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A catalyst‐free, one‐pot 1,3‐dipolar cycloaddition reaction between azomethine ylides (generated in situ) and (E)‐3‐styrylquinoxalin‐2(1H)‐ones led to the formation of a series of quinoxalinone containing spiropyrrolidine‐oxindoles. Subsequently, the in vitro cytotoxicity of the synthesized derivatives against the panel of Human NCI‐60 cancer cell lines alongside normal cell lines was evaluated using SRB assay. Among all the derivatives, 4 h was found to be the most potent, selective, restrict cell migration and induce apoptosis with elevated ROS levels in HCT‐116. This study emphasizes the potency of the derivatives as promising leads for the further development of potent anti‐cancer agents. [ABSTRACT FROM AUTHOR]

Cholinium N‐Tris(hydroxymethyl)methyl‐3‐amino‐2‐hydroxypropanesulfonate [Ch][TAPSO] has been found as an efficient ionic liquid catalyst for the synthesis of tetrahydro‐4H‐chromenes and 3,4‐dihydropyrano[c]chromenes in water and EtOH : Water (3 : 2) respectively. [Ch][TAPSO] being a basic IL has also been observed to extract acidic compounds such as rhodamine B from IL‐ immiscible organic solvent such as acetone through acid‐base interaction. The extraction process of fluorescent dye rhodamine B was determined by ultraviolet‐visible (UV‐Vis) spectroscopy. The observed percentage extraction rate is 100 % upto 6 mM solution of rhodamine in acetone. This method results in faster reaction with operational simplicity and excellent yields of the products. Furthermore, the catalyst has a great capacity for reutilisation. [ABSTRACT FROM AUTHOR]

Molecular iodine in combination with TBHP offers an advanced concept for organic synthesis and catalysis by improving the selectivity and sustainability of organic transformations. It leads to the development of metal free greener protocols under ambient conditions either as a catalytic duo or as a reagent system in combination with an additive. The advent of this indispensable tool led to formation of complex organic architectures empowering novel reaction pathways through C−H functionalization, cyclization, cycloaddition, rearrangement, sulfonylation/sulfenylation and oxidation reactions in organic synthesis. [ABSTRACT FROM AUTHOR]

Background and Aim: After liver transplant, pre‐existent porto‐systemic shunts (PSS) may persist, causing "portal steal," leading to graft dysfunction, hepatic encephalopathy (HE), and eventual rejection. In recipients of small‐for‐size transplant liver grafts, shunts may be created intraoperatively, facilitating diversion of portal flow to systemic circulation to avoid ill‐effects of portal overperfusion. These iatrogenic shunts may also subsequently lead to portal steal. We aim to evaluate safety and efficacy of endovascular techniques in management of portal steal due to PSSs in living donor liver transplantation (LDLT) recipients. Methods: Between 2013 and 2020, we encountered five LDLT recipients with large PSS, who presented with graft dysfunction and/or HE. One patient had a surgically created shunt and four had spontaneous shunts, not surgically ligated during transplant. Endovascular techniques including plug‐assisted or balloon‐occluded retrograde transvenous obliteration (PARTO/BRTO) or covered inferior vena cava (IVC) stent grafts were to occlude these PSS and counter the portal steal in all patients. Technical success and clinical outcomes at 1‐year‐follow‐up were assessed. Results: Imaging showed large PSS causing portal steal syndrome in all five patients. IVC stent graft was used to isolate the shunt in two patients and PARTO/BARTO was performed in three patients. One patient had guarded prognosis due to multiple organ dysfunction and died 5 days after endovascular procedure. At 1‐year follow up, graft functions normalized in four patients with no recurrence of HE. No procedure‐related complications were seen. Conclusion: Endovascular techniques can be safely and effectively used to counter portal steal syndrome in LDLT recipients, thus avoiding surgical re‐exploration in these patients. [ABSTRACT FROM AUTHOR]

