A case report of liver infiltration from a large renal cell carcinoma: Diagnostic and management enigma

INTRODUCTION AND IMPORTANCE

Renal cell carcinoma is the most lethal malignancy of urinary tract. Invasion of right lobe of liver by Renal cell carcinoma is rare and possess a treatment challenge. Simultaneous nephrectomy with right hepatectomy has been proposed as a part of multi-modality treatment approach. But its safety and feasibility is not well established.

CASE PRESENTATION

We herein discuss a case of 30-year old female patient who underwent simultaneous nephrectomy with right hepatectomy along with single peritoneal metastasectomy for a huge Renal cell carcinoma of right kidney and infiltrating the right lobe of liver. Intra-operatively a single peritoneal nodule was present which came positive for malignancy on frozen section. Considering young age, good performance status and oligometastatic disease definitive procedure in the form of combined right nephrectomy and right hepatectomy was performed. She was discharged from the hospital on 6th post-operative day with an uneventful post-operative course.

CLINICAL DISCUSSION

The patients with locally advanced Renal cell carcinoma with involvement of adjacent organs require en block surgical resection in combination with targeted therapy and immunotherapy. The surgical management of patients with direct liver infiltration requires a right nephrectomy with some form of liver resection based on the extent of liver involvement to achieve a margin negative resection. In our case a plan of formal right hepatectomy was made as the tumor was infiltrating into segment VI, VII, and VIII.

CONCLUSION

The combined nephrectomy and right hepatectomy is safe and feasible for this type of huge RCC invading right hepatic lobe.

The outcome of 100 patients with achalasia cardia following laparoscopic Heller myotomy with blunt dissection technique

Background

Laparoscopic Heller myotomy (LHM) can be performed by blunt dissection technique (BDT). Only a few studies have assessed long-term outcomes and relief of dysphagia following LHM. The study reviews our long-term experience following LHM by BDT.

Methods

This retrospective study was analysed from a prospectively maintained database (from 2013 to 2021) of a single unit of the Department of Gastrointestinal Surgery at G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi. The myotomy was performed by BDT in all patients. A fundoplication was added in selected patients. Post-operative Eckardt score >3 was considered treatment failure.

Results

A total of 100 patients underwent surgery during the study period. Of them, 66 patients underwent LHM, 27 underwent LHM with Dor fundoplication and 7 underwent LHM with Toupet fundoplication. The median length of myotomy was 7 cm. The mean operative time was 77 ± 29.27 min and the mean blood loss of 28.05 ± 16.06 ml. Five patients had intraoperative oesophageal perforation. The median length of hospital stay was 2 days. There was no hospital mortality. The post-operative integrated relaxation pressure (IRP) was significantly lower than the mean pre-operative IRP (9.78 vs. 24.77). Eleven patients developed treatment failure, of which ten patients presented with recurrence of dysphagia. There was no difference in symptom-free survival amongst various types of achalasia cardia (P = 0.816).

Conclusion

LHM performed by BDT has a 90% success rate. Complication using this technique is rare, and recurrence post-surgery can be managed with endoscopic dilatation.

An understanding of mitochondria and its role in targeting nanocarriers for diagnosis and treatment of cancer

Nanotechnology has changed the entire paradigm of drug targeting and has shown tremendous potential in the area of cancer therapy due to its specificity. In cancer, several targets have been explored which could be utilized for the better treatment of disease. Mitochondria, the so-called powerhouse of cell, portrays significant role in the survival and death of cells, and has emerged as potential target for cancer therapy. Direct targeting and nanotechnology based approaches can be tailor-made to target mitochondria and thus improve the survival rate of patients suffering from cancer. With this backdrop, in present review, we have reemphasized the role of mitochondria in cancer progression and inhibition, highlighting the different targets that can be explored for targeting of disease. Moreover, we have also summarized different nanoparticulate systems that have been used for treatment of cancer via mitochondrial targeting.

Reliability, availability and maintainability analysis of a cement plant: a case study

Purpose

The demand of cement in India is expected to increase rapidly as the government has been giving immense boost to various housing facilities, infrastructure projects, road networks and railway corridors. One of the ways to meet this rise in the demand of cement is to increase the capacity utilization of the existing cement plants by improving their availability. The availability of a cement plant can be improved by avoiding failures and reducing maintenance time through reliability, availability and maintainability (RAM) analysis of its subsystems. The paper aims to discuss this issue.

