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A 55 year old female, presented with flank pain and fullness since 2 years. On examination, a 10x10cm, ballotable lump was present in the right flank. CT Abdomen showed a 9.5x8.8 cm, exophytic mass lesion in the right kidney with patchy arterial enhancement and heterogenous enhancement in the venous phase. Whole body PET CT showed well defined, metabolically active masses in the right kidney, thyroid and cervical lymph nodes. Nephrectomy specimen received, showed a tumor measuring 12x7x6.5 cm creamy-white, fleshy, replacing the kidney. Histopathology revealed an unusual renal neoplasm with tubule formation merging with bland spindle cells and a focal myxoid stroma. Tumor cells were immunoreactive for CK7, EMA, vimentin and were negative for PAX8, CD10 & AMACR. The diagnosis of Mucinous Tubular and Spindle cell carcinoma (MTSCC) was established. FNAC of the thyroid nodules showed a classic papillary thyroid carcinoma.

Objective: The primary objective of the study was to compare the effectiveness of homoeopathic treatment with standard allopathic regimen in acute ADL and secondary objective was to assess the reduction in frequency, duration and intensity of subsequent attacks, improvement of the quality of life of patients. Methods: The study was designed as a comparative randomized trial conducted from October 2012 to April 2014, on 112 patients at Regional Research Institute, Puri, Odisha. The ADL patients enrolled were randomized to receive either homoeopathic treatment or standard allopathic treatment for a period of six months. The outcome parameters used were ADL score and WHO QOL Bref. Results: 112 Patients were considered for primary outcome analysis as per the Intention to treat principle. (Homoeopathy= 55 and Allopathy= 57) and were analysed on 11th day of treatment. Both the treatments produced equal improvement in ADL scores. However, during the six months study period, the frequency, duration and intensity of attacks were better in Homoeopathy group compared to allopathy group. There was statistically significant improvement in Homoeopathy for Domain 4 of WHOQOL (P = 0.004) as compared to allopathy group. Medicines like Apismellifica (n = 23), Rhus toxicodendron (n = 20), Pulsatilla (n = 8), Arsenic album (n = 1), Bryonia alba (n = 1), Silicea (n = 1) and Hepar sulph (n = 1) were found most useful in the acute attacks. Conclusion: This study provides evidence to support the fact that individualized homoeopathy treatment is equally effective for ADL as the standard allopathy treatment in the management of ADL.

Context: Laparoscopic cholecystectomy is one of the most commonly performed minimal access surgeries nationwide, safely done as a day care procedure. Anesthetic techniques facilitating early recovery and home discharge have become the need of the hour. Aims: To compare early, intermediate, late recovery characteristics and time to home readiness following use of sevoflurane or desflurane as maintenance anesthesia in laparoscopic cholecystectomy in Indian subpopulation. In addition, postoperative complications such as coughing and shivering and total antiemetic and analgesic requirements postoperatively were also noted. Settings and Design: This was a prospective randomized study, and randomization was done by computerized random number table into two groups (30 patients in each group). Group S received sevoflurane and Group D received desflurane as maintenance agent. Subjects and Methods: Sixty patients of age group 18–60 years belonging to the American Society of Anesthesiologists Grade I and II undergoing laparoscopic cholecystectomy were recruited. A standard anesthesia induction was done and airway was secured with a ProSeal laryngeal mask airway of appropriate size. The patients subsequently received either sevoflurane 1%–2% or desflurane 3%–6% with 60% N2 O in O2 as per group assigned. Inhalational agent was discontinued at the time of endoscope removal. Early, intermediate, and late recovery parameters were noted. Statistical Analysis: The tests of significance used were parametric test (unpaired t-test) and ANOVA. The outcome measures were compared statistically using unpaired t-test and ANOVA, and P < 0.05 was considered statistically significant. Results: Early recovery parameters were achieved faster in patients receiving desflurane as compared to sevoflurane with no difference in time to achieve intermediate recovery and home readiness. Conclusion: Despite a faster early recovery with desflurane, no additional benefit in terms of home discharge and patient satisfaction was found, thus making use of either of the agents suitable for laparoscopic cholecystectomy on a day care basis.

