Safety of robotic cholecystectomy as index training procedure: the UK experience.

AIMS: To evaluate the safety profile of robotic cholecystectomy performed within the United Kingdom (UK) Robotic Hepatopancreatobiliary (HPB) training programme. METHODS: A retrospective evaluation of prospectively collected data from eleven centres participating in the UK Robotic HPB training programme was conducted. All adult patients undergoing robotic cholecystectomy for symptomatic gallstone disease or gallbladder polyp were considered. Bile duct injury, conversion to open procedure, conversion to subtotal cholecystectomy, length of hospital stay, 30-day re-admission, and post-operative complications were the evaluated outcome parameters. RESULTS: A total of 600 patients were included. The median age was 53 (IQR 65-41) years and the majority (72.7%; 436/600) were female. The main indications for robotic cholecystectomy were biliary colic (55.5%, 333/600), cholecystitis (18.8%, 113/600), gallbladder polyps (7.7%, 46/600), and pancreatitis (6.2%, 37/600). The median length of stay was 0 (IQR 0-1) days. Of the included patients, 88.5% (531/600) were discharged on the day of procedure with 30-day re-admission rate of 5.5% (33/600). There were no bile duct injuries and the rate of conversion to open was 0.8% (5/600) with subtotal cholecystectomy rate of 0.8% (5/600). CONCLUSION: The current study confirms that robotic cholecystectomy can be safely implemented to routine practice with a low risk of bile duct injury, low bile leak rate, low conversion to open surgery, and low need for subtotal cholecystectomy.

Atypical Presentation of Gall Bladder Adenocarcinoma as Paraneoplastic Myeloneuropathy.

ABSTRACT: Paraneoplastic neurologic syndromes are a rare, heterogeneous group of complications associated with malignancy, unrelated to direct tumor invasion or metastasis. They are the remote effects of a malignancy owing to immune-mediated reaction toward the antigens that are common to both the malignant and normal cells. Few paraneoplastic syndromes are reported with gall bladder cancer. However, neurological symptoms are infrequent. Here we share an interesting case of adenocarcinoma of gall bladder with initial presentation as a paraneoplastic noncompressing myeloneuropathy.

Presentation of metastatic carotid body paraganglioma on F-18 FDG PET/CT: a rare disease.

Carotid body paraganglioma is a slow growing tumor of head and neck region. It can rarely be malignant in nature which is characterized by distant metastases on anatomical imaging. We share an interesting presentation of a malignant carotid body on F-18 FDG PET/CT in form of liver and skeletal metastases.

Impact of Cr Doping on the Structural, Optical, and Magnetic Properties of Sol-Gel-Synthesized Bi0.80Ba0.10Pr0.10FeO3 Nanopowders.

The sol-gel route was used to synthesize a series of compounds of the system Bi0.8Ba0.10Pr0.10Fe1-x Cr x O3 within the 0 ≤ x ≤ 0.15 compositional range. To explore the impact of Cr3+ ion substitution on the structural, dielectric, optical, and magnetic properties, we introduced varying concentrations of Cr3+ while maintaining a fixed 10% atomic concentration of each Ba2+ and Pr2+ in BiFeO3. X-ray diffraction analysis revealed a structural phase transition from rhombohedral (R3c) for an undoped (i.e., without Cr) sample to two coexisting phases, i.e., a mix of rhombohedral and orthorhombic (Pbnm) phases for the Cr-doped samples. Cr3+ doping significantly changes the band gap energy from 1.84 eV (x = 0.0) to 1.93 eV (x = 0.15), which makes this material suitable for photovoltaic applications. Furthermore, each sample exhibited ferromagnetic behavior due to the disruption of the spiral spin structures and adjustments in superexchange interactions, attributed to modifications in the Fe-O and Fe-O-Fe bond lengths. A reduction in magnetization is observed at higher Cr concentrations that can be ascribed to the dilution of magnetic moments due to the increase of the orthorhombic phase percentage and the introduction of nonmagnetic Cr3+ ions. Our results show that Cr doping in the Bi0.8Ba0.10Pr0.10FeO3 system induces enhanced multiferroic properties at room temperature.