Background: Biliary injury is the most feared complication of laparoscopic cholecystectomy (LC). This study aimed to assess the awareness of culture of safety in cholecystectomy (COSIC) concept among the surgical residents in India. Methods: A manual survey was conducted among general surgery residents attending a postgraduate course. Survey consisted of questions pertaining to knowledge of various aspects of COSIC, e.g., the critical view of safety (CVS). Results: With a response rate of 51%, 259 residents were included in this study. They had more exposure to LC (63.3% assisted / performed > 15 LC) than to open cholecystectomy (60.6% assisted / performed ≤ 10 open cholecystectomy). The majority (80.2%) clearly differentiated Calot triangle from the hepatocystic triangle (HCT). However, 25.8% could not correctly define HCT. The majority (88.5%) had seen the Rouviere's sulcus during LC. While almost all (98.4%) respondents claimed to know about the segment 4, only 41.9% could correctly describe it. Awareness of the correct direction of the gallbladder retraction was lower for the infundibulum (53.5%) than for fundus (89.2%). The majority (88.3%) claimed to know CVS but only 11.5% knew it correctly, and 15.1% described > 3 components. The majority (78.7%) practiced to identify the cystic duct-common bile duct junction. Awareness was low for time-out (28.1%), intraoperative cholangiography (20.6%), bailout techniques (18.9%), and for overall COSIC concept (15.7%). Conclusions: Knowledge of COSIC among surgical residents seems to be suboptimal, especially for the CVS, time-out, bailout techniques, and overall concept of COSIC. Strategies to educate them more effectively about COSIC are highly imperative to train them well for future practice. [ABSTRACT FROM AUTHOR]

Large surface area exfoliation of the hydrogen (H)‐implanted Ge is investigated in this work. H+ ions with a fluence of 1 × 1017 cm−2 are implanted in Ge samples at liquid nitrogen and room temperature (RT). The formation of surface blisters and craters is observed in the samples annealed between 300 and 450 °C after implantation. Interestingly, samples implanted at RT show large surface area exfoliation extending over several hundreds of micrometer region after annealing. Secondary ion mass spectroscopy (SIMS) and depth‐resolved Raman spectroscopy are used to characterize the depth profile of implanted H+ ions and stress in the damage region, respectively. The formation of the damage band filled with extended planar defects in the form of nanocracks is observed using a cross‐sectional transmission electron microscope (TEM). The physical understanding of the H‐induced internal pressure and stress in the surface blisters/craters is carried out using Föppl–von Karman theory of thin plates. [ABSTRACT FROM AUTHOR]

3‐[N‐Tris(hydroxymethyl)methylamino]‐2‐hydroxypropanesulfonic acid (TAPSO) served as a highly efficient, biodegradable and cost effective catalyst for the synthesis of α‐aminophosphonates and tetrahydropyridines. This is the first report on the application of TAPSO as a catalyst in organic synthesis. The key features of this protocol are readily available starting materials, ecofriendly catalyst, operational simplicity and high yields. [ABSTRACT FROM AUTHOR]

A selective synthesis of 3‐(α,α‐dibromoacetyl)‐4‐hydroxy‐6‐methyl‐2H‐pyran‐2‐one (3) has been achieved by bromination of DHA using CuBr2/CHCl3‐EtOAc. The reaction of 3 with different thioureas/thiomides/thiosemicarbazide offers a convenient and efficient method for the syntheses of 2‐substituted 4‐(4‐hydroxy‐6‐methyl‐2H‐2‐oxopyran‐3‐yl)thiazoles. These thiazoles were evaluated for their antimicrobial and antifungal activity. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and aim: Microsatellite instability and fragile histidine triad (FHIT) loss have been seen to be involved in gallbladder carcinogenesis. We studied expression loss of mismatch repair (MMR) proteins and loss of FHIT expression in gallbladder cancer by immunohistochemistry using antibodies against MLH1, MSH2 and MSH6 proteins. Methods: One hundred and two consecutive cases of gallbladder cancer were retrospectively collected and expression of MLH1, MSH2 and MSH6 and FHIT protein was studied. The expression pattern was correlated with various clinicopathologic parameters and survival. Results: Expression loss of MMR proteins was found in 52.9% and loss of FHIT expression was found in 45% cases of gallbladder cancer. Loss of FHIT expression was seen in 12% of dysplasia associated with carcinoma. Expression loss of MMR proteins was found in 16% of dysplasia associated with chronic cholecystitis and 32.6% of dysplasia associated with carcinoma. Expression loss of MMR proteins had significant positive correlation with tumor stage and had worse survival compared with patients with intact expression. Loss of FHIT expression was significantly correlated with both tumor grade and stage. Conclusions: Frequency of expression loss of MMR proteins and loss of FHIT expression increased from dysplasia to carcinoma suggesting that both these abnormalities have a role in pathogenesis and occur at an early stage in carcinogenesis of gallbladder. Fifty three percent of gallbladder cancer with expression loss of MMR proteins also showed loss of FHIT expression and were frequent in advanced stage disease suggesting that reduced FHIT expression may be correlated with expression loss of MMR proteins on immunohistochemistry. [ABSTRACT FROM AUTHOR]

