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The increased detection of thyroid nodules in the human population has led to an increase in the number of thyroid surgeries without an improvement in survival outcomes. Though the choice for surgery is straightforward in malignant thyroid nodules, the decision is far more complex in those nodules that get categorized into indeterminate thyroid nodules (ITN) by fine needle aspiration. Therefore, there is a pressing need to develop a tool that will aid in decision-making among the ITN. In this context, the development of various molecular testing (MT) panels has helped to confirm or rule out malignancy, reducing unnecessary surgeries and potentially guiding the extent of surgery as well. Currently, such tests are widely used among the Western population but these MT panels are not used by the South Asian population because of non-availability of validated panels and the high cost involved. There is a need to develop a suitable panel which is population-specific and validate the same. In this review, we would focus on current trends in the management of ITN among the South Asian population and how to develop a novel MT panel which is cost-effective, with high diagnostic accuracy obviating the need for expensive panels that already exist.

Tubular adenomas of the breast belong to the category of fibroepithelial tumours of the breast, and it is composed of compact bilayer tubules with a sparse intervening stroma. It is usually circumscribed (may be nodular) benign tumour of the breast.Tubular adenomas are very rare benign tumours of the breast which mimic the clinical and radiological presentation of fibroadenomas. It usually presents as, a well-circumscribed, palpable painless mass. Surgical excision of this tumour is the main stay treatment. This report documents, a rare presentation of tubular adenoma in a 17-year-old girl who presented with a swelling in the right breast with pain, nipple discharge and nipple inversion. Breast ultrasound revealed, a large well-circumscribed heteroechoic lesion (8.5*3.8cm) within the right breast, giving breast within breast appearance and reported as Breast Imaging Reporting and Diagnostic Scoring system BIRADS III. Patient was provisionally diagnosed as giant fibroadenoma and was planned for excisional biopsy. Histopathological examination confirmed it to be tubular adenoma. The patient had an excellent postoperative recovery.

PURPOSEThe current American Joint Cancer Committee (AJCC) staging system for salivary gland tumors does not include histology and grade in its classification despite their proven prognostic importance. We planned to analyze if a modified staging system integrating these two factors into the staging improves prognostic performance and then validate it externally.MATERIALS AND METHODSFrom SEER database (2000-2018), patients with major salivary gland carcinoma who underwent surgical resection between 2004 and 2015 were analyzed. Histologies were recoded into two groups based on grade and type of histology into “Low Aggression” and “High aggression” groups. Cox proportional hazards model was used to identify predictor variables for overall survival and disease-specific survival and models were generated based on least absolute shrinkage and selection operator regression. Model performance was evaluated by Akaike Information Criterion, concordance index and calibration plot. The best model chosen was externally validated from our hospital database of patients who underwent surgery for salivary gland tumor between January 1, 2012 to December 31, 2019.RESULTSSix thousand two hundred forty-six patients were analyzed with a median follow up of 58 months. Age > 65 years, male sex, metastatic disease, Histological Stratification, Grade of tumor, AJCC stage and Primary Site were the significant factors influencing overall survival and disease-specific survival. By least absolute shrinkage and selection operator regression method, Correlation analysis and Interaction testing by multiple regression, AJCC stage and Histological Risk stratification were used for generating four models, out of which the best model was selected by Akaike Information Criterion, C index and calibration plot. This model was then externally validated in our hospital database of 269 patients.CONCLUSIONWe propose an externally validated modified salivary gland staging system that incorporates histology and grade of tumor for improved hazard discrimination among patient subgroups.

