Clinico-pathologic profile and outcomes of pediatric endocrine patients managed by endocrine surgeons: Experience over three decades in a tertiary center in India.

BACKGROUND: Pediatric endocrine disorders requiring surgical intervention are rare and so are experienced surgeons dealing with these. The aim of the current study was to investigate disease profile and perioperative outcome of pediatric patients with surgical endocrine disorders in an endocrine surgery unit. METHODS: This retrospective study (Sep 1989-Aug 2019) consisted of pediatric endocrine surgery patients (<18 years) who were managed by a team of pediatric endocrinologists and endocrine surgeons at our center. Patients were divided into three cohorts consisting of a decade each. Clinico-pathologic variables, perioperative events operative and follow-up details were recorded. RESULTS: A total of 332 children were included and their mean age was 14.6 ± 3.9 years (M:F = 1:1.6). Thyroid disorders were most prevalent (59.8%), followed by adrenal (28.2%), parathyroid (10.4%), and pancreas (1.5%). Incidence of benign, malignant, and congenital/developmental disorders were 65.4, 28.1 and 8.3, respectively. Familial association was observed in 8.9% children, which is highest among pheochromocytoma patients. Overall, 201 thyroidectomies + associated procedures, 35 parathyroidectomies, 96 adrenal and paraganglioma resections, and 5 pancreatic procedures were performed. Median hospital stay was 5.6 ± 4.1 days. The number of cases increased significantly over 3 decades. Clinical profile and outcome did not vary except for significant decrease in incidence of malignant pathology (p = 0.04) and increase in VHL cases (p = 0.04) in the last decade though overall increase in familial cases was nonsignificant (p = 0.11). No perioperative mortality was observed except for 3% after adrenalectomy. CONCLUSION: A team of dedicated endocrine surgeons and pediatric endocrinologists is effective in management of pediatric endocrine surgery.

Artificial intelligence predicts normal summer monsoon rainfall for India in 2023.

Inaccuracy in the All Indian Summer Monsoon Rainfall (AISMR) forecast has major repercussions for India's economy and people's daily lives. Improving the accuracy of AISMR forecasts remains a challenge. An attempt is made here to address this problem by taking advantage of recent advances in machine learning techniques. The data-driven models trained with historical AISMR data, the Niño3.4 index, and categorical Indian Ocean Dipole values outperform the traditional physical models, and the best-performing model predicts that the 2023 AISMR will be roughly 790 mm, which is typical of a normal monsoon year.

Production of high-value oxidative enzymes by Cyathus bulleri on agricultural and agri-food wastes for application in the textile sector.

Ligninolytic and other oxidative enzymes have emerged as promising biocatalysts in several industries. Since their production at a low cost is necessary for any large-scale application, we demonstrate the use of rice bran (RB), an agricultural waste and agri-food wastes such as potato peelings (PP), banana peelings (BP), and green pea peelings (GPP) for their production. High activity of laccase (12 U/ml), manganese peroxidase (16.11 ± 1.43 U/ml), and aryl alcohol oxidase (1.25 U/ml) was obtained on the PP on the 12th day of growth and ~ 6 U/ml of lytic polysaccharide monooxygenase was obtained on the 14th day of growth demonstrating PP to be a good substrate for their production. RB served as the next best substrate for the production of these enzymes. While the GPP was effective for the production of laccase (9.2 U/ml), this and the BP were not good substrates for the production of other enzymes. Efficient (48-82%) decolorization of several azo-, triarylmethane- dyes, and real textile effluent, without the addition of any mediator, demonstrated the high oxidative ability of the crude culture filtrate produced on the PP (CF-PP), which was a significant improvement compared to the treatment given by the previously reported culture filtrate obtained on wheat bran (CF-WB). An extensive breakdown of Reactive Orange (RO) 16 was demonstrated using CF-PP resulting in the formation of a new product at m/z of 294.05 (6-acetamido-3,4-dioxo-3,4-dihydronapthalene-2-sulfonate), previously reported to be produced on ozonation/advanced oxidation of RO16. The predominant laccase and manganese peroxidase isoforms produced on the PP were also identified.

Detoxification and decolorization of complex textile effluent in an enzyme membrane reactor: batch and continuous studies.