Inoculants of Arbuscular Mycorrhizal Fungi Influence Growth and Biomass of Terminalia arjuna under Amendment and Anamendment Entisol.

Entisol soil is hard and compact in nature, rendering it high in bulk density, which influences root penetration adversely and thereby poor plant growth. In this experiment, used seven treatments in different combination in normal soil, were used as growth media for the Terminalia arjuna seedling. T3 (60% entisol) found the best as it gave the highest biomass in the species regardless of arbuscular mycorrhizal fungi (AMF) treatment. AMF treatment enhanced the growth and biomass of plants significantly in all the given treatments. AMF colonization observed a maximum in tertiary roots. T1 (100% entisol soil) exhibited the highest degree of AMF colonization in tertiary roots, resulting in the highest mycorrhiza dependency of plants for this soil. The addition of normal soil to entisol soil was found to decrease the bulk density, resulting in increased root diameter, and T3 plants exhibited the highest biomass and AMF compatibility for T. arjuna species. The T. arjuna plant's growth and biomass responded positively to AMF in all types of treatments. The plant's growth and biomass were highest in the T3 treatment, which had a bulk density of 1.50 g/cm3. In this study, we combined the entisol with mycorrhizal inoculation of the nursery growing medium to promote plant growth and biomass, improve the plant's ability to hold water and absorb nutrients, and lower the entisol's bulk density. The T. arjuna (Roxb) plant responds very favorably to mycorrhiza inoculation in nursery conditions with the entisol growth medium.

Functional network copolymeric hydrogels derived from moringa gum: Physiochemical, drug delivery and biomedical properties.

The article explores the synthesis of network hydrogels derived from moringa gum (MG) through a grafting reaction with poly (vinylsulfonic acid) and carbopol. These hydrogels are designed for use in drug delivery (DD) and wound hydrogels dressing (HYDR) applications. The copolymers were characterized by FESEM, EDX, AFM, FTIR, 13C NMR, XRD and DSC. Tetracycline release from hydrogel occurred gradually with a non-Fickian diffusion and was best described by the Hixson-Crowell kinetic model in artificial wound fluid. The HYDR demonstrated compatibility with blood, exhibited antioxidant properties and possessed tensile strength, in addition to their mucoadhesive characteristics. The copolymer dressings absorbed approximately 7 g of simulated fluid. The copolymers exhibited significant antioxidant activity, measuring at 84 % free radicals scavenging, during DPPH assay. These dressings demonstrated permeability to H2O and O2,. The hydrogel alone did not reveal antibacterial activities; however, when combined with antibiotic drug tetracycline, the dressings revealed notable antibacterial activities against Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli. The observed biomedical properties suggested that these hydrogels could serve as promising materials for drug delivery HYDR applications.

Navigating the Pedagogical Landscape: Exploring the Implications of AI and Chatbots in Nursing Education.

This viewpoint paper explores the pedagogical implications of artificial intelligence (AI) and AI-based chatbots such as ChatGPT in nursing education, examining their potential uses, benefits, challenges, and ethical considerations. AI and chatbots offer transformative opportunities for nursing education, such as personalized learning, simulation and practice, accessible learning, and improved efficiency. They have the potential to increase student engagement and motivation, enhance learning outcomes, and augment teacher support. However, the integration of these technologies also raises ethical considerations, such as privacy, confidentiality, and bias. The viewpoint paper provides a comprehensive overview of the current state of AI and chatbots in nursing education, offering insights into best practices and guidelines for their integration. By examining the impact of AI and ChatGPT on student learning, engagement, and teacher effectiveness and efficiency, this review aims to contribute to the ongoing discussion on the use of AI and chatbots in nursing education and provide recommendations for future research and development in the field.

A Unique Case of Eight Fetuses in a Single Fetu.

Fetus in fetu is a rare congenital anomaly in which a malformed parasitic twin is found within the body of a living child or adult. In this case report, a 1-day-old child presented with a large firm abdominal mass on the left side of the upper abdomen. Imaging studies misdiagnosed the mass as an intraperitoneal benign dermoid cyst displacing the bowel loops and internal viscera. A surgical resection was performed on 21 days of life, and pathology confirmed eight fetuses inside the cyst.

Comparison of bone health among pre-menopausal and post-menopausal females in rural Eastern India: A pilot study.

