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Background: Penile squamous cell carcinoma (SCC) is a rare malignancy with a high propensity for regional dissemination. While current guidelines recommend inguinal lymph node dissection (ILND) for patients with high-risk features, the surgery carries a high risk of lymphedema [1]. Indocyanine Green (ICG)-guided lymphangiography has been used to increase nodal yield and detection rates in lymph node dissections [2]. Objectives: To demonstrate that “reverse” ICG-guided ILND is a safe and novel technique that may reduce rates of postoperative lymphedema in penile cancer patients and may intraoperatively help identify candidates for lymphovascular anastomosis (LVA). Methods: To evaluate the efficacy of “reverse” ICG-guided ILND, 2.5 mg mixed ICG solution was injected superficially into the intradermal layer at the first and fourth interdigital spaces of the foot prior to beginning robotic-assisted bilateral ILND. The lower extremity lymphatic channels are prospectively identified and preserved during dissection with the aid of near infrared fluorescence imaging. Results: A total of 9 groin dissections have been completed using this technique. Reverse lymphatic mapping was successful in 7 out of 9 (77.7 %) groin dissections. With a follow-up range of 0.9–24 months, there have been no instances of post-operative lymphedema in patients who underwent successful mapping. Conclusion: Reverse lymphatic mapping during robot-assisted inguinal lymphadenectomy is a safe and feasible technique. Enhanced intraoperative visualization of lymphatic structures not only may help minimize the risk of postoperative lymphedema, but it may also help identify those patients at high risk of developing lymphedema and allow for prophylactic interventions. Further investigation is necessary to establish the oncologic safety of reverse lymphatic mapping during ILND.

Abstract The phenomenon of non-reciprocal critical current in a Josephson device, termed the Josephson diode effect, has garnered much recent interest. Realization of the diode effect requires inversion symmetry breaking, typically obtained by spin-orbit interactions. Here we report observation of the Josephson diode effect in a three-terminal Josephson device based upon an InAs quantum well two-dimensional electron gas proximitized by an epitaxial aluminum superconducting layer. We demonstrate that the diode efficiency in our devices can be tuned by a small out-of-plane magnetic field or by electrostatic gating. We show that the Josephson diode effect in these devices is a consequence of the artificial realization of a current-phase relation that contains higher harmonics. We also show nonlinear DC intermodulation and simultaneous two-signal rectification, enabled by the multi-terminal nature of the devices. Furthermore, we show that the diode effect is an inherent property of multi-terminal Josephson devices, establishing an immediately scalable approach by which potential applications of the Josephson diode effect can be realized, agnostic to the underlying material platform. These Josephson devices may also serve as gate-tunable building blocks in designing topologically protected qubits.

Abstract Image sensors capable of capturing individual photons have made tremendous progress in recent years. However, this technology faces a major limitation. Because they capture scene information at the individual photon level, the raw data is sparse and noisy. Here we propose CASPI: Collaborative Photon Processing for Active Single-Photon Imaging, a technology-agnostic, application-agnostic, and training-free photon processing pipeline for emerging high-resolution single-photon cameras. By collaboratively exploiting both local and non-local correlations in the spatio-temporal photon data cubes, CASPI estimates scene properties reliably even under very challenging lighting conditions. We demonstrate the versatility of CASPI with two applications: LiDAR imaging over a wide range of photon flux levels, from a sub-photon to high ambient regimes, and live-cell autofluorescence FLIM in low photon count regimes. We envision CASPI as a basic building block of general-purpose photon processing units that will be implemented on-chip in future single-photon cameras.

A 66 year old male with history of inflatable penile prosthesis (IPP) placement was incidentally diagnosed with a 5 cm inguinal mass abutting the IPP reservoir after prostate MRI performed for an elevated PSA. This was surgically resected en bloc with his ipsilateral testicle and IPP reservoir, with final pathology demonstrating a high-grade round cell NUTM::CIC fusion sarcoma. Management is primarily surgical, though patients with high-risk features may require adjuvant chemoradiation.

Worsening heart failure (WHF) is a distinct under-diagnosed and under-treated condition, independent of location of care. Heart failure (HF) progression is punctuated by repeated WHF events, each resulting in reduced cardiac function. One-third of the patients with HF with reduced ejection fraction experience a decompensation event. These decompensation events often result in the emergency department visits and HF hospitalization. Despite its inclusion in recent guidelines, there is no precise definition of WHF or its various forms. It is worth noting that WHF signals a need for treatment optimization as per guideline-directed medical therapy and the addition of novel drugs like a stimulator of soluble guanylate cyclase that benefit this high-risk patient population. This practical document is based on the expert opinion of cardiologists, cardiothoracic surgeons, and physicians that discussed the definition, assessment, pharmacological management, and monitoring of WHF patients in a hospitalized setting. In addition, there is also a need for an expert opinion for the management of WHF in an outpatient setting.