Design/methodology/approach

The data related to time between failure (TBF) and time to repair (TTR) of all the critical subsystems of a cement plant were collected over a period of two years for carrying out RAM analysis. Trend test and serial correlation test were performed on TBF and TTR data to verify whether these data are independent and identically distributed or not. Afterwards, the authors use EasyFit 5.6 professional software to find best-fit distribution of TBF and TTR data and their parameters. The effectiveness of a preventive maintenance policy was evaluated by simulating the real and proposed systems.

Findings

The results of the analysis show that the raw mill and the coal mill are critical subsystems of a cement plant from a reliability point of view, whereas the kiln is a critical subsystem from an availability point of view. The analysis shows that the repair time of the cement mill should be reduced for improving the availability of the cement plant. The RAM analysis showed that the capacity of the case study company is 17 percent underutilized due to maintenance-related problems and 15 percent underutilized because of management-related problems.

Practical implications

The study exhibits the usage of RAM analysis in deciding preventive maintenance programs of several cement plant subsystems. Thus, it would serve as a reference for reliability and maintenance managers in deciding maintenance strategies of cement plants as well as in improving their capacity utilization.

Originality/value

The study exhibits the usage of RAM analysis in deciding preventive maintenance programs of several cement plant subsystems. Even more, using a simulation study, the authors show that preventive maintenance of the cement plant beyond a certain level can be disadvantageous as it leads to an increase in downtime and decrease in availability.

Herbonanoceuticals: A Novel Beginning in Drug Discovery and Therapeutics

The Indian pharmaceutical industry is the world’s second largest industry (by volume) that develops products and market drugs licensed for use as medications. Medicines manufactured in the modern era are associated with major controversies such as non–target specificity, resistance, repeated administration, immune rejection, and other adverse effects on the body. Thus, there is a great need to find drugs that do not raise the aforementioned issues. Nature is an excellent hub providing a diverse range of phytoconstituents that open the way to phototherapeutics, which need a scientific path to deliver the active elements in a supported way to increase patient compliance and reduce the need for repeated administration. To discover a novel phytochemical as a lead compound for a therapeutic purpose is a real challenge. In former times, drug discovery was a complex process, as it took several years to find a lead compound for use against a particular disease. Nowadays, however, virtual screening methods have been developed, which are target specific, time consuming, and cost effective. To avoid increased and repeated administration of a drug, nanosized drug delivery systems for herbal drugs have been developed to enhance the activity and overcome problems associated with synthetic medicines. This review summarizes three main fields: drug discovery, docking for drug design, and last—but not least—drug delivery systems. Nowadays, nanobased drug delivery systems are in demand for delivery of herbal medicines used for therapeutic purposes. Herbonanoceuticals—herbal drugs of a nanosize—have better remedial value and fewer detrimental effects than modern medicines. Therefore, herbonanoceuticals can be a boon in the field of therapeutics.

Rational Design and Synthesis of Biologically Active Disubstituted 2(3H) Furanones and Pyrrolone Derivatives as Potent and Safer Non Steroidal Anti-inflammatory Agents

BACKGROUND

Furanone and pyrrolone heterocyclic ring system represent important and interesting classes of bioactive compounds. Medicinal chemists use these heterocycyclic moieties as scaffolds in drug design and discovery.

METHODS

A series of 3-arylidene-5-(naphthalene-2-yl)-furan-2(3H)-ones (2a-j) were synthesized by incorporating pharmacophore of COX-2 inhibitor rofecoxib and naphthyl ring of naproxen as potential non steroidal anti-inflammatory agents. These furanone derivatives were subsequently reacted with dry ammonia gas and benzylamine to furnish corresponding 3-arylidene-5-(naphthlen-2-yl)-1H-pyrrol-2(3H)-ones (3a-e) and 3-arylidene-1-benzyl-5- (naphthalene-2-yl)-1H-pyrrol-2(3H)-ones (4a-e), respectively. The newly prepared heterocyclics were screened for their expected in-vivo biological activities including anti-inflammatory, analgesic and ulcerogenic actions in rodents. The COX-2 inhibitory behavior of synthesized compounds was also assessed via automated docking studies.