PURPOSE: The aim of this study was to identify the at-risk female population (pre- and post-menopausal), identify the risk factors for low bone mineral density (BMD) and assess the knowledge of the subjects regarding osteoporosis by Osteoporosis Knowledge Assessment Tool (OKAT) in both the groups and to determine areas for early intervention in a predominantly rural and tribal area of Eastern India. STUDY DESIGN: This was a cross-sectional hospital-based study conducted in a predominant tribal and rural area of Eastern India. Females who were pre- and post-menopausal without a prior diagnosis of osteoporosis were included in the study. MAIN OUTCOME MEASURES: Factors affecting osteoporosis and quantified knowledge regarding the disease. RESULTS: A total of 388 females were included in the study (pre-menopausal = 190 and post-menopausal = 198). Although no significant difference was noted in the age at menarche between both the groups, a gradual significant shift in the age at menarche was noted in the younger females (p = .031). The mean OKAT score in the pre-menopausal and post-menopausal group was 9.5 ± 3.4 and 9.2 ± 3.5, respectively. 80% of females in the pre-menopausal group had normal T-scores whereas only 25% of the females in the post-menopausal group had normal T-scores. CONCLUSION: Targeted educational programs which influence the preventive health behaviour in general and osteoporosis knowledge in particular would bridge this gap. Peer-led community intervention programs which focus on behaviour change with respect to lifestyle and diet modification in the younger population should be the step ahead to reduce the prevalence of the disease.

Synthesis of Vanadyl Complexes of N-Confused Porphyrins and Their Bromoperoxidase-like Catalytic Activity.

Two new vanadyl complexes of N-confused porphyrins (NCPs), [VONCTPP] (V-1) and [VONCP(OMe)8] (V-2), have been synthesized for the first time and investigated as a catalyst for the oxidative bromination reaction of phenol and its derivatives. This article further delineates crystal structures, photophysical, and redox properties of both the vanadyl complexes. Complexes V-1 and V-2 exhibited a significant red shift in their absorption spectra compared with their respective free bases. The single-crystal structure of V-1 revealed that the complex is in the 2H tautomeric form, while EPR studies revealed the +4 oxidation state of vanadium metal having an axial compression with dxy1 configuration. Catalytic potential for bromoperoxidases-like activity has been explored for both complexes V-1 and V-2 for the first time in NCP chemistry with excellent TOF values (4.7-6.3 s-1 for V-1 and 7.3-8.7 s-1 for V-2) using KBr as a source of bromine and H2O2 as a green oxidant in aqueous acidic medium at 298 K. Notably, both catalysts show excellent recyclability over five cycles. The vanadyl-metalated NCPs exhibit excellent stability in the air.

Microenvironment shapes small-cell lung cancer neuroendocrine states and presents therapeutic opportunities.

Small-cell lung cancer (SCLC) is the most fatal form of lung cancer. Intratumoral heterogeneity, marked by neuroendocrine (NE) and non-neuroendocrine (non-NE) cell states, defines SCLC, but the cell-extrinsic drivers of SCLC plasticity are poorly understood. To map the landscape of SCLC tumor microenvironment (TME), we apply spatially resolved transcriptomics and quantitative mass spectrometry-based proteomics to metastatic SCLC tumors obtained via rapid autopsy. The phenotype and overall composition of non-malignant cells in the TME exhibit substantial variability, closely mirroring the tumor phenotype, suggesting TME-driven reprogramming of NE cell states. We identify cancer-associated fibroblasts (CAFs) as a crucial element of SCLC TME heterogeneity, contributing to immune exclusion, and predicting exceptionally poor prognosis. Our work provides a comprehensive map of SCLC tumor and TME ecosystems, emphasizing their pivotal role in SCLC's adaptable nature, opening possibilities for reprogramming the TME-tumor communications that shape SCLC tumor states.

Preparation and Judd-Ofelt Analysis of Warm Red Luminescent Eu3+ Complexes for Semiconductor Lasing Devices.