Quantum devices based on InSb nanowires (NWs) are a prime candidate system for realizing and exploring topologically-protected quantum states and for electrically-controlled spin-based qubits. The influence of disorder on achieving reliable quantum transport regimes has been studied theoretically, highlighting the importance of optimizing both growth and nanofabrication. In this work, we consider both aspects. We developed InSb NW with thin diameters, as well as a novel gating approach, involving few-layer graphene and atomic layer deposition-grown AlO _x . Low-temperature electronic transport measurements of these devices reveal conductance plateaus and Fabry–Pérot interference, evidencing phase-coherent transport in the regime of few quantum modes. The approaches developed in this work could help mitigate the role of material and fabrication-induced disorder in semiconductor-based quantum devices.

The abandonment of seafarers is one of the major challenges that seafarers onboard vessels may face. In 2022, 1555 seafarers were abandoned on 113 ships. The port state's role in seafarer abandonment is crucial because it can assist abandoned seafarers by facilitating their repatriation. In practice, however, it has been seen in many cases that the port state of the vessel had restricted the disembarkation of the abandoned crew from the vessel by citing the reason that the vessel cannot be left unmanned. The present study will assess such measures adopted by the port states in light of International Law instruments, including the Maritime Labour Convention, 2006 and the International Covenant on Civil and Political Rights, 1966.

This case series highlights that extra-adrenal and recurrent pheochromocytomas can require en bloc vascular resection to achieve negative margins. Through this series of cases performed in a multidisciplinary fashion, we aim to highlight the technical aspects of these cases that can add to their complexity. Vascular invasion alone should not preclude an otherwise feasible oncologic resection.

Abstract Aims To describe clinical characteristics and outcomes for those with STEMI and reduced left ventricular ejection fraction (LVEF) in low‐income and middle‐income countries (LMICs). Methods and results Adults presenting with STEMI to two government‐owned tertiary care centres in Delhi, India were prospectively enrolled in the North India ST‐elevation myocardial infarction (NORIN‐STEMI) registry. LVEF was evaluated at presentation and clinical characteristics were compared across LVEF categories. Overall, 3597 patients were included, of whom 468 (13%) had LVEF >50%, 1482 (41%) had mildly reduced LVEF (40–49%), 1357 (38%) had moderately reduced LVEF (30–39%), and 290 (8%) had severely reduced LVEF (24 h, prior MI, and hyperlipidaemia were associated with decreasing LVEF category. Although most patients with reduced LVEF were discharged on appropriate guideline‐directed therapies, adherence at 1 year was low (ACE inhibitor/ARB 91% to 41%, beta blocker 98% to 78%, aldosterone receptor antagonist 69% to 6%). After multivariable adjustment, a Cox regression model showed moderately reduced LVEF (HR 1.77, 95% CI 1.20, 2.60) and severely reduced LVEF (HR 3.63, 95% CI 2.41, 5.48) were associated with increased risk of all‐cause mortality compared with LVEF ≥50%. Conclusions On presentation for STEMI, almost 90% of NORIN‐STEMI participants had at least mildly reduced LVEF and almost half had LVEF

Multiterminal Josephson junctions may provide a novel way to realize topologically non-trivial band structures in an n-dimensional phase space. Here, the authors experimentally demonstrate the proposed necessary conditions to measure these states.

In recent years, the number of deaths and injuries resulting from traffic accidents has been increasing dramatically all over the world due to distracted drivers. Thus, a key element in developing intelligent vehicles and safe roads is monitoring driver behaviors. In this paper, we modify and extend the U-net convolutional neural network so that it provides deep layers to represent image features and yields more precise classification results. It is the basis of a very deep convolution neural network, called U2-net, to detect distracted drivers. The U2-net model has two paths (contracting and expanding) in addition to a fully-connected dense layer. The contracting path is used to extract the context around the objects to provide better object representation while the symmetric expanding path enables precise localization. The motivation behind this model is that it provides precise object features to provide a better object representation and classification. We used two public datasets: MI-AUC and State Farm, to evaluate the U2 model in detecting distracted driving. The accuracy of U2-net on MI-AUC and State Farm is 98.34 % and 99.64%, respectively. These evaluation results show higher accuracy than achieved by many other state-of-the-art methods.