Restricted availability of cell and animal models is a rate-limiting step for investigation of salivary gland neoplasm pathophysiology and therapeutic response. Conditionally reprogrammed cell (CRC) technology enables establishment of primary epithelial cell cultures from patient material. This study tested a translational workflow for acquisition, expansion and testing of CRC-derived primary cultures of salivary gland neoplasms from patients presenting to an academic surgical practice. Results showed that cultured cells were sufficient for epithelial cell-specific transcriptome characterization to detect candidate therapeutic pathways and fusion genes, and for screening for cancer risk-associated single nucleotide polymorphisms (SNPs) and driver gene mutations through exome sequencing. Focused study of primary cultures of a low-grade mucoepidermoid carcinoma demonstrated amphiregulin-mechanistic target of rapamycin-protein kinase B (AKT; AKT1) pathway activation, identified through bioinformatics and subsequently confirmed as present in primary tissue and preserved through different secondary 2D and 3D culture media and xenografts. Candidate therapeutic testing showed that the allosteric AKT inhibitor MK2206 reproducibly inhibited cell survival across different culture formats. By contrast, the cells appeared resistant to the adenosine triphosphate competitive AKT inhibitor GSK690693. Procedures employed here illustrate an approach for reproducibly obtaining material for pathophysiological studies of salivary gland neoplasms, and other less common epithelial cancer types, that can be executed without compromising pathological examination of patient specimens. The approach permits combined genetic and cell-based physiological and therapeutic investigations in addition to more traditional pathologic studies, and can be used to build sustainable bio-banks for future inquiries. This article has an associated First Person interview with the first author of the paper., Summary: Genetics and therapeutic responses of uncommon neoplasms, including salivary gland cancers, are investigatable through isolation of primary cells from patient material using conditional reprogramming cell technology without compromising pathological diagnosis.

Using conditional cell reprogramming, we generated a stable cell culture of an extremely rare and aggressive neuroendocrine cervical cancer. The cultured cells contained HPV-16, formed colonies in soft agar and rapidly produced tumors in immunodeficient mice. The HPV-16 genome was integrated adjacent to the Myc gene, both of which were amplified 40-fold. Analysis of RNA transcripts detected fusion of the HPV/Myc genes, arising from apparent microhomologous recombination. Spectral karyotyping (SKY) and fluorescent-in-situ hybridization (FISH) demonstrated coordinate localization and translocation of the amplified Myc and HPV genes on chromosomes 8 and 21. Similar to the primary tumor, tumor cell cultures expressed very high levels of the Myc protein and, in contrast to all other HPV-positive cervical cancer cell lines, they harbored a gain-of-function mutation in p53 (R273C). Unexpectedly, viral oncogene knockdown had no effect on the growth of the cells, but it did inhibit the proliferation of a conventional HPV-16 positive cervical cancer cell line. Knockdown of Myc, but not the mutant p53, significantly inhibited tumor cell proliferation. On the basis of these data, we propose that the primary driver of transformation in this aggressive cervical cancer is not HPV oncogene expression but rather the overexpression of Myc.

Objective To analyze the association between the feeding habits and prevalence of the early childhood caries among pre-school children of Udaipur city, Rajasthan. Study Design A cross-sectional study was conducted in school children between age group of 24–72 months. Demographic and attitudinal data were sought from parents of stratified randomly selected 586 children from this age group which was calculated according to a pilot study done two months prior to the study. Results Twenty-two point eight percent of the children examined were found to be affected with ECC. Forty-three point two percent and 65.3% of the children were breast fed and bed time fed respectively. Fifty-nine point one percent were weaned after 12 months of age. Conclusion It was observed that there was increase risk of developing ECC with bed time feeding and among those children weaned after 12 months of age.