Successful management of 30 kg Gigantic para-testicular liposarcoma.

We report the successful management of a paratesticular liposarcoma, which, to the best of our knowledge, is the largest known of its type. A 62-year-old male presented with a painless, gradually progressive left testicular "giant" mass measuring 60 × 40 cm, weighing 30 kg and growing over a period of three 3 years. Additionally, a 5 × 5 cm trophic ulcer could be seen at the bottom of the scrotum. The ultrasound of the left testis revealed the testis having been completely replaced with a cystic and solid tumour. Preoperative serum testicular tumour markers (STM) were within normal limits. The markers included Alpha Feto Protein, Beta Human Chorionic Gonadotropin and Lactose Dehydrogenase. A left sided high inguino-scrotal approach with a huge skin resection including the trophic ulcer with complete removal of the tumour and a primary complex closure of the wound was performed. The post-operative period was uneventful, and histopathology revealed a dedifferentiated liposarcoma. We believe social taboo and fear of disfigurement impart a sense of shame in patients which led to the delayed presentation in a hospital in the index patient. The absence of metastases even with a protracted course is surprising.

Effect of Transurethral Resection of the Prostate on Urodynamic Parameters in Patients with Benign Prostatic Enlargement with Upper Urinary Tract Dilatation.

OBJECTIVE: To evaluate the urodynamic outcomes of transurethral resection of the prostate (TURP) in patients of benign prostatic enlargement (BPE) with upper urinary tract dilatation and correlate with International Prostate Symptoms Score (I-PSS). METHODS: In this prospective study, patients of BPE with upper urinary tract dilatation from July 2017 to June 2019 were enrolled. At presentation, detailed I-PSS, ultrasonography abdomen, serum creatinine, and serum PSA were recorded. All the patients were catheterized and observed for postobstructive diuresis. At 4 weeks, repeat ultrasound and serum creatinine were recorded. Urodynamic study (UDS) was performed after ensuring sterile urine culture. Patients underwent TURP as per the standard technique. A repeat UDS was performed after 3 months, and analysis was done. RESULTS: Forty-four patients were enrolled of which data of 37 patients were analyzed. In the filling phase of the UDS, there was a significant decrease in detrusor pressure at the end filling phase from 27 to 9.0 cm H2O after TURP. Maximum cystometric capacity and bladder compliance significantly improved at 3 months following surgery. In the voiding phase, peak flow rate showed a significant increase, postvoid residual urine volume significantly decreased, and peak detrusor pressure marginally decreased following TURP. The I-PSS decreased from 20 ± 8 to 5 ± 6 following TURP. CONCLUSION: High detrusor pressure and reduced compliance is a risk factor for upper urinary tract dilatation. Changes in the bladder dynamics and resolution of hydronephrosis following TURP reflected in the changes in urodynamic parameters and I-PSS.

σ-Aromatic cyclic M3(+) (M = Cu, Ag, Au) clusters and their complexation with dimethyl imidazol-2-ylidene, pyridine, isoxazole, furan, noble gases and carbon monoxide.

The σ-aromaticity of M3(+) (M = Cu, Ag, Au) is analyzed and compared with that of Li3(+) and a prototype σ-aromatic system, H3(+). Ligands (L) like dimethyl imidazol-2-ylidene, pyridine, isoxazole and furan are employed to stabilize these monocationic M3(+) clusters. They all bind M3(+) with favorable interaction energy. Dimethyl imidazol-2-ylidene forms the strongest bond with M3(+) followed by pyridine, isoxazole and furan. Electrostatic contribution is considerably more than that of orbital contribution in these M-L bonds. The orbital interaction arises from both L → M σ donation and L ← M back donation. M3(+) clusters also bind noble gas atoms and carbon monoxide effectively. In general, among the studied systems Au3(+) binds a given L most strongly followed by Cu3(+) and Ag3(+). Computation of the nucleus-independent chemical shift (NICS) and its different extensions like the NICS-rate and NICS in-plane component vs. NICS out-of-plane component shows that the σ-aromaticity in L bound M3(+) increases compared to that of bare clusters. The aromaticity in pyridine, isoxazole and furan bound Au3(+) complexes is quite comparable with that in the recently synthesized Zn3(C5(CH3)5)3(+). The energy gap between the highest occupied molecular orbital and the lowest unoccupied molecular orbital also increases upon binding with L. The blue-shift and red-shift in the C-O stretching frequency of M3(CO)3(+) and M3(OC)3(+), respectively, are analyzed through reverse polarization of the σ- and π-orbitals of CO as well as the relative amount of OC → M σ donation and M → CO π back donation. The electron density analysis is also performed to gain further insight into the nature of interaction.