Building owners are working on converting their legacy documentation 2D floor plans into digital 3D representations, but the manual process is labor-intensive and time-consuming. In this paper, deep learning is leveraged to automate the process. This automation requires interoperability between artificial neural networks and prevailing 3D modeling software. The system processes 2D floor plans and outputs parameters of recognized walls, single doors, double doors, and columns. The parameters include the start point and end point of the wall and the center point of the door and column. These parameters are input into Revit 2022 through the Revit API 2022 after post-processing. The dimensional parameter integration affordances of object detection and instance segmentation are studied and compared using Faster R-CNN and Mask R-CNN models. Instance segmentation was found to require more time for data labeling but was more capable of informing the modeling of irregularly shaped objects. The mean Average Precision (mAP) of object detection and instance segmentation are 71.7% and 69.3%, respectively. Apart from single doors, the average precision for other categories falls within the range of 74% to 96%. The results provide software developers with guidance on choosing between object detection and instance segmentation strategies for processing legacy building documents. These types of systems are anticipated to be pivotal to the industry’s transition from 2D to 3D information modalities and advise practitioners to carefully choose suitable models and consider the recommendations provided in this study to mitigate potential failure cases.

The title sterically congested piperazine derivative, C20H27FN2O2, was prepared using a modified Bruylants approach. A search of the Cambridge Structural Database identified 51 compounds possessing an N-tert-butyl piperazine substructure. Of these only 14 were asymmetrically substituted on the piperazine ring and none with a synthetically useful second nitrogen. Given the novel chemistry generating a pharmacologically useful core, determination of the crystal structure for this compound was necessary. The piperazine ring is present in a chair conformation with di-equatorial substitution. Of the two N atoms, one is sp3 hybridized while the other is sp2 hybridized. Intermolecular interactions resulting from the crystal packing patterns were investigated using Hirshfeld surface analysis and fingerprint analysis. Directional weak hydrogen-bond-like interactions (C—H...O) and C—H...π interactions with the dispersion interactions as the major source of attraction are present in the crystal packing.

Abstract The twist angle between a pair of stacked 2D materials has been recently shown to control remarkable phenomena, including the emergence of flat‐band superconductivity in twisted graphene bilayers, of higher‐order topological phases in twisted moiré superlattices, and of topological polaritons in twisted hyperbolic metasurfaces. These discoveries, at the foundations of the emergent field of twistronics, have so far been mostly limited to explorations in atomically thin condensed matter and photonic systems, with limitations on the degree of control over geometry and twist angle, and inherent challenges in the fabrication of carefully engineered stacked multilayers. Here, this work extends twistronics to widely reconfigurable macroscopic elastic metasurfaces consisting of LEGO pillar resonators. This work demonstrates highly tailored anisotropy over a single‐layer metasurface driven by variations in the twist angle between a pair of interleaved spatially modulated pillar lattices. The resulting quasi‐periodic moiré patterns support topological transitions in the isofrequency contours, leading to strong tunability of highly directional waves. The findings illustrate how the rich phenomena enabled by twistronics and moiré physics can be translated over a single‐layer metasurface platform, introducing a practical route toward the observation of extreme phenomena in a variety of wave systems, potentially applicable to both quantum and classical settings without multilayered fabrication requirements.

The manufacturing process of cement emits one metric ton of carbon dioxide greenhouse gas. Considering the situation reducing the gas emission without affecting cement production, industrial wastes like metakaolin (MK) can be partially replaced with cement due to high pozzolanic reactivity to arrive the high-strength concrete. This present examination attentions on the obtaining optimum percentage of metakaolin to be substituted for cement proportion and aims to determine the concrete sample’s mechanical characteristics, equivalent CO _2 emissions, and energy factor for environmental advantages through comparison with metakaolin varied from 0% to 20% at 5% incremental rate was determined and compared with the conventional control mix. Concrete samples are tested at the periodical interval of 7, 14, and 28 days in addition results, 5% of metakaolin is the optimum percentage to be replaced for cement in concrete. The negative sign implies that replacing binder with MK gradually decreases energy requirements (−2.16% to −7.74%) as well as carbon dioxide emissions (−4.17% to −15.41%). The use of mineral admixture like high reactive metakaolin additional cementitious elements has a considerable effect and may have an impact on the creation of environmentally friendly, sustainable concrete. In conclusion, effective utilization of high reactive metakaolin in high-strength concrete leads to substantial cost, and reducing global gas emissions eventually reduces energy consumption and a notable decrease in environmental pollution.