A series of novel 4-(3,3-dimethylspiro{bicyclo[2.2.1]heptan-2,5′-isoxazoline-2}-3′-yl)-2-phenyl-2,3-dihydro-1 H-1,5-benzodiazepines were synthesized. These molecules were screened in vitro for their antifungal and antibacterial activity, and none of the tested compounds showed promising antimicrobial or antifungal activity. J. Heterocyclic Chem., 2011. [ABSTRACT FROM AUTHOR]

Background: Secondary biliary cirrhosis is a potential complication of post-cholecystectomy bile duct stricture (PCBDS). This study addresses the factors that determine the severity of pathological changes on liver biopsy and the correlation with long-term outcome following repair. Methods: Liver biopsies obtained at surgery for repair of PCBDS in 71 patients were reviewed and pathological changes were scored from 0 to 3. Patients with fibrosis score 0–2 were categorized as the non-cirrhotic group and those with score 3 (secondary biliary cirrhosis) were categorized as the cirrhotic group. Clinical and biochemical parameters, stricture type and outcome were analyzed by univariate and multivariate analysis for correlation with degree of fibrosis. Follow-up liver biopsies (3–60 months) after stricture repair were obtained in five patients. Results: There were 58 patients in the non-cirrhotic group and 13 in the cirrhotic group. On univariate analysis, portal hypertension and prolonged injury-repair duration correlated with secondary biliary cirrhosis. Patients with a fair outcome in the cirrhotic group (4/13) had derangements in liver function tests but had patent biliary enteric anastomosis on evaluation. Of the five patients in whom liver biopsies were obtained at follow up, two had regression, two were static, and one had progression. Conclusion: All patients with PCBDS had varying degrees of fibrosis. Prolonged injury-repair interval and portal hypertension were the important parameters correlating with secondary biliary cirrhosis. Early repair of biliary stricture is recommended to prevent liver fibrosis. A successful relief of biliary obstruction may halt and/or reverse pathological changes in the liver. [ABSTRACT FROM AUTHOR]

Aim: Gallbladder cancer (GBC) is frequently associated with gallstones (GS). At the same time, however, a very small number of patients with GS develop GBC. Cholesterol and metal salts are the common constituents of all GS. To understand their role in the etiopathogenesis of GBC, cholesterol, calcium, and magnesium composition in GS is compared in cancerous and benign gallbladders. Methods: GS from patients with GBC ( n = 11), chronic cholecystitis (CC; n = 23), and xanthogranulomatous cholecystitis (XGC; n = 11) undergoing cholecystectomy were analyzed using proton nuclear magnetic resonance spectroscopy. The diagnosis of the gallbladder disease was based on histopathological examinations. Cholesterol, calcium, and magnesium in the GS of GBC, XGC, and CC were analyzed, compared, and correlated using statistical methods. Results: The quantity of cholesterol was significantly less in the GS of GBC than in benign gallbladder diseases (CC or XGC, P < 0.0001 for both). Both calcium and magnesium were significantly higher in GBC than in benign disease (calcium: P < 0.0005 and magnesium: P < 0.0001 for GBC vs CC; calcium: P < 0.02 and magnesium: P < 0.04 for GBC vs XGC). In all the GS, calcium was higher than magnesium. Calcium and magnesium were positively correlated in GBC ( R = 0.69) and XGC ( R = 0.75), and cholesterol and calcium were negatively correlated in CC ( R =−0.61). Conclusion: Differences in the GS composition between malignant and benign gallbladder patients may provide useful clues to the etiopathogenesis of GBC. These clues could lead to the identification of patients with GS in vivo who are at high risk of developing GBC, and advocate prophylactic cholecystectomy to prevent GBC. [ABSTRACT FROM AUTHOR]