Water‐soluble organic cages are attractive targets for their molecular recognition and sensing features of biologically relevant molecules. Here, we have successfully designed and synthesized a pair of water‐soluble cationic cages employing click reaction as the fundamental step followed by the N‐methylation of the triazole rings. The rigid and shape‐persistent 3D hydrophobic cavity, positively charged surface, H‐bonding triazolium rings, and excellent water solubility empower both cages to exhibit a superior affinity and selectivity for binding with adenosine‐5'‐triphosphate (ATP) compared to cyclophanes and other macrocyclic receptors. Both cage molecules (PCC⋅Cl and BCC⋅Cl) can bind a highly emissive dye HPTS (8‐hydroxypyrene‐1,3,6‐trisulfonic acid trisodium salt) to form non‐fluorescent complexes. The addition of ATP resulted in the stronger cage⊂ATP complexes with the retention of HPTS emission upon its displacement. The resultant indicator‐displacement assay system can efficiently sense and quantify ATP in nanomolar detection limits in buffer solutions and human serum matrix. Spectroscopic and theoretical studies revealed the synergistic effect of π⋅⋅⋅π stacking interaction between the aromatic moiety of the cationic cages and the adenine moiety of ATP, as well as the electrostatic and hydrogen bonding interaction between the phosphate anion of ATP and triazole protons of cages, played the pivotal roles in the sensing process. [ABSTRACT FROM AUTHOR]

Bis‐coumarins are distinguished derivatives of coumarin which bear numerous pharmaceutical and other applications. In continuation of our ongoing research towards the development of benign protocols for various heterocyclic systems, herein we report an Amberlyst 15 mediated synthesis of unsymmetrical bis‐coumarins via in situ generation and cyclization of symmetrical bis‐coumarinyl methanes derived from o‐hydroxy aromatic aldehydes and 4‐hydroxy coumarin. Aldehydes of both electron‐donating and electron‐withdrawing units underwent smooth conversion to their respective unsymmetrical bis‐coumarins (76–98 % yield) without leaving any side products or intermediates. The catalyst used in the present protocol is cost‐effective, eco‐friendly, and readily available which could be recovered and reused several times. This methodology offers operational simplicity, low catalyst loading, and avoids the use of toxic solvents/reagents and the product can be isolated without chromatography. DFT study indicated that the driving force for the cyclisation of symmetrical bis‐coumarin is the minimization of the tetrahedral bond angle deviations along with other small non‐covalent interactions. Some DFT data was also verified with the data obtained from the X‐rays crystallographic study. [ABSTRACT FROM AUTHOR]

Lipoma is a benign neoplasm arising from yellow fat. Often it can be hyperplasia or combination of neoplasm and hyperplasia. It is composed of mature adipocytes and uniform nuclei that are identical to those seen in normal adult fat. It is called as universal tumour/ubiquitous tumour as it can occur anywhere in the body outside of brain. It can be localised (encapsulated) or diffuse (nonencapsulated). It can occur in sites like subcutaneous, subfascial, intramuscular, intermuscular in anterior abdominal wall, paraosteal, submucosal, subserosal sites. Here, a case of torsion of the lipoma in the greater omentum is reported presenting as acute abdomen. This eight-year-old girl presented with symptoms of right iliac fossa pain, signs of localised peritonitis and right psoas irritation. Appendicular mass/abscess was considered on clinical examination. The radiological evaluation ruled out appendicular pathology and an ovarian pathology possibly a torted ovary was suspected. During surgical exploration, a tumour of greater omentum was identified and resected. This rarity of the differential diagnosis for a right Iliac fossa mass is highlighted herewith.

Abstract Aims and Objectives Synechia formation in a postoperative nasal cavity is a major factor for suboptimal clinical outcome in functional endoscopic sinus surgery (FESS). Nasal packs medicated with steroids like triamcinolone and topical agents like mitomycin C have been shown to reduce the formation of synechiae in postoperative patients. This study attempts to compare the efficacy of mitomycin C and triamcinoloneimpregnated nasal pack in the prevention of crusting and synechiae formation in patients undergoing FESS. Methods Ninety-eight consenting patients with chronic rhinosinusitis were randomized into two groups of 49 each to receive either triamcinolone-impregnated or mitomycin C-impregnated nasal pack after FESS. Blinded, postoperative endoscopic examination was done at the first and third week and at first and third month and scoring was done according to the Lund Kennedy scoring system. The primary variable for assessing the outcome was synechiae formation in the postoperative period, while reduction of crusting, discharge, mucosal edema, polypoidal mucosal changes, and maintenance of ostial patency were secondary variables. Results Significant reduction in synechiae formation and crusting at 3 months duration was found in the group receiving triamcinolone nasal pack as compared with mitomycin C nasal pack. Mitomycin C was found to significantly reduce crusting in the first postoperative week. Positive trends in reduction of discharge, mucosal edema, polypoidal changes, and in maintenance of patency of ostia were observed in both the groups, but there was no significant difference between the two groups. Conclusion These results suggest that triamcinolone has a long-term effect in the reduction of synechia formation and crusting in post-FESS patients as compared with mitomycin C, though similar effects were seen in both groups in the immediate postoperative period.