The distinct fiber addition to concrete can improve weak performance in tension. Due to its higher performance, fiber hybridization is becoming more and more competitive. In this study, the hardened and durability characteristics of performance-based concrete reinforced with polypropylene, basalt and hooked end steel fibers are investigated. Total 12 mixes are prepared to evaluate the different characteristics of performance-based concrete. The influence of basalt fibers (0.2, 0.25, 0.5, 0.75 & 1%), polypropylene fibers ( 0.025, 0.03, 0.035, 0.05 & 1%), hooked end steel fibers (0.225, 0.475, 0.65, 0.75, 0.80 & 1%) to explore the impact of fiber synergy, various hybrid fibers with maximum volume fraction of 1% were used out of total concrete volume with and without copper slag (20% & 40%) replacement with fine aggregate are investigated on the hardened characteristics including; compressive strength, flexural strength, splitting tensile strength. Moreover, durability properties including; water absorption, electrical Resistivity, for performance-based concrete are also conducted. Out of the 12 mixes considered for this study, PP0.05B0.2S0.75CS40 performs better and exhibit excellent performance in terms of strength and durability.

Pulmonary hypertension in left heart disease (PH-LHD) is the most prevalent form of PH. It is classified as group 2 PH as per WHO classification. As the prevalence of left heart disease such as congestive heart failure is increasing, the number of patients with associated PH is rising, coupled with high morbidity and mortality. Pulmonary hypertension is initially passive or isolated post-capillary (Ipc-PH) due to increased left sided filling pressures. In long standing cases pre-capillary component is added due to development of pulmonary vascular disease, termed combined post- and pre-capillary PH (Cpc-PH) or reactive PH. We describe the hemodynamics, pathophysiology, role of echocardiography and right heart catheterization in PH-LHD. We discuss the significance of PH associated with congestive heart failure as well as valvular heart disease. Although there is no treatment for PH-LHD, we discuss and critically analyze various studies investigating the role of pulmonary vasodilators in this condition. As PH-LHD is an under studied disease, we highlight the areas where further research is required.

Many civil engineering structures are constructed in terms of aspect like economy, strength and serviceability requirement. The fibres play a prominent role in bridging the micro cracks at the early stage of crack propagation and makes the structure ductile. The impact of chopped basalt fibre on high-strength reinforced concrete composites is the focus of this research. The chopped basalt fibre hardened property of concrete was investigated and compared it with controlled concrete. Moreover, physical property of concrete i.e. slump cone and compaction factor incorporating chopped basalt fibre volume fraction in variation of 0%,0.75%,1.5%,2.25%,3% to the total volume of concrete mix was also investigated. To analyse the hardened properties of chopped basalt fibre high strength concrete, 135 test samples were made and cured for 7, 14, and 28 days. The test findings show that increasing the volume percentage of fibres reduces slump from 135 mm to 132 mm for BFHS0.75 but does not result in a significant increase in concrete compressive strength of 77.1 MPa for BFHS0.75 However, on addition of chopped basalt fibres at 2.25% (BFHS2.25) the percentage increment of flexural strength increases by 72.8% (10.3 MPa) with control mix (5.96 MPa) and after that it decreases when 3% fibres were incorporated. Similarly, split-tensile strength increases at all fibre dosage and fibre addition of 3% (BFHS3) increases by 12.28% (5.65 MPa) with controlled concrete (5.04 MPa). The analytical results and suggested regression model could be used in real-world situations with fiber reinforced high strength concrete related issues. There is a significant relationship between mechanical property and independent variable through ANOVA in SPSS.

Abstract Background Thrombotic microangiopathy (TMA) secondary to gemcitabine therapy (GiTMA) is a very rare pathology that carries a poor prognosis, with nearly half of the cases progressing to end stage renal disease. GiTMA is most commonly associated with adenocarcinomas, most notably pancreatic cancers. The mainstay of management is withdrawal of the offending drug and supportive care. Plasmapheresis has a limited role and hemodialysis may help in the management of fluid overload secondary to renal failure. Furthermore, a C5 inhibitor, eculizumab, has been successfully used in the treatment of GiTMA. Case presentation A 64-year-old Caucasian female with history of pancreatic adenocarcinoma on gemcitabine chemotherapy presented with signs and symptoms of fluid overload and was found to have abnormal kidney function. Her BP was 195/110 mmHg, serum creatinine 4.48 mg/dl, hemoglobin 8.2 g/dl, platelets 53 × 103/cmm, lactate dehydrogenase 540 IU/L, and was found to have schistocytes on blood film. A diagnosis of TMA secondary to gemcitabine therapy was suspected. Hemodialysis for volume overload and daily plasmapheresis were initiated. After six days of plasmapheresis, renal function did not improve. Further work up revealed ADAMTS 13 activity >15%, low C3, and stool culture and Shiga-toxin PCR were negative. Renal biopsy was consistent with TMA. Gemcitabine was discontinued, but renal function failed to improve and eculizumab therapy was considered due to suspicion of aHUS. Serum creatinine >2.26 mg/dl and a platelet count of >/= 30 × 109/L is highly suggestive of aHUS, while TTP is more likely when creatinine is