Background: Despite extensive work-up to establish the cause of splenomegaly, splenectomy may be required for diagnosis in certain situations. The aim of this study was to find out the role of diagnostic splenectomy in the current era. Methods: Between January 1989 and June 2004, 211 patients underwent splenectomy for indications other than trauma. In 41 (19%) patients, splenectomy was carried out for diagnostic purposes. Retrospective analysis of these patients was done for the purpose of the study. Results: All patients who underwent diagnostic splenectomy had a complete haemogram, biochemical tests for liver and renal function, bone marrow biopsy and abdominal ultrasonography before splenectomy. There were 28 (68%) men and 13 (32%) women with median age of 37 years (range, 6–62 years). The median duration of symptoms was 12 months (range, 1–180 months). Common presentations were fever ( n = 27; 66%), malaise ( n = 26; 63%), pallor ( n = 33; 80%) and gross splenomegaly ( n = 27; 66%). Thirty-two (78%) patients had hypersplenism. Splenic lesions were shown in 14 (34%) patients on ultrasonogram and in 16 (39%) patients on contrast-enhanced computed tomography scan of the abdomen. Open splenectomy was carried out in all patients. Seventeen (41%) patients had postoperative complications. Among these, three (7%) patients had postoperative bleeding. One patient died because of acute respiratory distress syndrome. Final histopathology of the spleen showed lymphoma in 15 (37%), tuberculosis in five (12%) and other lesions in five (12%) patients. Sixteen (39%) patients had only congestive splenomegaly. Conclusion: A high proportion of patients presenting with idiopathic splenomegaly will have underlying haematological malignancies even in tropical countries. The clinical presentation, laboratory profile and imaging findings were not helpful in differentiating between patients with haematological malignancies and non-malignant conditions. Splenectomy still has an important role in establishing the pathology in patients presenting with idiopathic splenomegaly. [ABSTRACT FROM AUTHOR]

The FHIT gene is a relatively newly discovered tumor suppressor gene, which is located on the chromosome 3p14.2. The gene encompasses the FRA3B fragile site. The gene has been implicated in the pathogenesis of various carcinomas, particularly cancers of the stomach and oral squamous cell carcinomas. The protein encoded by the gene bears a significant homology to a group of proteins that have a histidine triad motif, designated HIT proteins. The function of the protein remains essentially unknown. Loss of heterozygosity and microsatellite instability are responsible for FHIT gene alterations. A mutation in a gene will invariably give abnormal transcripts and contribute to the pathogenesis of cancer. A better understanding of FHIT mutations will also help us to understand the pathogenesis of the multistep process of carcinogenesis. Therapeutic potentials of Fhit can also be explored. Replacement of FHIT cDNA in human cancer cell lines has resulted in the suppression of tumor growth. This opens the possibility of therapeutic potentials using recombinant vectors carrying the FHIT gene. [ABSTRACT FROM AUTHOR]