Viability of aromatic all-pnictogen anions.

Aromaticity in novel cyclic all-pnictogen heterocyclic anions, P2N3(-) and P3N2(-), and in their heavier analogues is studied using quantum mechanical computations. All geometrical parameters from optimized geometry, bonding, electron density analysis from quantum theory of atoms in molecules, nucleus-independent chemical shift, and ring current density plots support their aromaticity. The aromatic nature of these molecules closely resembles that of the prototypical aromatic anion, C5H5(-). These singlet C2v symmetric molecules are comprised of five distinct canonical structures and are stable up to at least 1000 fs without any significant distortion. Mechanistic study revealed a plausible synthetic pathway for P3N2(-) - a click reaction between N2 and P3(-), through a C2v symmetric transition state. Besides this, the possibility of P3N2(-) as a η(5)-ligand in metallocenes is studied and the nature of bonding in metallocenes is discussed through the energy decomposition analysis.

Metastable behavior of noble gas inserted tin and lead fluorides.

Ab initio computations are carried out to explore the structure and stability of FNgEF3 and FNgEF (E = Sn, Pb; Ng = Kr-Rn) compounds. They are the first reported systems to possess Ng-Sn and Ng-Pb bonds. Except for FKrEF3, the dissociations of FNgSnF3 and FNgEF, producing Ng and SnF4 or EF2, are only exergonic in nature at room temperature, whereas FNgPbF3 has a thermochemical instability with respect to two two-body dissociation channels. However, they are kinetically stable, having positive activation barriers (ranging from 2.2 to 49.9 kcal mol(-1)) with respect to those dissociations. The kinetic stability gradually improves in moving from the Kr to Rn analogues. The remaining possible dissociation channels for these compounds are found to be endergonic in nature. The nature of the bonding is analyzed by natural bond order, electron density, and energy decomposition analyses. Particularly, the natural population analysis reveals that they are best represented as F(-)(NgEF3)(+) and F(-)(NgEF)(+). All the Xe/Rn-E bonds in FNgEF3 and FNgEF are covalent in nature.

Structure-selectivity relationship in ruthenium-catalyzed regio- and stereoselective addition of alkynes to pyrazoles: an experimental and theoretical investigation.

Ruthenium(II) complexes, [Ru(dppe)(PPh3)(CH(3)CN)(2)Cl][BPh4] {dppe = diphenylphosphinoethane} (1) and [Ru(dppp)2(CH(3)CN)Cl][BPh4] (2){dppp = diphenylphosphinopropane}, are efficient catalysts for vinylation of pyrazoles by alkynes. While the 1-catalyzed reaction is trans-selective, the corresponding 2-catalyzed reaction is cis-selective. The experimental results have been rationalized by density functional theory calculations.

First-Line Immune Combination Therapies for Nonclear Cell Versus Clear Cell Metastatic Renal Cell Carcinoma: Real-World Multicenter Data From Germany.

INTRODUCTION: The aim was to compare treatment outcomes of clear cell metastatic renal cell carcinoma (ccmRCC) versus non-ccmRCC (nccmRCC) patients who received first-line immune combination therapies. MATERIALS AND METHODS: Within our retrospective multi-institutional consecutive database of eight tertiary-care centers, we identified mRCC patients treated with first-line immune combination therapies between 11/2017 and 12/2022. Using log-rank analysis and multivariable Cox regression, we tested for differences in overall survival (OS) and progression-free survival (PFS) of nccmRCC versus ccmRCC patients. Covariables consisted of age at diagnosis, sex, International Metastatic Renal Cell Carcinoma Database Consortium risk groups, Eastern Cooperative Oncology Group status, and sarcomatoid feature. RESULTS: Of 289 study patients, 39 (13%) patients harbored nccmRCC. Median OS was 37 months versus not reached for ccmRCC versus nccmRCC patients (P = .6). Median PFS was 13 versus 15 months (P = .9). Multivariable Cox regression models did not identify nccmRCC as an independent predictor of higher overall mortality in mRCC patients (hazard ratio [HR]: 1.23; P = .6) or a higher progression rate (HR: 1.0; P = 1.0). CONCLUSION: In our real-world multi-institutional study, no differences in OS and PFS between ccmRCC and nccmRCC patients receiving first-line immune combination treatment were observed, even after adjustment for important patient and tumor characteristics. More prospective trials in nccmRCC patients are needed.