Thrombospondin-1 (THBS1) levels elevate under hypoxia and have relevance in several cardiovascular disorders. The association of THBS1 with endothelial dysfunction implies its important role in hypertension. To establish the hypothesis, we screened patients with hypertension and their respective controls from the two different environmental regions. Cohort 1 was composed of Ladakhis, residing at 3500 m above sea level (ASL), whereas Cohort 2 was composed of north-Indians residing at ~200 m ASL. Clinical parameters and circulating THBS1 levels were correlated in the case–control groups of the two populations. THBS1 levels were significantly elevated in hypertension patients of both cohorts; however, the levels were distinctly enhanced in the hypertensive patients of HA as compared to normoxia (p < 0.002). The observation was supported by the receiver operating curve analysis with an area under curve of 0.7007 (0.627–0.774) demonstrating the discriminatory effect of hypobaric hypoxia on the levels as compared to normoxia (p < 0.011). Significant correlation of THBS1 and mean arterial pressure was observed with upraised positive correlations in the hypertensive highlanders as compared to the hypertensive patients from sea-level. The prevalence of differential distribution of THBS1 and CD47 genes variants, their interactions, and association with the THBS1 levels were also determined. Genotype-interactions between THBS1 rs2228263 and CD47 rs9879947 were relevant and the regression analysis highlighted the association of risk genotype-interactions with increased THBS1 levels in hypertension. Genetic studies of additional thrombospondin pathway-related genes suggest the complex role of THBS1 in the presence of its family members and the related receptor molecules at HA.

Sliding wear performance of thermal spray WC-based coatings has been widely studied. However, there is no systematic investigation on the influence of test conditions on wear behaviour of these coatings. In order to have a good understanding of the effect of test parameters on sliding wear test performance of HVAF-sprayed WC–CoCr coatings, ball-on-disc tests were conducted under varying test conditions, including different angular velocities, loads and sliding distances. Under normal load of 20 N and sliding distance of 5 km (used as ‘reference’ conditions), it was shown that, despite changes in angular velocity (from 1333 rpm up to 2400 rpm), specific wear rate values experienced no major variation. No major change was observed in specific wear rate values even upon increasing the load from 20 N to 40 N and sliding distance from 5 km to 10 km, and no significant change was noted in the prevailing wear mechanism, either. Results suggest that no dramatic changes in applicable wear regime occur over the window of test parameters investigated. Consequently, the findings of this study inspire confidence in utilizing test conditions within the above range to rank different WC-based coatings.

Although surgical excision is the standard of therapy for small renal masses (SRMs), there is a growing recognition of active surveillance as an option in select patients who are poor surgical candidates or who have shorter life expectancy. A number of patients on expectant management, however, subsequently advance to definitive therapy. In this study, we systematically reviewed the literature and performed a pooled analysis of active surveillance series to evaluate the rate and indications for definitive treatment after initiating a period of active surveillance. Fourteen clinical series (1245 patients; 1364 lesions) met our selection criteria. Mean lesion size at presentation was 2.30 ± 0.40 cm with a mean follow-up of 33.6 ± 16.9 months. Collectively, 34.0% of patients underwent delayed intervention, which ranged in individual series from 3.6% to 70.3%. Of patients undergoing delayed intervention, the average time on active surveillance prior to definitive treatment was 27.8 ± 10.6 months. A pooled analysis revealed that 41.0% of patients underwent therapy secondary to tumor growth rate and 51.9% secondary to patient or physician preference in the absence of clinical progression. Overall, 1.1% of all patients progressed to metastatic disease during the average follow-up period. Thus, active surveillance may be an appropriate option for carefully selected patients with SRMs. However, delayed treatment is pursued in a significant percentage of patients within 3 years. Prospective registries and clinical trials with standardized indications for delayed intervention are needed to establish true rates of disease progressions and recommendations for delayed intervention.

Epithelial to mesenchymal transition (EMT) is a cellular program that converts non-motile epithelial cells into invasive mesenchymal cells. EMT is implicated in cancer metastasis, chemo-resistance, cancer progression, and generation of cancer stem cells (CSCs). Inducing mesenchymal to epithelial transition (MET), the reverse phenomenon of EMT, is proposed as a novel strategy to target triple negative and tamoxifen-resistant breast cancer. Triple negative breast cancer (TNBC) is characterized by the loss of hormone receptors, a highly invasive mesenchymal phenotype, and a lack of targeted therapy. Estrogen receptor-positive breast cancer can be targeted by tamoxifen, an ER antagonist. However, these cells undergo EMT over the course of treatment and develop resistance. Thus, there is an urgent need to develop therapeutic interventions to target these aggressive cancers. In this study, we examined the role of novel diphenylamine analogs in converting the mesenchymal phenotype of MDA-MB-231 TNBC cells to a lesser aggressive epithelial phenotype. Using analog-based drug design, a series of diphenylamine analogs were synthesized and initially evaluated for their effect on E-cadherin protein expression and changes incell morphology, which was quantified by measuring the spindle index (SI) value. Selected compound 1 from this series increases the expression of E-cadherin, a primary marker for epithelial cells, and decreases the mesenchymal markers SOX2, ZEB1, Snail, and vimentin. The increase in epithelial markers and the decrease in mesenchymal markers are consistent with a phenotypic switch from spindle-like morphology to cobblestone-like morphology. Furthermore, Compound 1 decreases spheroid viability, cell migration, and cell proliferation in triple negative BT-549 and tamoxifen-resistant MCF-7 breast cancer cells.