A simple method for quantification of conjugated bile acids in human bile using 1H NMR spectroscopy is presented. Bile acids in human bile are essentially conjugated with either glycine or taurine. The amide NH resonances from the conjugated bile acids are invariably devoid of interfering signals in 1H NMR spectra. Under physiologic conditions of human bile (pH ∼7.0 to 7.7), amide signal intensities are attenuated due to the chemical exchange and hence quantitative estimation is precluded. In the present study, the quantity of total glycine and taurine conjugated bile acids could be obtained accurately by suppressing the amide exchange by reducing the pH slightly lower than physiologic value (6.0 ± 0.5). Further, the quantity of glycine conjugated bile acids can be calculated accurately by subtracting the quantity of taurine conjugated bile acids from the total conjugated bile acids as determined from the present method. Magn Reson Med 53:1441-1446, 2005. © 2005 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Purpose:To develop and test a clinical case definition for identification of generalized tonic–clonic seizures (GTCSs) by community-based health care providers.Methods:To identify symptoms that can help identify GTCSs, patients with history of a jerky movements or rigidity in any part of the body ever in life were recruited from three sites: the community, secondary care hospital, and tertiary care hospital. These patients were administered a 14-item structured interview schedule focusing on the circumstances surrounding the seizure. Subsequently, a neurologist examined each patient and, based on available investigations, classified them as GTCS or non-GTCS cases. A logistic regression analysis was performed to select symptoms that were to be used for case definition of GTCSs. Validity parameters for the case definition at different cutoff points were calculated in another set of subjects.Results:In total, 339 patients were enrolled in the first phase of the study. The tertiary care hospital contributed the maximal number of GTCS cases, whereas cases of non-GTCS were mainly from the community. At the end of phase I, the questionnaire was shortened from 14 to eight questions based on statistical association and clinical judgment. After phase II, which was conducted among 170 subjects, three variables were found to be significantly related to the presence of GTCSs by logistic regression: absence of stress (13.1; 4.1–41.3), presence of frothing (13.7; 4.0–47.3), and occurrence in sleep (8.3; 2.0–34.9). As a case definition using only three variables did not provide sufficient specificity, three more variables were added based on univariate analysis of the data (incontinence during the episode and unconsciousness) and review of literature (injury during episode). A case definition consisting of giving one point to an affirmative answer for each of the six questions was tested. At a cutoff point of four, sensitivity was 56.9 (47.4–66.0) and specificity, 96.3 (86.2–99.4). Among the 197 GTCS and 26 new non-GTCS patients recruited from hospitals from select SEAR Member Countries, in phase III, the sensitivity of this clinical case definition was 72% and specificity, 100%. A stratified analysis by gender in all the three phases did not show any differences between the sexes.Conclusions:Based on these criteria, we recommend that all patients with a history of two or more episodes of jerking or rigidity of limbs, having a score of≥4 in the case definition, be identified as having GTCSs and started on antiepileptic medications. This clinical case definition can be very useful for community-based health care providers to identify and manage cases of GTCSs in the community. This should play a major role in the reduction of treatment gap for epilepsy in developing countries. [ABSTRACT FROM AUTHOR]

Patients with long-standing extrahepatic portal venous obstruction (EHPVO) develop extensive collaterals in the hepatoduodenal ligament as a result of enlargement of the periportal veins. These patients are also prone to develop obstructive jaundice as a result of strictures and/or choledocholithiasis. Surgical management of obstructive jaundice in such patients becomes difficult in the presence of these collaterals.To review the approach to management of patients with EHPVO and obstructive jaundice.Retrospective review of patients with EHPVO and obstructive jaundice requiring surgical and/or endoscopic management between 1992 and 2002.Thirteen patients (nine males, aged 12–50 years) with EHPVO and obstructive jaundice were evaluated. No patient had underlying cirrhosis or hepatocellular carcinoma. Five patients (group A) had biliary stricture; three (group B) had choledocholithiasis; and five (group C) had biliary stricture with choledocholithiasis. Primary surgical management was performed in group A (portosystemic shunt in four-strictures resolved in three; hepaticojejunostomy in one). In group B (n = 3) endoscopic stone extraction was successful in two patients. One patient underwent staged procedure (portosystemic shunt followed by biliary surgery). In group C, initial endoscopic management failed in four patients in whom it was attempted. All five patients thereafter underwent surgery (staged procedure, one; choledochoduodenostomy, one; devascularization, one; abandoned, two). Repeat postoperative endoscopic management was successful in two of the group C patients. Overall (group B and C), massive intraoperative hemorrhage occurred in three patients (one died). Postoperative hemorrhage occurred in one patient.In patients with EHPVO and obstructive jaundice, primary biliary tract surgery has significant morbidity and mortality. Endoscopic management should be the preferred modality. In patients with endoscopic failure, a staged procedure (portosystemic shunt followed by biliary surgery) should be preferred. Strictures alone may resolve after a portosystemic shunt. Endoscopic stenting may be required as an adjunct. [ABSTRACT FROM AUTHOR]