RESULTS

The chemical structure of the synthesized compounds was characterized by using modern spectroscopic techniques. Result of in-vivo pharmacological studies demonstrated that almost all N-Benzyl-pyrrol-2(3H)-ones (4a-e) showed better anti-inflammatory and analgesic activities in comparison with the other two series of furan-2(3H)-ones and pyrrol- 2(3H)-ones. The moldock score value of the tested compounds was found in the range of -116.66 to -170.328 and was better than the standard drug.

CONCLUSION

Among all the synthesized compounds, only nine compounds (2d, 2g, 2h, 3d, 4a, 4b, 4c, 4d and 4e) exhibited potent anti-inflammatory and analgesic activities with significantly reduced gastrointestinal toxicity in various animal models in comparison to standard drug, diclofenac. Therefore, it is recommended to explore the potential of the synthesized compounds as lead candidates for the development of new therapeutic agents.

Isolated fallopian tube torsion in early pregnancy presenting as resolving appendicular lump

Isolated fallopian tube torsion (IFTT) is a rare clinical entity, especially in pregnancy. It is frequently misdiagnosed as acute appendicitis or ovarian torsion. We present an unusual case of IFTT occurring in early pregnancy, which was detected when patient presented for medical termination of pregnancy in family planning clinic. This case report highlights sub acute presentation of IFTT in early pregnancy which clinically presented as resolving appendicular lump.

Variations in physico-chemical and microbiological characteristics of water during breeding of Cyprinus carpio in a closed hatchery system

Physico-chemical and microbial characteristics of culture water were examined during the induced breeding of Cyprinus carpio in a controlled environmental system. Water temperature, dissolved oxygen, nitrate, phosphate, pH, ammonia nitrogen, total bacterial count, hardness, salinity, carbonate and bicarbonate were estimated before and after spawning and hatching. Average alteration in water pH before and after spawning was 7.91-7.57 and 7.86-7.58 respectively. Total hardness, carbonate and bicarbonate showed insignificant variations. Nitrate, ammonia nitrogen and phosphate contents significantly increased after spawning and hatching p < 0.05. The average increase in nitrate was from 2.94 to 8.62 microg l(-1) after spawning and 3.10 to 8.49 microgl(-1) after hatching. Ammonia nitrogen contents were sharply increased from an average of 0.011 to 1.87 mg l(-1) after spawning and 0.013 to 0.56 mg l(-1) after hatching. The average phosphates increased from 2.59 to 4.15 microg l(-1) after spawning and 2.61 to 4.03 microg l(-1) after hatching. Dissolved oxygen was sharply depleted even after a continuous aeration. Temperature played a vital role during breeding. No successful breeding was observed at a temperature of 17 degrees C or below and 31 degrees C or above. There is a significant association between temperature, spawning and hatching (p < 0.05). By optimizing temperature, the breeding success of this carp was achieved with a statistical significance of p < 0.05. Total bacterial count was significantly increased after spawning and hatching. It was related to the amount of discharge and may cause mass mortality of fish embryo and spawn in a closed hatchery system.

CYP1B1, a developmental gene with a potential role in glaucoma therapy

The association of CYP1B1 gene alterations in primary congenital glaucoma individuals has been known for about a decade. Recent evidence has shown the involvement of CYP1B1 mutations in a number of forms of glaucoma and anterior segment disorders. This suggests a wide role for CYP1B1 in ocular physiology. Histochemical studies of eyes from individuals with primary congenital glaucoma revealed abnormalities in the anterior chamber angle, the region between the cornea and the iris, containing the trabecular meshwork. The cells of the trabecular meshwork serve as a filter to allow drainage of the aqueous humour, the fluid formed by the ciliary body that fills the anterior chamber. Mutations in CYP1B1 that affect its activity have frequently been shown to influence development of the trabecular meshwork, and it is thought that CYP1B1, a monooxygenase, acts to form or degrade some endobiotic compound that is necessary for proper development of the filtering structures. The rapidly developing area of stem cell research suggests a potential therapeutic approach for glaucomas resulting from deleterious mutations in CYP1B1, that is, the transfer of stem cells, differentiated to a specific lineage, containing wild-type CYP1B1 to specific regions of the eye, where they will develop into normal cells of that region and rectify the defect.