Quasiperiodic metastrucures are characterized by edge localized modes of topological nature, which can be of significant technological interest. We here investigate such topological modes for stiffened and sandwich beams, which can be employed as structural members with inherent vibration localization capabilities. Quasiperiodicity is achieved by altering the geometric properties and material properties of the beams. Specifically, in the stiffened beams, the geometric location of stiffeners is modulated to quasiperiodic patterns, while, in the sandwich beams, the core’s material properties are varied in a step-wise manner to generate such patterns. The families of periodic and quasiperiodic beams for both stiffened and sandwich-type are obtained by varying a projection parameter that governs the location of the center of the stiffener or the alternating core, respectively. The dynamics of stiffened quasiperiodic beams is investigated through 3-D finite element simulations, which leads to the observation of the fractal nature of the bulk spectrum and the illustration of topological edge modes that populate bulk spectral bandgaps. The frequency spectrum is further elucidated by employing polarization factors that distinguish multiple contributing modes. The frequency response of the finite stiffened cantilever beams confirms the presence of modes in the non-trivial bandgaps and further demonstrates that those modes are localized at the free edge. A similar analysis is conducted for the analysis of sandwich composite beams, for which computations rely on a dynamic stiffness matrix approach. This work motivates the use of quasiperiodic beams in the design of stiffened and sandwich structures as structural members in applications where vibration isolation is combined with load-carrying functions.

Objectives. The robotic-assisted laparoscopic retroperitoneal lymph node dissection (R-RPLND) represents a new frontier in the surgical management of testicular cancer in the realm of minimally invasive urologic oncology. We aimed to review the early outcomes as compared to the laparoscopic and open approaches as well as describe the operative technique for the R-RPLND. Materials and Methods. We reviewed all the literature related to the R-RPLND based on an electronic PubMed search up until July 2017. Results and Discussion. Encouraged by favorable early oncologic and safety outcomes for treatment of clinical stage (CS) I nonseminomatous germ cell tumor (NSGCT), the R-RPLND affords the same recovery advantages as the laparoscopic retroperitoneal lymph node dissection (L-RPLND) while offering greater dexterity, superior visualization, and a theoretically shorter learning curve for the surgeon. While R-RPLND has a promising future in the management of patients with primary and postchemotherapy NSGCT, larger and more vigorous prospective studies are needed before supplanting the open RPLND as the gold standard approach for primary low-stage NSGCT or becoming an equivalent surgical modality in the postchemotherapy setting.

Introduction: Dexmedetomidine is a potent and highly selective alpha-2 adrenoreceptor agonist with the unique sedative, analgesic, perioperative sympatholytic, anaesthetic-sparing and haemodynamic-stabilizing properties. Fentanyl is a potent, synthetic opioid pain medication with a rapid onset and short duration of action. Aim: To examine the effects of fentanyl and dexmedetomidine with paracetamol administered by intravenous route on the postoperative Interleukin (IL-6) and C-reactive protein (CRP) response in oral cancer surgery. Materials and Methods: This prospective comparative study included 60 patient of American Society of Anaesthesiologists (ASA) grade I or II, aged 18 to 70 years. 60 patients were divided into two groups: Group A- Paracetamol (10 mg/kg) with fentanyl (2 µg/kg), maintenance with fentanyl (3 µg/kg); and Group BParacetamol (10 mg/kg) with dexmedetomidine (0.5 µg/kg), maintenance with dexmedetomidine (0.4 µg/kg). Blood samples were collected before induction at the end of surgery and 24 hours after surgery for serum level of CRP and IL-6. Results: The demographic profiles such as age, weight, duration of surgery, ASA grade and tumour stage were similar in both groups. CRP and IL-6 level were significantly lower in groups postoperatively at 24 hours as compared to preoperatively and immediate postoperatively. The Visual Analogue Scale (VAS) score and rescue analgesic for 24 hour were lower in group B than group A. Conclusion: Dexmedetomidine is an effective drug which reduces requirement of opioid and potentially increases the analgesia. Adverse effects were not significantly different between the groups.

