blood transfusion (170 vs. 250 ml, p = 0.03) was significantly less in the MIS group. The overall morbidity (60% vs. 49%, p = 0.306) was comparable between the two groups. The median length of hospital stay in the MIS group was 11 d, compared to 12 d in the open surgery group, (p = 0.634). The rate of R0 resection (87% vs. 89%, p = 0.668) was comparable between the two groups. CONCLUSION: MIS is feasible and safe for total pelvic exenteration and posterior exenteration in carefully selected locally advanced primary colorectal cancer, when performed by an experienced surgical team in high volume centers. An R0 resection with adequate margin can be achieved with good perioperative outcomes in MIS. Long-term oncological outcomes would require further follow up to confirm.

Incidence, treatment, and outcomes of primary and recurrent Non-Wilms renal tumors in children: Report of 109 patients treated at a single institution.

INTRODUCTION: Non-Wilms renal tumors represent a compelling subset of childhood renal tumors. However, their relative rarity renders accurate diagnosis, and therapy challenging which in some instance is inferred from their adult counterparts. OBJECTIVE: To describe the incidence and analyze the diagnostic challenges, therapies and, outcomes of non-Wilms renal tumors at the largest tertiary cancer centre in India. METHODS: All patients with histologically confirmed non-Wilms renal tumours diagnosed in the paediatric oncology unit of Tata Memorial Hospital between 2006 and 2019 were included. Data regarding clinical and radiological features and treatment outcomes were retrieved from the prospectively maintained institutional database. At the outset, histological types were categorised into a high and low-risk group depending on anticipated survival. Survival analysis was performed utilising the Kaplan-Meier method on SPSS software version 24.0. RESULTS: Of the 569 patients with renal tumors, 109 (19%) patients with primary (n = 97) or recurrent (n = 12) non-Wilms renal tumors were included. Histological high-risk group included clear cell sarcoma (CCSK) (39.4%), renal cell carcinoma (RCC) (19.3%), malignant rhabdoid tumor (MRTK) (12.8%), Ewing's sarcoma (rES) (15.6%), synovial sarcoma (2%), and undifferentiated sarcoma (2%). The low-risk group comprised of congenital mesoblastic nephroma (CMN) (4.6%), cystic partially differentiated nephroblastoma (2%), and other rare tumors (3%). Diagnostic error occurred in 2 patients in the high-risk group. All low-risk tumours were treated with surgery alone and most (97%) high-risk tumors were operated either upfront (61.5%) or after preoperative chemotherapy (38.4%). Adjuvant therapy based on histology was offered to 70%. The recurrent tumors received various salvage treatments including chemotherapy; radiotherapy; surgery and immunotherapy, however, only 2 patients could be salvaged. The 3-year overall survival for the entire cohort with primary tumors was 59%, and the survival rates were 76.7%, 77.9%, 0.0%, and 52% for CCSK, RCC, MRTK, and rES (summary figure). Low-risk tumors had 100% survival while the recurrent tumors had a median survival of 10.5 months. CONCLUSIONS: Non-Wilms renal tumors constitute a heterogeneous group of tumors, accounting for less than 20% of all renal tumors. Low-risk tumors are associated with excellent outcomes following surgery alone while the high-risk tumours have a variable outcome. MRTK and recurrent non-Wilms tumour have the worst survival. Favourable outcomes for CCSK and RCC and worst outcomes for MRTK were observed in this study. Renal ES have higher incidence of treatment failure and unsatisfactory outcomes. Recurrent non-Wilms tumours have an extremely poor outcome and more alternative or innovative approaches are needed for their treatment.

Robotic versus laparoscopic sphincter-preserving total mesorectal excision: A propensity case-matched analysis.

BACKGROUND: Robotic total mesorectal excision (R-TME) is expected to have advantages over laparoscopic total mesorectal excision (L-TME). The aim is to compare the short-term outcomes between initial cases of L-TME and RTME. MATERIALS AND METHODS: Among a total of 168 patients assigned to receive either R-TME (n = 84) or L-TME (n = 84), short term outcomes were compared between the groups by 1:1 propensity score matching of eight variables. RESULTS: The inter-sphincteric resection rate (42.9% vs. 25%; P = 0.006) and operative time (372.4 ± 102.8 vs. 301 ± 53.6, P = 0.000) were significantly greater in R-TME. The conversion rate, blood loss, and length of hospital stay were similar. The anastomotic leak rate and major surgical complications rates were significantly higher in L-TME (9.5% vs. 1.2%; P = 0.016) and (13.1% vs. 4.8%; P = 0.034) respectively. CONCLUSION: The oncologic quality and short-term outcomes in the two groups were comparable; however, anastomotic leak rates and major complications were significantly lower in R-TME. For experienced laparoscopic surgeons, robotic sphincter-saving TME is associated with lower morbidity when compared with laparoscopic approach.