Evaluation of maceration, microwave, ultrasound-assisted extraction methods on free, esterified and bound phenolic profile and antioxidant activity of black rice.

Black rice (Oryza sativa L.) is a rich source of phenolics and anthocyanins. It was aimed to investigate the effect of different extraction methods such as conventional solvent extraction, ultrasound-assisted extraction (UAE), and microwave-assisted extraction (MAE) on antioxidant activity and phenolic profiling of black rice free, esterified, and bound phenolics fractions. Spectrophotometric methods were used to evaluate antioxidant activity and HPTLC was used for phenolics profiling. The highest content of % yield, total anthocyanin (TAC), total phenolic (TPC), and total flavonoid (TFC) contents were detected in MAE. It was also observed that antioxidant activity based on DPPH, ABTS, superoxide radical-scavenging and ferric reducing antioxidant power (FRAP) assays showed highest activity in MAE. Eight phenolic compounds were identified and quantified by a validated HPTLC method. MAE showed most abundant phenolic compounds. A significant positive correlation was established between % yield, total phenolic content, and total flavonoid content (p < 0.05) where a significant negative correlation was established between % yield, TPC, and TFC with IC50 of antioxidant activity (p < 0.05). Diverse phenolic contents and antioxidant activity were studied with different forms of phenolics with the different extraction methods. It designates that the extraction techniques had effects on the bioactive compounds as well biological properties.

Conquering new battlegrounds: Successful management of isolated giant retrovesical hydatid cyst with robotic assistance.

Hydatid disease (HD) is an accidental human parasitic infestation by cestodes and is most commonly caused by Echinococcus granulosus. Liver happens to be the most common site of involvement, although involvement of other organ symptoms is not uncommon. Involvement of the retrovesical pouch by hydatidosis is generally secondary in nature with an incidence of 0.1%-0.5% only. Primary retrovesical hydatid cyst (RVHC) is extremely rare with only few cases in existing literature. RVHC can present with a wide gamut of symptoms ranging from asymptomatic to obstructive uropathy. A 38-year-old male presented to us with complaints of lower urinary tract symptoms (LUTS) and was found to have an isolated primary retrovesical hydatid cyst on evaluation. The RVHC had compressed the right ureter leading to a grossly hydronephrotic non-functional right kidney. The patient was started on albendazole therapy and underwent robot assisted right nephroureterectomy and partial pericystectomy for the RVHC. The postoperative period was uneventful with resolution of symptoms. This report highlights the various clinical presentations of RVHC as well as the minimal invasive management of this rare entity.

Laparoscopic Nephroureterectomy for Nonfunctioning Ectopic Pelvic Kidney with Ectopic Ureter and Lower Ureteral Stricture Opening in the Vestibule of the Vagina But No Incontinence: Challenges in Diagnosis and Surgical Dissection.

Failure of mature kidney to reach its natural location in renal fossa is termed as renal ectopia. Ectopic kidney can be found in pelvic, iliac, abdominal, and thoracic location. Pelvic ectopia has been estimated to occur in 1 of 2100 to 3000 autopsies. In contrast, ectopic ureters are commonly associated with complete renal duplication. Commonest presentation in females in continuous urinary incontinence with normal voiding habits as ectopic ureter open below the bladder neck in urethra or vagina. An ectopic kidney with ectopic ureter is extremely rare congenital anomaly. We report a 36-year-old woman presenting with left lower abdomen pain with no history of fever, dysuria, or urinary incontinence. On evaluation, she was found to have left nonfunctioning ectopic pelvic kidney with ectopic ureter opening in the vestibule of the vagina, which was managed with laparoscopic nephroureterectomy. One should suspect an ectopic ureter in a female presenting with continuous urinary incontinence since birth. However, diagnosis is challenging when clinical presentation is unusual with no urinary incontinence as seen in the index case. Detailed local examination in correlation with imaging is key for diagnosis and rule out other congenital anomalies. Laparoscopic approach in such clinical scenario is a safe and feasible option.

Bilateral simultaneous "Santosh Post-graduate Institute tubularized flap pyelovesicostomy" in a case of bilateral pelvi-ureteric junction obstruction with bilateral giant hydronephrosis.

