Correction to: Indian sarsaparilla, Hemidesmus indicus (L.) R. Br. ex Schult: tissue culture studies.

Following publication of the original article (Kher et al. 2020), the authors identified following mistake in the author affiliation.

Indian sarsaparilla, Hemidesmus indicus (L.) R. Br. ex Schult: tissue culture studies.

Hemidesmus indicus (L.) R. Br. ex Schult is commonly known as anantmul or Indian sarsaparilla. The roots of this plant, which display a wide range of medicinal, biological, and phytopharmaceutical properties, are used in the pharmaceutical and food industries. Conventionally, the plant is propagated by seed germination or vegetatively, but the efficacy of traditional methods has some limitations: plants derived from seed germination are prone to seed-borne diseases, or plantlet production using vegetative propagation is limited. In contrast, plant tissue culture allows for large-scale propagation and secondary metabolite production in vitro without sacrificing plants from their natural habitats. Many efforts have been made over 40 years of research to establish efficient micropropagation protocols to speed up cultivation of this plant, including callus-mediated in vitro propagation, somatic embryogenesis, and shoot multiplication using cotyledenory nodes, stem segments, shoot tips, and nodal explants. Among these explants, nodal explants are the most commonly used for H. indicus micropropagation. The application of adenine sulfate, citric acid, ascorbic acid, and arginine may be useful in preventing explant browning, premature leaf senescence, and shoot tip abscission during in vitro culture. This review provides insight into micropropagation, use of synthetic seeds for short-term germplasm preservation, and in vitro production of secondary metabolites such as 2-hydroxy-4-methoxybenzaldehyde, lupeol, vanillin, and rutin, from in vitro root and callus cultures. Furthermore, unexplored and possible innovative areas of research in Hemidesmus biotechnology are also discussed. KEY POINTS: • Hemidesmus indicus has multiple therapeutic applications. • H. indicus roots are used in confectionary and pharmacy. • This review comprehensively assesses H. indicus tissue culture. • Challenges and future research of H. indicus biotechnology are discussed.

Drain Usage in Head and Neck Surgery: A National Survey of Thirty-five Surgeons across Ten Units

Introduction Drain usage is commonplace in head and neck surgery. There is an increasing body of literature disputing their routine placement in certain procedures. The aim of this study is to explore modern-day practice in terms of drain usage and the use of haemostatic agents. Methods A simple questionnaire was devised and sent to 35 ENT Surgeons across 10 units nationally. Results There was an overall response rate of 77.1% (n=27). There was considerable heterogeneity amongst surgeons in terms of indication for insertion, how the decision is made to remove the drain and if any alternative/adjunctive haemostatic agents are being used. Discussion The management of drains is poorly defined and guidelines are lacking. With increased pressure on resources, the risk of infection and discomfort to the patient, further reflection is required to evaluate if careful patient selection rather than habitual drain insertion in every case is more appropriate.

Sandalwood: basic biology, tissue culture, and genetic transformation.

MAIN CONCLUSION: Sustainable resource preservation of Santalum species that yield commercially important forest products is needed. This review provides an understanding of their basic biology, propagation, hemi-parasitic nature, reproductive biology, and biotechnology. Many species of the genus Santalum (Santalaceae) have been exploited unremittingly for centuries, resulting in the extinction of one and the threatened status of three other species. This reduction in biodiversity of sandalwood has resulted from the commercial exploitation of its oil-rich fragrant heartwood. In a bid to conserve the remaining germplasm, biotechnology provides a feasible, and effective, means of propagating members of this genus. This review provides a detailed understanding of the biological mechanisms underlying the success or failure of traditional propagation, including a synopsis of the process of hemi-parasitism in S. album, and of the suitability of host plants to sustain the growth of seedlings and plants under forestry production. For the mass production of economically important metabolites, and to improve uniformity of essential oils, the use of clonal material of similar genetic background for cultivation is important. This review summarizes traditional methods of sandalwood production with complementary and more advanced in vitro technologies to provide a basis for researchers, conservationists and industry to implement sustainable programs of research and development for this revered genus.

Biotechnological advances in Vitex species, and future perspectives.