Pulmonary metastasectomy of colorectal cancer origin: Evaluating process and outcomes.

BACKGROUND: This study was undertaken to evaluate the effect of change in policy of computed tomography (CT) scan of the thorax in staging and follow-up of colorectal cancer (CRC). Another objective was to review the outcomes following pulmonary metastasectomies (Pmets) and to determine the prognostic factors affecting outcomes. METHODS: This is a retrospective analysis from a prospective cohort database of patients, who underwent Pmet for CRC origin from August 2004 to February 2016. The outcome measures were number of Pmets per year, overall survival (OS), disease-free survival (DFS), and prognostic factors affecting survival. RESULTS: Of 71 patients, 38% (n = 27) underwent Pmet before 2013 and 62% ( n = 44) had surgery after 2013. The 2-year DFS after Pmet was 49.3% and estimated 5-year OS was 51.4% at a median follow-up of 28 months. There was a significant increase in number of Pmets/year ( P = 0.0015), increased detection of synchronous pulmonary metastasis (PM) ( P = 0.005), increased diagnosis of extra-pulmonary metastases (EPM) ( P = 0.005), and improved OS ( P = 0.026) after introduction of CT scan as staging tool. Site of primary tumor (colon) ( P = 0.045), primary nodal stage ( P = 0.009), and the presence of EPM ( P = 0.01) were independent important prognostic factors affecting survival. CONCLUSION: The CT scan of thorax as a baseline tool for staging and follow-up in CRC increases referral for pulmonary metastasectomy. Surgery achieves excellent prognosis and long-term survival outcomes in CRC with isolated PM and carefully selected patients with solitary liver metastasis.

Simultaneous bilateral laparoscopic adrenalectomy for pheochromocytoma in multiple endocrine neoplasia (MEN) syndrome: Case report with review literature.

INTRODUCTION: Laparoscopic adrenalectomy has gained favour as a preferred surgical approach in the multiple endocrine neoplasia (MEN) type 2 patients. Currently, there is limited literature on bilateral simultaneous laparoscopic adrenalectomy in MEN 2 syndrome. We reported two cases of bilateral pheochromocytoma associated with MEN 2 syndrome cured by simultaneous bilateral laparoscopic adrenalectomy. PRESENTATION OF CASE: First patient presented with big lips since childhood and episodic abdominal pain. On investigations, he was diagnosed with features of MEN 2B syndrome. Second patient was hypertensive and presented with abdominal pain. On evaluation she had features of MEN 2A syndrome. DISCUSSION: Minimally invasive approach was preferred in both cases. Bilateral simultaneous adrenalectomies were uneventfully done with acceptable operative time and blood loss with rapid perioperative recovery. These cases highlighted the feasibility of laparoscopic simultaneous bilateral adrenalectomy for pheochromocytomas in MEN 2 syndrome. CONCLUSION: Laparoscopic simultaneous bilateral adrenalectomy is a safe feasible and preferable technique for pheochromocytomas associated with MEN 2 syndrome.

Serum ßhCG and Lipid Profile in Early Second Trimester as Predictors of Pregnancy-Induced Hypertension.

OBJECTIVES: A variety of biological, biochemical, and biophysical markers implicated in the pathophysiology of pre-eclampsia during the last two decades have instigated the growing interest in this study to include both ßhCG and lipid profile studies in the early second trimester as early predictors of pregnancy-induced hypertension. Early identification of at-risk women may help in taking timely preventive and curative management to prevent or delay complications associated with pregnancy-induced hypertension. METHOD: A prospective study was performed on 120 patients attending the outpatient department of the Obstetrics and Gynaecology of the Maharaja Agrasen Hospital. All the patients were screened for serum ßhCG and serum lipid profile in their early second trimester (14-20 weeks) and followed up till their delivery. Comparative studies of serum ßhCG and serum lipid profile were performed between those who remain normotensive (group I) and those who developed pregnancy-induced hypertension (group II). RESULTS: TG, total cholesterol, VLDL, and LDL values for those women who developed PIH (group II) were significantly higher than those who remain normotensive (group I), with p value of <0.05 which is statistically significant. HDL and ßhCG values for group II were not higher than those in group I with p value >0.05 which is statistically insignificant. CONCLUSION: Maternal lipid profile in second trimester is very good noninvasive test which can be used for prediction of pregnancy-induced hypertension before its clinical onset. However, there is no correlation between maternal serum ßhCG and pregnancy-induced hypertension.