Aims and Objectives: To evaluate the pre-treatment and post-treatment dental arch changes in both upper and lower arches in orthodontic patients treated with extraction of first premolar teeth. Subjects and Methods: Measurements were made on casts of 50 post treated cases in the age group of 12-30 years for individual tooth measurements, width of the arches (inter-incisal, inter-canine, inter-premolar and inter-molar) arch length (both right and left sides, anterior segment, posterior segment and total arch length for both for the maxillary and mandibular dental casts. Statistical Analysis Used: Kolmogorov-Smirnov test for Normality, Regression Analysis was done as variables were tested and proved to follow normality. Statistical software Statistical Package for the Social Sciences version 18 (SPSS Inc.; Chicago, Illinois, USA) was used for data analysis. Descriptive statistics and paired t-tests were used to compare the changes in the Class I and Class II div 1 groups. Results: There was a significant increase in the inter-incisor and inter-canine width post-treatment in the Class I and Class II div 1 subjects in the upper arch but no significant change in inter-incisor width in the lower arch in class I subjects. A significant decline in the inter-molar arch width in both the groups were seen. The inter-premolar arch width declined significantly in Class I cases while it increased significantly in Class II div 1 subjects. There was a significant increase in anterior arch length and a significant decrease in posterior arch length in all subjects. Conclusions: The findings of this original clinical research should significantly help the orthodontists in orthodontic treatment planning in patients requiring extractions of premolars.

Ambras syndrome, a form of congenital hypertrichosis lanuginosa, is extremely rare in neonates. It is characterized by typical pattern of hair distribution, dysmorphic facial features and a familial pattern of inheritance. We report a case of Ambras syndrome in a preterm neonate with history of consanguinity and positive family history.

Background: To assess the status of occupational hazards and their prevention among the practicing dentists in Chandigarh city, India. Materials and Methods: A closed-ended questionnaire was prepared to record demographic status, types of occupational hazards encountered, and status of measures used for their prevention. A total 113 out of 130 dentists completed the questionnaire and the response rate was 86.9%. Frequency tables were prepared and coefficient of correlation was computed to check correlation between different variables. Statistical significance was set at P < 0.05. Results: The most common occupational hazard reported was injury from "sharps" (77%), out of which needle prick injury was the most frequent. Of the other occupational problems job related stress (43.3%), musculoskeletal problems (39.8%), and allergies (23.8%) from things used in dental clinics were most common. A reasonably high percentage of dentists were immunized against hepatitis-B virus (88.4%) and were following proper infection control measures and hospital waste disposal methods. Very few dentists were following the correct method of disposal of excess amalgam (11%) and measurement of radiation exposure (27.5%) within their clinic. Most of them (90.2%) were satisfied with their current working hours and job. Conclusion: Prevalence of occupational hazards among the studied group was high and certain preventive measures were not being followed properly. Therefore, there is a need to improve the knowledge of dentists regarding these hazards and their prevention.

Introduction: Poisoning is a common medico-social problem. It is a significant contributor to morbidity and mortality. Our study is to determine the socio demographic profile of the poisoning cases reported and to find out the pattern of poisoning cases at a tertiary care hospital in rural set up. Method: Participants comprised of acute poisoning admissions to the emergency of UPRIMS & R, Saifai, Etawah, U.P. during 8 months period. Data regarding pattern of poisoning, basic demographics and drug utilization were collected by retrospective review of patient records. Results: Major poisoning cases were observed in the age group between 21-30 years (39.09%). The populations with possibility of exposure to poisoning in their occupations were farmers (41.5%), housewives (31.2%) and students (18.8%). The maximum numbers of poisoning cases reported were due to organophosphorus (57.1%).The number of intentional poisoning cases (91.9%) were more when compared to accidental poisoning cases (5.2%). Conclusion: Prevailing treatment protocols require updating on proper guidelines for better management of poisoning. Pattern and magnitude of poisoning are multidimensional and demand multi-sectoral approach for facing this problem. There is need for stringent pesticide regulation laws and counselling and training programs to reduce incidence of poisonings.