Six novel red photoluminescent Eu3+ complexes with 3-formyl chromone as the primary sensitizer (L) were synthesized using the solution precipitation method. These complexes are [Eu(L3).X] where X is 2H2O (C1), phen (C2), neo (C3), bipy (C4), dmph (C5), and biquno (C6). These complexes were characterized by elemental analysis, EDAX analysis, SEM, FT-IR, thermo-gravimetric analysis (TGA/DTA) and photoluminescence spectra. The transition rates, quantum efficiency, and J-O intensity parameters were calculated using emission data and luminescence decay time (τ). Complexes exhibit a strong emission peak (5D0 → 7F2) of the Eu3+ ion in their luminescence emission spectra in solid and solution states, making them an effective emitter of the red color in OLEDs. The branching ratio of these complexes ranges from 80.67-82.92 in solid and 50.53-62.65 in solution state; CIE color coordinate of complexes falls in the red region. The color purity ranges [CP(%)] values for solid 95.26-97.27% and for solution ranges 85.11-93.43%. Correlated color temperature (CCT) of the complexes (C1-C6) ranged from 2710 to 3049 K in the solid state and 1775 to 2450 K in the solution state. These complexes are promising red emitters in OLEDs, semiconductors, and leasing devices.

Prevalence of internet addiction and its relationship with insomnia, depression, anxiety, and stress among medical students of a tertiary care medical institute of Eastern India.

Background: Internet has become an integral part of our daily lives but as the use of internet is increasing, it is important to be aware of the prevalence, context, and impact of its addiction on sleep and the presence of anxiety, depression, and stress in our lives. Aim: To assess the prevalence of internet addiction and its association with insomnia, depression, anxiety, and stress among medical students in a tertiary care medical institute in Eastern India. Materials and Methods: A descriptive cross-sectional questionnaire-based study with a purposive sampling method was conducted among 420 undergraduate medical students of different professional years. Out of 420 medical students, 413 students who gave consent and returned complete performa were taken in the study using a semi-structured performa for sociodemographic details, Young's Internet Addiction Test, Insomnia Severity Index, and Depression Anxiety Stress Scale. Results: We found 31.2% of students had internet addiction, 24.2% had clinical insomnia, 58.1% had stress, 68.8% had anxiety, and 64.6% had depression. Potential internet addiction was significantly related to average screen time, insomnia, stress, anxiety, and depression. Conclusions: Internet addiction is prevalent among medical students affecting sleep, anxiety, depression, and stress, which needs urgent preventive strategies.

Gender differences in quality of life of vitiligo patients attending a tertiary care center.

Background: Vitiligo is a common depigmenting dermatosis characterized by milky-white macules or patches. Any pathological discoloration of the skin has been linked to an impact on the body image of an individual, and vitiligo has been linked to decreased self-esteem and poor socialization of the affected people. In Indian society, vitiligo is labeled as Shweta-Kushta (i.e., white-colored leprosy) and is compared to leprosy-a more stigmatizing skin condition. Aim: This study aims to study gender-related differences in the quality of life of Indian vitiligo patients. Methodology: In this hospital-based cross-sectional study, a total of 55 vitiligo patients (females 25 and males 30) were enrolled using the purposive sampling technique. The sample was assessed on Dermatology Life Quality Index (DLQI) questionnaire, Rosenberg Self-Esteem Scale (RSS), and General Health Questionnaire-12 (GHQ-12) to assess their quality of life, self-esteem, and psychological well-being, respectively. The gender differences in sociodemographic and clinical details as well as their relationship with the quality of life of the patients were sought with the help of appropriate statistical measures. Results: The patients of both genders were comparable in terms of all sociodemographic and clinical variables except the females being less educated and employed than the males. There was a statistically significant trend of higher mean DLQI total score in females than males (6.6 ± 3.55 vs 4.8 ± 2.71, Mann-Whitney U = 263.5, P =0.058). Significantly, the average DLQI score in female vitiligo patients was negatively related to family income (r s = -.659, P <.001) and it was significantly higher for the patients from a rural background than those from an urban background (8.55 ± 3.30 vs 5.07 ± 3.03, Mann-Whitney U = 33.5, P <.05). The average DLQI score was negatively correlated to RSS score but positively correlated to GHQ-12 score in patients of both genders. Conclusion: The quality of life of female patients with vitiligo is poorer than the same in male patients. The poor financial condition of families and rural living are two factors related to the poorer quality of life of female patients. A poorer quality of life in vitiligo patients of both genders is linked with decreased self-esteem and decreased psychological well-being. Gender-related issues in the quality of life and the overall well-being of such patients are important in their management and policy-making.