There is an urgent need to look for bio-based technologies to address the pollution related to textile dyes in waterbodies. The aim of this study was to evaluate an engineered laccase variant, LCC1-62 of Cyathus bulleri, expressed in recombinant Pichia pastoris, for the decolorization and detoxification of real textile effluent. The partially purified laccase effectively (~60-100%) decolorized combined effluent from different dyeing units at a laccase concentration of 500 U/L at a 50-mL level. Decolorization and detoxification of the combined effluents, from a local textile mill, were evaluated at 0.3 L volumetric level in a ray-flow membrane reactor in batch and continuous modes of operation. In batch studies, maximum decolorization of 97% and detoxification of 96% occurred at a hydraulic retention time (HRT) of 6 h without any additional laccase requirement. In continuous studies, the reactor was operated at an HRT of 6 h with a lower enzyme dosage (~120 U/L of the effluent). Decolorization was accompanied by a loss in laccase activity which was restored to ~120 U/L by the addition of laccase in two regimes. The addition of laccase, when the residual laccase activity decreased to 40% (~50 U/L), resulted in high decolorization (~5 ppm residual dye concentration) and low variance (σ2) of 2.77, while laccase addition, when the residual dye concentration decreased to ~8% (~10 U/L), resulted in an average dye concentration of 13 ppm with a high variance of 62.08. The first regime was implemented, and the continuous reactor was operated for over 80 h at an HRT of 3 and 6 h, with the latter resulting in ~95% decolorization and 96% reduction in the mutagenicity of the effluent. Less than 10% membrane fouling was observed over long operations of the reactor. The findings strongly suggest the feasibility of using LCC1-62 in an enzyme membrane reactor for large-scale treatment of textile effluents.

Synthesis and molecular characterization of levan produced by immobilized Microbacterium paraoxydans.

In this study, we report high molecular weight (HMW) levan production by whole cells of Microbacterium paraoxydans, previously reported to be a good producer of fructooligosaccharides. Structural analysis of the extracellularly produced fructan indicated the glycosidic bonds between the adjacent fructose to be of ß-(2, 6) linkage with over 90% of the fructan to have molecular weight around 2 × 108 Da and 10% with a molecular weight of ∼20 kDa. Immobilization of the cells in Ca-alginate led to the production of 44.6 g/L levan with a yield of 0.29 g/g sucrose consumed. Factors affecting the conversion rate were identified by One-Factor-At-a-Time (OFAT) analysis and the combination of these (initial sucrose concentration of 400 g/L, 100 mM buffer pH 7, the temperature of 37 °C and 20 mM CaCl2) led to the production of ∼129 g/L of levan with a yield of ∼0.41 g/g sucrose consumed and volumetric productivity of 1.8 g/L/h.

Total vs less than total thyroidectomy for benign multinodular non-toxic goiter: an updated systematic review and meta-analysis.

BACKGROUND: We have performed an updated meta-analysis of randomized controlled trials (RCT) comparing total thyroidectomy (TT) with less than total thyroidectomy (LTT) for benign multinodular non-toxic goiter (BMNG). OBJECTIVES: The objective was to evaluate the effects and outcomes of TT as compared to LTT. METHODS: Eligibility criteria: RCTs comparing TT vs LTT. INFORMATION SOURCES: PubMed, Embase, Cochrane Library and online registers were searched for articles comparing TT with LTT. Risk of bias: Articles were assessed for risk of bias using the Cochrane's revised tool to assess risk of bias in randomized trials (RoB 2 tool). SYNTHESIS OF RESULTS: The main summary measures were risk difference using a random effects model. RESULTS: Five randomized controlled trials were included in the meta-analysis. Recurrence rate was lower for TT compared to LTT. Adverse events like temporary or permanent recurrent laryngeal nerve (RLN) palsy and permanent hypoparathyroidism were similar in both groups except for the rate of temporary hypoparathyroidism which was lower in the LTT group. DISCUSSION: All studies had unclear risk of bias for blinding of the participants and personnel and high risk of bias for certain selective reporting. This meta-analysis did not show any clear benefit or harm of either procedure (TT vs LTT) for goiter recurrence and re-operation rates (for both recurrence and incidental thyroid cancer). However, re-operation for goiter recurrence was significantly higher in the LTT group based on a single RCT. Evidence suggests increased rates of temporary hypoparathyroidism with TT but there was no difference in the rate of RLN palsy and permanent hypoparathyroidism between the two methods. The overall quality of evidence was low to moderate.