Vitex is a large genus consisting of 230 species of trees and shrubs with multiple (ornamental, ethnobotanic and pharmacological) uses. Despite this, micropropagation has only been used to effectively propagate and preserve germplasm a limited number (six) of Vitex species (V. agnus-castus, V. doniana, V. glabrata, V. negundo, V. rotundifolia, V. trifolia). This review on Vitex provides details of published micropropagation protocols and perspectives on their application to germplasm preservation and in vitro conservation. Such details serve as a practically useful user manual for Vitex researchers. The importance of micropropagation and its application to synthetic seed production, in vitro flowering, production of secondary metabolites, and the use of molecular markers to detect somaclonal variation in vitro, are also highlighted.

Nonfatal air embolism during shoulder arthroscopy.

An air embolism is a rare but potentially fatal complication of shoulder arthroscopy. In this article, we report the case of a patient who developed a nonfatal air embolism during shoulder arthroscopy for an acute bony Bankart lesion and a greater tuberosity avulsion fracture. The venous air embolism occurred immediately after the joint was insufflated with air for diagnostic air arthroscopy. The diagnosis was based on a drop in end-tidal carbon dioxide and blood pressure and presence of mill wheel (waterwheel) murmur over the right heart. Supportive treatment was initiated immediately. The patient recovered fully and had no further complications of air embolism. This patient's case emphasizes the importance of being aware that air embolisms can occur during shoulder arthroscopy performed for acute intra-articular fractures of the shoulder. Monitoring end tidal carbon dioxide can be very useful in early detection of air embolisms.

A prospective observational study of the outcome of central venous catheterization in 100 patients.

CONTEXT: To Study the outcome following central vein catheterization in patients receiving chemotherapy. AIMS: To Study the outcome of central venous catheterization in terms of difficulty during insertion, duration, incidence of infections and other complications and reasons for removal. SETTINGS AND DESIGNS: Prospective observational study conducted in 100 patients attending to Gujarat Cancer and Research Institute. MATERIALS AND METHODS: Both onco-medical and onco-surgical patients who required insertion of central venous catheters were enrolled after ethical approval from June 2008 to November 2010. The study comprised 100 patients. STATISTICAL ANALYSIS USED: Mean and percentage. RESULTS: Mean duration of the indwelling catheter was 109 days for Hickman catheter, 39 days for cavafix and 59 days for certofix. Difficulty in insertion and arrhythmias were common complications. There were no incidences of major life threatening complications. Catheter related infection was 30%. The commonest reason for catheter removal was treatment completion 72%. The next frequent cause was catheter infection 14% and patient death 6%. CONCLUSIONS: Even though central venous catheterization is associated with acceptable complications, they serve a useful aid in management of patients on chemotherapy.

Arterial cannulation can hasten the onset of symmetrical peripheral gangrene.

Symmetrical peripheral gangrene (SPG) is a devastating complication seen in critical care settings due to several contributory factors like low perfusion, high dose of vasopressors, disseminated intravascular coagulation, etc. Arterial cannulation is commonly done in critical patients for monitoring. We report a case of patient who developed early features of SPG which recovered in one hand, although it progressed in the hand which had the arterial cannula.

Minimally invasive pediatric surgery: Our experience.

AIM: Departmental survey of the pediatric laparoscopic and thoracoscopic procedures. MATERIALS AND METHODS: It is a retrospective study from January 1999 to December 2007. The various types of surgeries, number of patients, complications and conversions of laparoscopic and thoracoscopic procedures were analyzed. RESULTS: The number of minimally invasive procedures that had been performed over the past 9 years is 734, out of which thoracoscopic procedures alone were 48. The majority of the surgeries were appendicectomy (31%), orchiopexy (19%) and diagnostic laparoscopy (16%). The other advanced procedures include laparoscopic-assisted anorectoplasty, surgery for Hirschprung's disease, thoracosocpic decortication, congenital diaphragmatic hernia repair, nephrectomy, fundoplication, etc. Our complications are postoperative fever, bleeding, bile leak following choledochal cyst excision and pneumothorax following bronchogenic cyst excision. A case of empyema thorax following thoracoscopic decortication succumbed due to disseminated tuberculosis. Our conversion rate was around 5% in the years 1999 to 2001, which has come down to 3% over the past few years. Conversions were for sliding hiatus hernia, nephrectomy, perforated adherent appendicitis, Meckel's diverticulum, thoracoscopic decortication and ileal perforation. CONCLUSION: The minimally invasive pediatric surgical technique is increasingly accepted world wide and the need for laparoscopic training has become essential in every teaching hospital. It has a lot of advantages, such as less pain, early return to school and scarlessness. Our conversion rate has come down from 5% to 3% with experience and now we do more advanced procedures with a lower complication rate.