Hematopoietic stem cell transplantation (HSCT) is a highly effective treatment strategy for lymphoproliferative disorders and bone marrow failure states including aplastic anemia and thalassemia. However, its use has been limited by the increased treatment related complications, including acute kidney injury (AKI) with an incidence ranging from 20% to 73%. AKI after HSCT has been associated with an increased risk of mortality. The incidence of AKI reported in recipients of myeloablative allogeneic transplant is considerably higher in comparison to other subclasses mainly due to use of cyclosporine and development of graft-versus-host disease (GVHD) in allogeneic groups. Acute GVHD is by itself a major independent risk factor for the development of AKI in HSCT recipients. The other major risk factors are sepsis, nephrotoxic medications (amphotericin B, acyclovir, aminoglycosides, and cyclosporine), hepatic sinusoidal obstruction syndrome (SOS), thrombotic microangiopathy (TMA), marrow infusion toxicity, and tumor lysis syndrome. The mainstay of management of AKI in these patients is avoidance of risk factors contributing to AKI, including use of reduced intensity-conditioning regimen, close monitoring of nephrotoxic medications, and use of alternative antifungals for prophylaxis against infection. Also, early identification and effective management of sepsis, tumor lysis syndrome, marrow infusion toxicity, and hepatic SOS help in reducing the incidence of AKI in HSCT recipients.

Introduction: Talon cusp is an uncommon odontogenic anomaly which most frequently affects maxillary permanent incisors. Its presence causes the problem in esthetics, prevention of caries, and occlusal accommodation for the patient and problems in the diagnosis and clinical management for the dentist. Case Report: This article reports a case of talon cusp on the palatal surface of the permanent maxillary central incisor. Discussion: Since, the presence of talon cusp usually demands that definitive treatment be instituted; it represents a problem of clinical significance. The dentist should be able to diagnose it as the maxillary incisor is also the principal site for supernumerary tooth.

Mesiodens being the most common type of supernumerary tooth, usually results in malocclusion, poor aesthetics and cyst formation if it is not corrected. The management protocol involves surgical removal. The situation can be complicated in young permanent dentition where there are a lot of chances of damage to the permanent dentition during surgical removal of impacted teeth. This article reports a case of impacted mesiodens which was diagnosed during management of complicated crown fracture. The case was followed up to 3years which showed a good bone formation. The article highlights the need for regular follow-up after surgical removal of impacted teeth in young children, to see any changes or damage in the developing permanent teeth.

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The genes FTO and GNB3 are implicated in essential hypertension but their interaction remains to be explored. This study investigates the role of interaction between the two genes in the pathophysiology of essential hypertension.In a case-control study comprising 750 controls and 550 patients, interaction between the polymorphisms of FTO and GNB3 was examined using multifactor dimensionality reduction (MDR). The influence of interaction on clinical phenotypes like systolic and diastolic blood pressure, mean arterial pressure and body mass index was also investigated. The 3-locus MDR model comprising FTO rs8050136C/A and GNB3 rs1129649T/C and rs5443C/T emerged as the best disease conferring model. Moreover, the interacted-genotypes having either 1, 2, 3, 4 or 5 risk alleles correlated with linearly increasing odds ratios of 1.91 (P = 0.027); 3.93 (P = 2.08E-06); 4.51 (P = 7.63E-07); 7.44 (P = 3.66E-08) and 11.57 (P = 1.18E-05), respectively, when compared with interacted-genotypes devoid of risk alleles. Furthermore, interactions among haplotypes of FTO (H1-9) and GNB3 (Ha-d) differed by >1.5-fold for protective-haplotypes, CTGGC+TC [H2+Ha] and CTGAC+TC [H4+Ha] (OR = 0.39, P = 0.003; OR = 0.22, P = 6.86E-05, respectively) and risk-haplotypes, AAAGC+CT [H3+Hc] and AAAGC+TT [H3+Hd] (OR = 2.91, P = 9.98E-06; OR = 2.50, P = 0.004, respectively) compared to individual haplotypes. Moreover, the effectiveness of gene-gene interaction was further corroborated with a 1.29-, 1.25- and 1.38-fold higher SBP, MAP and BMI, respectively, in patients having risk interacted-haplotype H3+Hc and 2.48-fold higher SBP having risk interacted-haplotype H3+Hd compared to individual haplotypes.Interactions between genetic variants of FTO and GNB3 influence clinical parameters to augment hypertension.

Radioembolization offers a novel way to treat the nonresectable, liver predominant hepatic malignancies with better tumor response and overall progression-free survival rates. Transarterial catheter-based radioembolization procedure involves the hepatic arterial administration of glass- or resin-based beta emitting Yttirum-90 microspheres. Safe delivery of the tumoricidal radiation dose requires careful angiogram planning and coil embolization to quantify lung shunting and prevent systemic toxicity, respectively. Diagnostic pretreatment angiogram also serves to identify the hepatic arterial variant anatomy and other coexisting pathologies that might require a different or alternative approach. We describe a complex case of celiac artery stenosis with tortuous pancreaticoduodenal arterial arcade precluding access to the right hepatic artery for performing radioembolization. Celiac artery stenting of the stenosis was performed to facilitate subsequent safe and successful Yttrium-90 microsphere radioembolization.