Seasonal dependent suitability of physical parameterizations to simulate precipitation over the Himalayan headwater.

The Himalayan ecosystem is fragile and needs robust management strategies for sustainability of natural resources such as water and vegetation. Therefore, reliable precipitation estimation becomes quite important from operational and regulation standpoints. It is crucial for numerous activities including policy/planning, agriculture, reservoir operations, disaster management, and others. In addition, reliable information on temporal variability of precipitation is also crucial for various applications such as agricultural and hydrological. The western Himalaya receives two distinct weather systems during summer and winter. Summer is responsible (largely) for rainfall and winter is for snowfall. Therefore, we hypothesize that there may not be a single set of parameterization schemes that can represent well both the weather systems. To investigate, we set up the WRF modeling system and performed six experiments with a combination of three microphysics (MP3, MP3, and WSM6) and two cumulus schemes (KF, and BMJ). It was found that the precipitation along the Himalayan foothills (near to basin terminal) is underestimated in four out of six experiments. Only experiments with BMJ cumulus scheme along with WSM6 and MP8 microphysics were able to show a considerable amount of precipitation along these foothills. It was noted that all six experiments showed high precipitation in the upstream region and over the mountain peaks and ridges in North-Western Himalaya. For DJF, each experiment was found to have large biases and none of them represented the observation with high confidence. However, the selection of observation reference data itself is a challenging task because of data paucity in this region. Therefore, the closest experiment to the most appropriate observation was selected as the reliable configuration (MP8_KF: MP8 microphysics and KF cumulus scheme) for DJF precipitation simulation. In this study we have, for the first time, reported the role of seasonal sensitivity for the climate scale simulations as we found that different schemes were suitable for different weather systems.

Cardiac Changes and Their Reversal Following Curative Surgery in Pheochromocytoma: PheoCard Prospective Cohort Study.

BACKGROUND: Pheochromocytoma and paraganglioma (PPGL) are catecholamine producing tumors of chromaffin cell origin, known to cause varied cardiovascular manifestations from hypertension to myocardial infarction. This study sought to objectively evaluate the cardiac changes in PPGL patients and their reversal following curative surgery. METHODS: The PheoCard study was registered in ClinicalTrials.gov (NCT05082311) and involved 35 consecutive PPGL patients managed as per standard protocol involving alpha blockade followed by curative surgery. They underwent detailed cardiac evaluation using 2D-echocardiography and speckle tracking echocardiography at the time of diagnosis, 7-10 days after alpha blockade, and at 7 days, 3 months, and 6 months after surgical removal. Age- and gender-matched essential hypertensives and healthy individuals (10 in each group) served as two control groups. RESULTS: Patients with PPGLs had significantly higher mean blood pressure, left ventricle end-diastolic dimension and volume (LVEDD, LVEDV), left ventricle end-systolic volume (LVESV), septal wall thickness, LV hypertrophy, lower mean LV ejection fraction (LVEF), early diastolic mitral annular velocity (E/A), decreased amplitude of LV longitudinal strain, and increased circumferential strain (p < 0.001) when compared with the control groups at baseline. After alpha blockade, there was marked reduction in the mean LVEDD, LVEDV, LVESV, and normalization of E/A ratio (p < 0.001) in the PPGL patients. Following curative surgery (normalization of fractionated urinary metanephrines at 7-10 days post-operatively), there was early improvement in all echocardiographic parameters and it continued to improve even at 6 months after surgery. There was marked improvement in the global longitudinal strain as seen on serial speckle tracking echocardiography with recovery of most of the segments of LV depicting the reversal of subclinical endocardial dysfunction (p < 0.001). CONCLUSION: PPGL patients despite normal systolic function have subclinical LV diastolic dysfunction which is reversed after curative surgery. TRIAL REGISTRATION: ClinicalTrials.gov NCT05082311.

Truncal Ligation of Inferior Thyroid Artery Does Not Affect the Incidence of Hypocalcaemia After Central Compartment Lymph Node Dissection.