Haemorrhagic complication occurs in 5−16% of patients following pancreaticoduodenectomy (PD). We report an analysis of patients with post-PD bleed, to identify predictors of bleed, predictors of survival following bleed and the management of post-PD bleed.Two hundred and eighteen patients with periampullary cancers underwent PD from 1989 to 2002. Forty-four (20.2%) patients had a bleeding complication. Of these, 25 patients had an intra-abdominal (IA) bleed and 21 had gastrointestinal (GI) bleed (two had both IA and GI bleed). Clinical, biochemical and tumour characteristics were analysed to identify factors influencing bleeding complications.The median time to presentation was 4.5 days (0−21 days). Serum bilirubin (P = 0.000, OR: 1.090) and pancreaticojejunostomy (PJ) leak (P = 0.009, OR: 3.174) were significant independent factors predicting bleeding complications. Forty-three per cent of patients each had early bleed (<48 h after PD) or delayed bleed (7 days after PD). Comparison of early and late bleeds showed that IA bleed (P = 0.02) presented as early bleeds. Male sex (P = 0.00) longer duration of jaundice (P = 0.02), PJ leak (P = 0.001), HJ leak (P = 0.001), duct to mucosa type of PJ anastomosis (P = 0.03) and IA abscess (P = 0.00) were associated with a significantly higher incidence of late bleeds. Overall mortality after PD was 9.6% with 34% and 3% in bleeders and non-bleeders, respectively. Septicaemia (P = 0.01, OR: 5.49), and acute renal failure (P = 0.01) were associated with increased mortality.Bleeding complications following PD were seen in one-fifth of patients and were associated with high mortality. Serum bilirubin levels and PJ leak were significant factors associated with bleeding complications. Septicaemia and acute renal failure were significant factors associated with mortality in the bleeders. [ABSTRACT FROM AUTHOR]

An amendment to this paper has been published and can be accessed via the original article. [ABSTRACT FROM AUTHOR]

An objective methodology was employed in the present in vitro study to assess the bristle pressur required for plaque removal from the enamel surface of freshly extracted teeth. This bristle pressure has indirectly reflected the plaque tenacity or total attachment force of the plaque on the tooth surface. Equipment used to measure bristle pressure was especially fabricated for this purpose and described in detail with illustrations. The mean bristle pressure required for the removal of 1-day, 2-day, and 3-day old plaque was 5.509 gms/em², 7.757 gms/cm², and 14.28 gms/cm² which shows a ratio of 5:7:13 respectively, indicating an increase in plaque tenacity as it advances in age. Further, the increase in tenacity of plaque from 2-day to 3-day was more as compared to the increase in tenacity from 1-day to 2 day plaque. [ABSTRACT FROM AUTHOR]

Background: Post-cholecystectomy malignant biliary obstruction masquerading as benign biliary stricture (BBS) has not been reported in the literature; it presents a diagnostic and management challenge. Methods: Of the 349 post-cholecystectomy BBS managed at a tertiary care hospital in northern India between 1989 and 2004, 11 patients were found to have biliary malignancy. Records of these 11 patients were analyzed retrospectively for the purpose of this study. Results: Mean age of patients with malignant biliary strictures was significantly higher (52 vs 38 years, P = 0.000); they were more likely to have jaundice (100% vs 78%, P = 0.008) and pruritus (82% vs 48%, P = 0.03). Unlike most patients with BBS referred from elsewhere to us, they had had a smooth postoperative course uncomplicated by bile leak, had a longer cholecystectomy-presentation interval, and were more likely to have high strictures ((Bismuth type III/IV) 91% vs 49%, P = 0.008). Conclusions: Post-cholecystectomy biliary obstruction is not always benign. High bilirubin levels and hilar strictures, especially after an uneventful cholecystectomy, in a middle-aged patient should raise a suspicion of underlying missed malignancy. [ABSTRACT FROM AUTHOR]