Privacy-preserving blockchain-based federated learning for brain tumor segmentation.

Improved data sharing between healthcare providers can lead to a higher probability of accurate diagnosis, more effective treatments, and enhanced capabilities of healthcare organizations. One critical area of focus is brain tumor segmentation, a complex task due to the heterogeneous appearance, irregular shape, and variable location of tumors. Accurate segmentation is essential for proper diagnosis and effective treatment planning, yet current techniques often fall short due to these complexities. However, the sensitive nature of health data often prohibits its sharing. Moreover, the healthcare industry faces significant issues, including preserving the privacy of the model and instilling trust in the model. This paper proposes a framework to address these privacy and trust issues by introducing a mechanism for training the global model using federated learning and sharing the encrypted learned parameters via a permissioned blockchain. The blockchain-federated learning algorithm we designed aggregates gradients in the permissioned blockchain to decentralize the global model, while the introduced masking approach retains the privacy of the model parameters. Unlike traditional raw data sharing, this approach enables hospitals or medical research centers to contribute to a globally learned model, thereby enhancing the performance of the central model for all participating medical entities. As a result, the global model can learn about several specific diseases and benefit each contributor with new disease diagnosis tasks, leading to improved treatment options. The proposed algorithm ensures the quality of model data when aggregating the local model, using an asynchronous federated learning procedure to evaluate the shared model's quality. The experimental results demonstrate the efficacy of the proposed scheme for the critical and challenging task of brain tumor segmentation. Specifically, our method achieved a 1.99% improvement in Dice similarity coefficient for enhancing tumors and a 19.08% reduction in Hausdorff distance for whole tumors compared to the baseline methods, highlighting the significant advancement in segmentation performance and reliability.

5-HTP inhibits eosinophilia via intracellular endothelial 5-HTRs; SNPs in 5-HTRs associate with asthmatic lung function.

Background: Previous research showed that 5-hydroxytryptophan (5HTP), a metabolic precursor of serotonin, reduces allergic lung inflammation by inhibiting eosinophil migration across endothelial monolayers. Objective: It is unknown if serotonin receptors are involved in mediating this 5HTP function or if serotonin receptor (HTR) single nucleotide polymorphisms (SNPs) associate with lung function in humans. Methods: Serotonin receptor subtypes were assessed by qPCR, western blot, confocal microscopy, pharmacological inhibitors and siRNA knockdown. HTR SNPs were assessed in two cohorts. Results: Pharmacological inhibition or siRNA knockdown of the serotonin receptors HTR1A or HTR1B in endothelial cells abrogated the inhibitory effects of 5HTP on eosinophil transendothelial migration. In contrast, eosinophil transendothelial migration was not inhibited by siRNA knockdown of HTR1A or HTR1B in eosinophils. Surprisingly, these HTRs were intracellular in endothelial cells and an extracellular supplementation with serotonin did not inhibit eosinophil transendothelial migration. This is consistent with the inability of serotonin to cross membranes, the lack of selective serotonin reuptake receptors on endothelial cells, and the studies showing minimal impact of selective serotonin reuptake inhibitors on asthma. To extend our HTR studies to humans with asthma, we examined the CHIRAH and GALA cohorts for HTR SNPs that affect HTR function or are associated with behavior disorders. A polygenic index of SNPs in HTRs was associated with lower lung function in asthmatics. Conclusions: Serotonin receptors mediate 5HTP inhibition of transendothelial migration and HTR SNPs associate with lower lung function. These results may serve to aid in design of novel interventions for allergic inflammation.

Spectrum of Multiple Congenital Anomalies-Hypotonia-Seizures Syndrome 3 (MCAHS3) Due to Phosphatidylinositol Glycan Biosynthesis Class T (PIGT) Gene Mutations: A Narrative Review.