Preserving all parathyroids with intact blood supply in situ is a desirable goal while performing total thyroidectomy (TT) and central compartment dissection (CCLND), but the same is not feasible in presence of bulky and/or matted lymph nodes in the central compartment. The aim of this study was to investigate the difference in incidence of postoperative hypocalcemia between the groups of papillary thyroid carcinoma (PTC) patients who had truncal ligation (TL) versus ligation of peripheral branches (PL) of inferior thyroid artery (ITA) during TT and CCLND. Retrospective review of prospectively kept data of PTC patients undergoing TT and CCLND. Patients were divided in two groups: Group 1-(n = 57) patients who had to undergo TL and Group 2-(n = 99) patients having PL. Clinico-pathologic profile, operative details and follow-up events were noted. Clinico-pathologic profile of both groups was comparable except for higher incidences of tumor multicentricity (p = 0.014) in Group 1. There was no significant difference in the number of parathyroids identified between the Groups (p = 0.556) but more parathyroids were auto-transplanted in Group 1 (p = 0.001). The incidence of temporary (77.2% vs 83.8, p = 0.304) and permanent hypocalcemia (7% vs 8.1%, p = 0.810) was not significantly different between the groups and neither was need for intravenous calcium. At discharge, Group 1 patients received lower dose of calcium (p = 0.001) but not of vitamin D (p = 0.769). TL of ITA during CCLND does not result in increased temporary or permanent hypocalcemia rate.

Circumferential Laryngotracheal Resection in Thyroid Cancer: Experience and Outcome in a Single Center.

There is limited experience of laryngotracheal resection in patients with differentiated thyroid carcinoma (DTC). The aim of this study was to report our experience of circumferential laryngotracheal resection in DTC and its long-term outcome. In this retrospective study, 10 patients of locally invasive DTC who underwent circumferential laryngotracheal resection between January 2000 and December 2015 were included. Clinicopathologic profile and follow up was noted. Mean age of the cohort was 50.1 ± 7.8 years (M:F = 1: 2.3). Papillary carcinoma was the commonest pathology (60%) followed by follicular carcinoma (20%), 10% each had Hurthle cell and poorly differentiated thyroid carcinoma. Sixty percent patients presented with recurrent or persistent disease and 20% with distant metastases. Vocal cord palsy was observed in 30%. Fifty percent patients underwent tracheal resection with end to end anastomosis and remaining laryngotracheal resection. Carotid artery resection and anastomosis was performed in one patient. Shin stage IV invasion was observed in 80% and stage III in remaining. There was no perioperative mortality. All patients received adjuvant radioiodine therapy and 40% external beam radiotherapy. Median follow up was 48 months. One patient who earlier had tracheal resection underwent total laryngectomy due to recurrent disease after 24 months. Forty percent patients developed distant metastases during follow-up. Mean survival was 77.8 months (CI = 63.0-92.5). Five-year overall survival was 60% and was significantly high in those without distant metastases (p = 0.006). The outcome of circumferential larygotracheal resections for DTC is excellent in terms of local disease control and long term survival.

Safe and Standard Thyroid Cancer Surgery, or Lack Thereof: Patterns and Correlates of Patient Referral to Tertiary Care Centre for Revision Thyroid Surgery in a LMIC.