We present a case of bilateral giant hydronephrosis (HDN) secondary to bilateral pelvi-ureteric junction obstruction (PUJO) in a young girl, managed successfully by robot-assisted bilateral tubularized flap pyelo-vesicostomy. This case report highlights the feasibility, reproducibility and technicalities of this procedure.

Selective and sensitive detection of cinnamaldehyde by nitrogen and sulphur co-doped carbon dots: a detailed systematic study.

Nitrogen and sulfur co-doped carbon dots (NSCDs) synthesized through one-pot microwave-assisted pyrolysis of tartaric acid and thioacetamide have been used as a fluorescent probe for the sensitive and selective detection of clinically important organic aldehyde cinnamaldehyde. The as-prepared NSCDs displayed blue fluorescence (∼12% quantum yield), excellent aqueous solubility along with pH and excitation wavelength dependent emission behavior. In comparison to other aldehydes (formaldehyde, acetaldehyde, propionaldehyde, butyraldehyde, valeraldehyde, hexanal, crotonaldehyde and benzaldehyde) the fluorescence intensity of NSCDs was significantly quenched in the presence of cinnamaldehyde and the reduced intensity was linearly proportional to the concentration of cinnamaldehyde in the range of 0-15 mM with a detection limit of 99.0 µM. The fluorescence quenching of NSCDs was mainly attributed to the photo-excited electron transfer between NSCDs and aldehydes which was confirmed by measuring the life-time through time-resolved luminescence spectroscopy, energy levels of NSCDs through cyclic voltammetry (CV) and energy levels of aldehydes by density functional theory (DFT) based analyses. MTT assay of the NSCDs also proved their good biocompatibility and low toxicity towards human fibroblast cells thereby validating their suitability as a biologically relevant fluorescent probe for sensing cinnamaldehyde.

Ring Expansion of Donor-Acceptor Cyclopropane via Substituent Controlled Selective N-Transfer of Oxaziridine: Synthetic and Mechanistic Insights.

A distinctive N-substituent controlled electrophilic N-transfer of oxaziridines with donor-acceptor cyclopropanes in the presence of MgI2 is reported. Contrary to earlier reports, the oxaziridine having bulkier N-substituents can also give N-transferred product instead of the O-transferred one. Interestingly, the oxaziridines having α-H containing N-substituents lead to the pyrrolidine derivatives through [3 + 2] cycloaddition. A mechanistic reasoning for this divergent reactivity is depicted by density functional theory calculations and validated through energy decomposition analysis.

Cucurbit[6]uril: A Possible Host for Noble Gas Atoms.

Density functional and ab initio molecular dynamics studies are carried out to investigate the stability of noble gas encapsulated cucurbit[6]uril (CB[6]) systems. Interaction energy, dissociation energy and dissociation enthalpy are calculated to understand the efficacy of CB[6] in encapsulating noble gas atoms. CB[6] could encapsulate up to three Ne atoms having dissociation energy (zero-point energy corrected) in the range of 3.4-4.1 kcal/mol, whereas due to larger size, only one Ar or Kr atom encapsulated analogues would be viable. The dissociation energy value for the second Ar atom is only 1.0 kcal/mol. On the other hand, the same for the second Kr is -0.5 kcal/mol, implying the instability of the system. The noble gas dissociation processes are endothermic in nature, which increases gradually along Ne to Kr. Kr encapsulated analogue is found to be viable at room temperature. However, low temperature is needed for Ne and Ar encapsulated analogues. The temperature-pressure phase diagram highlights the region in which association and dissociation processes of Kr@CB[6] would be favorable. At ambient temperature and pressure, CB[6] may be used as an effective noble gas carrier. Wiberg bond indices, noncovalent interaction indices, electron density, and energy decomposition analyses are used to explore the nature of interaction between noble gas atoms and CB[6]. Dispersion interaction is found to be the most important term in the attraction energy. Ne and Ar atoms in one Ng entrapped analogue are found to stay inside the cavity of CB[6] throughout the simulation at 298 K. However, during simulation Ng2 units in Ng2@CB[6] flip toward the open faces of CB[6]. After 1 ps, one Ne atom of Ne3@CB[6] almost reaches the open face keeping other two Ne atoms inside. At lower temperature (77 K), all the Ng atoms in Ngn@CB[6] remain well inside the cavity of CB[6] throughout the simulation time (1 ps).