This study reports the synthesis of cofacial organic cage molecules containing aggregation‐induced emissive (AIE) luminogens (AIEgens) through four‐fold Cu(I)‐catalyzed azide–alkyne cycloaddition (CuAAC) "click" reactions. The shorter AIEgen, tetraphenylethylene (TPE), afforded two orientational isomers (TPE‐CC‐1A and TPE‐CC‐1B). The longer AIEgen, tetrabiphenylethylene (TBPE), afforded a single isomer (TBPE‐CC‐2). The click reaction employed is irreversible, yet it yielded remarkable four‐fold click products above 40 %. The phenyl rings around the ethylene core generate propeller‐shaped chirality owing to their orientation, which influences the chirality of the resulting cages. The shorter cages are a mixture of PP/MM isomers, while the longer ones are a mixture of PM/MP isomers, as evidenced by their x‐ray structures. The newly synthesized cage molecules are emissive even in dilute solutions (THF) and exhibit enhanced AIE upon the addition of water. The aggregated cage molecules in aqueous solution exhibit turn‐off emission sensing of nitroaromatic explosives, with selectivity to picric acid in the 25–38 nanomolar detection range. [ABSTRACT FROM AUTHOR]

Chiral self‐sorting during the formation of cage‐like molecules continues to fascinate and advance our understanding of the phenomenon in general. Herein, we report the chiral self‐sorting in the Pd6L12‐type metal‐organic cages. When a racemic mixture of axially chiral bis‐pyridyl ligands undergo coordination‐driven self‐assembly with Pd(II) ions to form Pd6L12‐type cages, the system has the option of chiral self‐sorting to afford any of at least 70 pairs of (one homochiral and 69 heterochiral) enantiomers and 5 meso isomers or a statistical mixture of everything. However, the system resulted in diastereoselective self‐assembly through a high‐fidelity chiral social self‐sorting to form a racemic mixture of D3 symmetric heterochiral [Pd6(L6R/6S)12]12+/[Pd6(L6S/6R)12]12+ cages. [ABSTRACT FROM AUTHOR]

When a racemic mixture of chiral building blocks self‐assembles to form discrete molecular or supramolecular cages, the system can adopt either social or narcissistic chiral self‐sorting. However, control over such chiral self‐sorting is hard to achieve with a desired choice of outcome. Herein, we report anion templated high‐fidelity chiral self‐sorting during the coordination‐driven self‐assembly of [Pd2L4] metal‐organic cages, with a racemic mixture of an axially chiral ligand. Upon varying the counter‐anions, the outcome of the choice of chiral self‐sorting, whether social or narcissistic, leading to kinetically favored heterochiral or thermodynamically favored homochiral cages, can be controlled through specific anion encapsulation. Non‐encapsulating anion afforded a mixture of all possible diastereomers. Anion exchange enabled structural transformations between the diastereomers and the conversion of the mixture of diastereomers into homochiral diastereomers. [ABSTRACT FROM AUTHOR]

A novel class of four-connecting three-dimensional molecular 2-5 based on biaryls for supramoelcular self-assembly is synthesized. The X-ray crystal structure analysis of tetraphenol with ethanol reveals a novel O-H...O hydrogen-bonded helical self-assembly in three dimensions leading to the generation of channels in the crystal lattice.