Saroj Kanta MishraBackground A surgeon's characteristics such as volume and practice setup are essential elements in outcome of thyroid cancer. However, little information is available from the developing world regarding qualities of primary surgeon, such as level of knowledge, skill, and proper documentation while referring to higher center. Methods Records of 164 patients of differentiated thyroid cancer (DTC) from January 1990 to December 2018 undergoing revision thyroid surgery following primary surgery elsewhere were retrospectively analyzed. Results Out of 164 patients with postoperative diagnosis of DTC, referral patterns were as follows: low volume (LV) to high volume (HV) ( n = 120, 73.2%), followed by HV to HV ( n = 44, 26.8%). The primary surgery assessed by the extent of residual disease was in agreement with the documentation in only 55%. The type of thyroidectomy performed was not mentioned in 9.8%. The status of the parathyroid glands was mentioned only in 15.8% and recurrent laryngeal nerve in 12.2%. Less than recommended surgery was performed in 52.5% patients. Despite less than recommended surgery, 44.5% patients were directly referred for radioactive iodine ablation (RAIA). Thirty two percent patients were referred for RAIA after hemithyroidectomy. Central or lateral compartment lymphadenectomy, even after indication, was less likely at LV centers (risk ratio [RR], 0.71; 95% confidence interval [CI], 0.64-0.77). Similarly, for DTC patients, the relationship between LV center surgery and subsequent referral for RAIA was RR, 0.71 (95% CI, 0.48-1.02). Conclusions Most patients referred from LV surgeons are less likely to have proper thyroidectomy, have inadequate documentation of the primary surgery, and are referred for RAIA after less than total thyroidectomy. Our study highlights the lacunae in the approach to and understanding of thyroid cancer surgery by secondary care physicians in our country. We believe that there is an urgent necessity of educational reform and training to rectify this problem.

Pre-Operative Selective vs Non-Selective α-Blockade in Pheochromocytoma-Paraganglioma Patients Undergoing Surgery: A Meta-Analysis.

The main objective of this systematic review and meta-analysis was to review, assess and report on the studies that have evaluated selective alpha blockade (SAB) vs. non-selective alpha blockade (NSAB) therapy in patients undergoing surgery for pheochromocytomas and paragangliomas (PPGL). We performed a systematic search of electronic databases. A meta-analysis was conducted to examine the effectiveness of the two blockades. RevMan 5.3 was used for the meta-analysis. Of the eight articles that met the inclusion criteria, there was only one randomized control trial. Meta-analysis showed that there was no significant difference between the groups SAB and NSAB with regard to intra-operative systolic blood pressure (SBP) >160 mm Hg (relative risk (RR) 0.95 [95% CI 0.57, 1.56] P = 0·83) and intra-operative vasopressor requirement (RR 1.10 [95% CI 0.96, 1.26] P = 0·16). Meta-analysis revealed that there was a significant difference between the groups (SAB vs NSAB) with respect to post-operative vasopressor requirement (RR 1.66 [95% CI 1.0, 2.74] P = 0·05). There was no significant difference between the groups with respect to post-operative complications (RR 0.84 [95% CI 0.58, 1.22] P = 0·36). In conclusion, as patients blocked selectively may have a higher incidence of vasodilator requirement intra-operatively, NSAB offers some haemodynamic advantage over SAB. However, NSAB's real clinical benefit cannot be ascertained with the current studies as this difference did not result in any significant advantage over SAB with regard to morbidity or mortality.

Yeast-Mycelial Dimorphism in Pichia pastoris SMD1168 Is Triggered by Nutritional and Environmental Factors.

This study reports, for the first time, morphological transition from yeast-like to filamentous form, normally associated with pathogenicity/increased protein secretion, in Pichia pastoris SMD1168 strain. The response was recorded in response to nutritional and environmental cues. The factors affecting this switch were extracellular pH (under nitrogen starvation conditions), carbon and nitrogen source under nitrogen- and carbon-limiting conditions respectively. Under nitrogen-limiting conditions, addition of fructose and sucrose in the culture medium induced filamentous morphology in a segregated form whereas addition of galactose led to a mixture of yeast and the filamentous form of the cells. Under carbon-limiting conditions, isoleucine and proline forced a filamentous form whereas glycine, valine, alanine and phenylalanine promoted yeast-like morphology. Similar dimorphic shift was also displayed by a recombinant methanol slow utilizing (Muts) strain (SMD-GCSF Muts) producing human granulocyte colony-stimulating factor in response to change in the initial inoculum level. Analysis of the extracellular metabolome by GC-MS indicated that several amino acids (leucine, proline, tyrosine), carboxylic acids (phenylacetic-, propanoic acid), alcohols and butylamine were present at different levels in the culture broth of the two morphological forms. High accumulation of proline and butylamine was seen in the extracellular culture filtrate of the filamentous form of the yeast. Presence of quorum-sensing molecules (phenylethyl alcohol, dodecanol) suggested complex network of pathways involved in this morphological transition.

Potential future malaria transmission in Odisha due to climate change.