Multiple congenital anomalies-hypotonia-seizures syndrome 3 (MCAHS3) results from mutations in the phosphatidylinositol glycan biosynthesis class T (PIGT) gene leading to defects in glycosylphosphatidylinositol transamidase complex (GPI-TA) synthesis. Glycosylphosphatidylinositol serves as an anchor to more than 150 mammalian proteins for attachment on cell surfaces, enabling specific functional properties. Mutations in the PIGT gene result in disruption of this extremely important post-translational protein modification, yielding dysfunctional proteins leading to MCAHS3. An exhaustive literature search was conducted across various electronic databases to reveal only 41 reported cases of MCAHS3 worldwide, emphasizing the rarity of this condition. Multiple congenital anomalies-hypotonia-seizures syndrome 3 has been reported as secondary to 18 different known PIGT variants to date, manifesting as a varying spectrum of craniofacial dysmorphism, developmental delay with epilepsy, cardiac and renal malformations, and unique features in biochemical testing and neuroimaging. This review aims to highlight the constellation of clinical symptoms, diagnostic modalities, and management challenges associated with MCAHS3 cases. It would help determine optimal diagnostic and treatment strategies for newly identified cases and facilitate new research on this rare condition.

Engineering the physical properties and photocatalytic activities of a ß-ketoenamine COF using continuous flow synthesis.

Covalent Organic Frameworks (COF) having conjugated backbone are an interesting class of metal-free, visible light active, heterogeneous photocatalysts. Interestingly, synthesis of COF using continuous flow process has emerged as an efficient, alternative method when compared to the traditional batch process. Here, we demonstrate the possibility to engineer the physical properties and hence the adsorption and catalytic activities of a ß-ketoenamine COF by varying monomer flow rate and microreactor design during the continuous flow synthesis. Crystallinity of the COF increases on varying the monomer flow rate from 100 (S-100) to 500 (S-500) and up to 1000 µLmin-1 (S-1000), in an S-shaped microreactor, resulting in an enhanced surface area: 525, 722 and 1119 m2g-1 respectively. The photophysical properties of the COF are also found to vary significantly with the change in flow synthesis conditions. S-1000 is characterized by the highest adsorption of MB, due to its high surface area and accessible pores. On the other hand, S-500 shows the highest photocurrent, a low recombination of photogenerated charges and the lowest charge transfer resistance. Thus, S-500 is found to be the best photocatalyst for the removal of a model pollutant (methylene blue, MB). Further, enhanced photocatalytic removal of MB using S-500 could be achieved by performing the photocatalysis in continuous flow.

Effectiveness of respiratory face masks in reducing acute PM2.5 pollution exposure during peak pollution period in Delhi.

The cities of North India, such as Delhi, face a significant public health threat from severe air pollution. Between October 2021 and January 2022, 79 % of Delhi's daily average PM2.5 (Particulate matter with an aerodynamic diameter ≤ 2.5 µm) values exceeded 100 µg/m3 (the permissible level being 60 µg/m3 as per Indian standards). In response to this acute exposure, using Respiratory Face Masks (RFMs) is a cost-effective solution to reduce immediate health risks while policymakers develop long-term emission control plans. Our research focuses on the health and economic benefits of using RFMs to prevent acute exposure to PM2.5 pollution in Delhi for different age groups. Our findings indicate that, among the fifty chosen RFMs, M50 has greatest potential to prevent short-term excess mortality (908 in age ranges 5-44), followed by M49 (745) and M48 (568). These RFMs resulted in estimated economic benefits of 500.6 (46 %), 411.1 (37 %), and 313.4 (29 %) million Indian Rupee (INR), respectively during October-January 2021-22. By wearing RFMs such as M50, M49, and M48 during episodes of bad air quality, it is estimated that 13 % of short-term excess mortality and associated costs could be saved if at least 30 % of Delhi residents followed an alert issued by an operational Air Quality Early Warning System (AQEWS) developed by the Ministry of Earth Sciences. Our research suggests that RFMs can notably decrease health and economic burdens amid peak PM2.5 pollution in post-monsoon and winter seasons until long-term emission reduction strategies are adopted. It is suggested that an advisory may be crafted in collaboration with statutory bodies and should be disseminated to assist the vulnerable population in using RFMs during winter. The analysis presented in this research is purely science based and outcomes of study are in no way to be construed as endorsement of product.