Future projections of malaria transmission is made for Odisha, a highly endemic region of India, through numerical simulations using the VECTRI dynamical model. The model is forced with bias-corrected temperature and rainfall from a global climate model (CCSM4) for the baseline period 1975-2005 and for the projection periods 2020s, 2050s, and 2080s under RCP8.5 emission scenario. The temperature, rainfall, mosquito density and entomological inoculation rate (EIR), generated from the VECTRI model are evaluated with the observation and analyzed further to estimate the future malaria transmission over Odisha on a spatio-temporal scale owing to climate change. Our results reveal that the malaria transmission in Odisha as a whole during summer and winter monsoon seasons may decrease in future due to the climate change except in few districts with the high elevations and dense forest regions such as Kandhamal, Koraput, Raygada and Mayurbhanj districts where an increase in malaria transmission is found. Compared to the baseline period, mosquito density shows decrease in most districts of the south, southwest, central, north and northwest regions of Odisha in 2030s, 2050s and 2080s. An overall decrease in malaria transmission of 20-40% (reduction in EIR) is seen during the monsoon season (June-Sept) over Odisha with the increased surface temperature of 3.5-4 °C and with the increased rainfall of 20-35% by the end of the century with respect to the baseline period. Furthermore, malaria transmission is likely to reduce in future over most of the Odisha regions with the increase in future warm and cold nights temperatures.

Outcome of 18f-Fluorodeoxyglucose Positron Emission Tomography (PET)-Directed Resections in Differentiated Thyroid Carcinoma (DTC): Experience in a Developing Country.

The aim of this study was to assess the accuracy of 18F-fluorodeoxyglucose positron emission tomography (18-FDG-PET scan) in localizing the disease in differentiated thyroid carcinoma patients undergoing re-operations. This is a retrospective analysis of a prospectively maintained data (December 2007 to December 2016). The patients included had elevated serum thyroglobulin (Tg) levels and negative iodine uptake (TENIS) and planned for re-operation with one or more accessible site of metastasis detected on FDG-PET scan. Clinical details, FDG-PET/CT findings, operative findings, histology, pre-, and post-operative Tg levels were recorded. Thirty-two patients were included. The mean age of the patients was 46.8 ± 15.8 years (M:F = 1:1.6) and mean pre-operative Tg value was 247.6 ± 92.3 ng/ml. FDG-PET disclosed a total of 77 hot spots in these 32 patients, 56 of which were surgically explored and resections performed. Patient- and lesion-based positive predictive value (PPV) of FDG-PET in detecting recurrent/metastatic DTC lesions was 87.5 and 71%, respectively. Remaining cases had granulomatous or nonspecific inflammatory lesions. A total of 12.5% of recurrent DTC patients explored could achieve biochemical cure. All these had disease confined to neck. Remaining patients continued to have high serum Tg level, though it fell substantially in majority of patients. False positive scans are frequent in regions with high prevalence of inflammatory diseases. Hence, FDG-PET directed re-operations should be taken up judiciously.

Medial Approach for Identification of Recurrent Laryngeal Nerve in Locally Advanced Differentiated Thyroid Carcinoma: Revisited.

Recurrent laryngeal nerve injury is a well-recognized and potentially catastrophic complication of thyroidectomy. In literature, four approaches have been described for identification of RLN, the superior, lateral, medial, and inferior approaches. But medial approach is lesser known amongst surgeons. Locally infiltrative thyroid cancer with extensive lymph nodal metastasis in central and lateral compartment sometimes makes it difficult to identify RLN by any of these standard approaches described above. A medial approach was described where RLN is identified as it extends up to interdigitate with the trunk or the branches of the inferior thyroid artery. We present here a new alternative technique for identification of recurrent laryngeal nerve through modified medial approach that was used in difficult thyroidectomies.

An overview of wind energy development and policy initiatives in India.

The Indian renewable energy sector has grown at a compounded annual growth rate of 15.51% in the last five years, where wind growth is about 8%. The Indian government has been adopting changes to create a safe, cheap, and sustainable energy system to fuel vigorous economic growth. The government has made significant efforts in ensuring universal access to energy, giving power to its residents. It is implementing a large-scale deployment of renewable energy, particularly solar and wind. This paper examines the country's wind sector in-depth, including the government policy, financial incentives, and accomplishments. The study goes on to discuss the prospects and problems of the wind sector, as well as solutions to overcome them to reach the estimated target of 140-150 GW by 2030. Wind power growth in the country has weakened in the last few years which may hamper the country's ambitious renewable energy targets. Wind industry is facing several hindrances ranging from discontinuation of incentives, land acquisition, DISCOM's poor health, change in bidding scheme, old wind sites, etc. Certain steps, such as repowering outdated wind farms, giving generation-based incentives, tax concessions, reassessing the country's wind potential, and constructing competitive renewable energy zones could aid in reviving the wind energy sector.

High level production of stable human serum albumin in Pichia pastoris and characterization of the recombinant product.

Human serum albumin (HSA) is an important therapeutic used in clinical settings for restoration of blood volume and treatment of chemotherapy induced neutropenia. Currently sourced from human serum, it carries the risk of contamination with viruses. The production of stable extracellular recombinant (r)HSA was achieved at nearly 1 g/L at shake-flask level in Pichia pastoris (syn. Komagataella phaffii) containing a three-copy containing HSA expression cassette, prepared in vitro. The HSA specific transcripts were increased by 1.82- to 2.46-fold in the three-copy containing clones indicating increased transcript levels to result in enhanced production of extracellular rHSA. The purified rHSA displayed secondary structure, zeta potential, size distribution and biological efficacy that matched with that of the commercial HSA. Cultivation strategy was developed at bioreactor level for the single HSA expression cassette containing recombinant which led to productivity of 300 mg/L/d of rHSA with minimum proteolytic cleavage.

Telemedicine: History and Success Story of Remote Surgical Education in India.

Initiation of telemedicine in medical education in India was at par with developed countries but acceptance and progress have been slow. However, the recent coronavirus disease-19 (COVID-19) pandemic leading to disruption of Halstedian model of surgical teaching has changed the traditional dynamics of perception of this mode of education. Sanjay Gandhi PostGraduate Institute of Medical Sciences (SGPGIMS), has been a pioneer and introduced the telemedicine system into surgical education as early as in year 2001. In this article, we reviewed the literature on tele-education in surgical field in Indian scenario, with particular emphasis on tele-education activities at the SGPGIMS, with respect to current thinking and future prospects on surgical training.

Clinical, Biochemical, Tumoural and Mutation Profile of VHL- and MEN2A-Associated Pheochromocytoma: A Comparative Study.

OBJECTIVE: To compare clinical, biochemical, tumoural and mutational characteristics of Von Hippel Lindau Syndrome (VHL)-associated pheochromocytoma (PCC) to multiple endocrine neoplasia 2A (MEN2A)-associated pheochromocytoma. DESIGN: Retrospective study design in a tertiary health care centre in Northern India. METHODS: A total of 47 patients with biochemical and histologically proven pheochromocytoma/paraganglioma (PCC/PGL): 29 associated with VHL and 18 with MEN2A, were divided in two cohorts, respectively. Analysis of their medical records along with a prospective follow-up was done. RESULTS: There were more children <19 years in VHL group (13 vs 1). Despite majority of VHL-PCC showing elevation of normetanephrine (NMN) (93%) as compared to MEN2A-PCC (22.2%), 75.8% presented with hypertension as compared to MEN2A (33.3%). The average size of VHL-PCC tumours was 5.66 cm. VHL-PCC as compared to MEN2A-PCC were multifocal (75% vs 61.1%), bilateral synchronous (72.4 vs 61.1%) and extra-adrenal (17.2% vs 0%). Both VHL (24%) and MEN2A-PCC (27.7%) showed multiple nodules, but more MEN2A PCC showed extra-tumoural hyperplasia (44.4% vs. 6.8%). In VHL, the commonest mutation (n = 17) was missense mutation with a hot spot on exon 3, while in MEN2A-PCC majority (66.6%) had 634 mutation in exon 11 and only 2 patients had the rare 611 mutation in exon 10. CONCLUSION: In contrast to world literature, our study suggests Indian VHL-PCC can be symptomatic in spite of noradrenergic phenotype, large in size and multifocal. Multiple nodules in VHL-PCC could increase risk of recurrence following subtotal adrenalectomy.