Physiological Significance and Expression of P450s in the Developing Eye

Expression of 10 CYP orthologs (Families 1-3) in developing mouse conceptus is constitutive. These forms have specific temporal and spatial expression. Studies on CYP1B1 indicate its requirement for normal eye development, both in human and mouse. The distribution of the enzyme in the mouse eye is in three regions, which may reflect three different, perhaps equally important, functions in this organ. Its presence in the inner ciliary and lens epithelia appears to be necessary for normal development of the trabecular meshwork and its function in regulating intraocular pressure. Its expression in the retinal ganglion and inner nuclear layers may reflect a role in maintenance of the visual cycle. Its expression in the corneal epithelium may indicate a function in metabolism of environmental xenobiotics.

Comparative expression profiling of 40 mouse cytochrome P450 genes in embryonic and adult tissues

This study is the first systematic investigation of the gestational age-dependent and adult tissue-specific expression patterns of each known mouse CYP family (40 genes) using normalized cDNA panels and uniform reverse transcriptase polymerase chain reaction-based assays. Twenty-seven of the P450s were constitutively expressed during development. The number gradually increased through the phases of gastrulation E7 (n=14), neural patterning and somitogenesis E11 (n=17), organogenesis E15 (n=20), and fetal period E17 (n=21). Cyp2s1, Cyp8a1, Cyp20, Cyp21a1, Cyp26a1, Cyp46, and Cyp51 were detected in each of the four stages studied. Members of family CYP1 demonstrated complex, nonoverlapping embryonic patterns of expression, indicating that Cyp1a1 and Cyp1a2 may not compensate for Cyp1b1 deficiency associated with abnormal eye development. Multiple Cyp forms were found to be constitutively expressed in each of the adult tissues studied: liver (n=31), kidney (n=30), testis (n=26), lung (n=24), and heart (n=13). The tissue-specific P450-expression profiles reported in this study provide a reference for more focused analysis of the tissue-specific and developmental functions of the cytochrome P450 monooxygenases.

Modulation of glyoxalase, glutathione S-transferase and antioxidant enzymes in the liver, spleen and erythrocytes of mice by dietary administration of fenugreek seeds

There is a growing interest in understanding the biological effect of time-tested folk medicinal plants. In the present work, the effect of dietary administration of fenugreek seeds on the glyoxalase system and antioxidant enzymes as well as levels of glutathione (GSH) have been examined in different tissues of mice. Swiss albino mice were fed with diet containing powdered fenugreek for 4 weeks. The mode and magnitude of effect was found to depend on the dose of fenugreek and type of tissue. The diet containing 1 and 2% of fenugreek enhanced the specific activity of gly I, whereas 5 and 10% inhibited its activity in the liver. However, on the other hand, the specific activity of gly II decreased continuously with dose. Dietary administration of fenugreek seeds resulted in an increase of GSH levels and the glutathione S-transferase (GST) activity in the liver. Fenugreek (1 and 2%) showed no appreciable change in superoxide dismutase (SOD) and catalase. However, 5 and 10% doses of fenugreek supplementation inhibited their activities. In the case of spleen, a significant change in gly I was observed only at 10% fenugreek. In addition, a significant increase was also observed with GSH levels. Fenugreek treatment up to 5% showed a small but consistent increase in erythrocytes. In the case of GST, the activity enhanced with dose. Significant elevation of catalase activity was observed with a 10% dose of fenugreek. The significance and relevance of these findings are suggested in relation to mechanistic aspects.

Radiation induced oxidative stress: I. Studies in Ehrlich solid tumor in mice

Understanding the response of tumors to ionizing radiation might potentially lead to improvement in tumor control and patient morbidity. Since the antioxidant status is likely to be linked to radioresponse, its modulation needs to be examined. Therefore, Swiss albino male mice (7-8 weeks old) with Ehrlich solid tumors were irradiated with different doses of gamma rays (0-9 Gy) at a dose rate of 0.0153 Gy/s; and enzymes involved in antioxidant functions were determined in the tumors. Radiation effects in terms of oxidative damage, LDH, nitric oxide and DNA fragmentation were also examined. In tumors, the specific activity of SOD was increased with dose but declined 6 Gy onwards. GST, DTD and GSH showed an almost progressive increase. These enhanced activities might have resulted from the increased protein expression. This possibility was supported by the Western Blot analysis for GST protein. These changes might be closely linked to the radiation-induced oxidative stress as reflected by the enhanced levels of peroxidative damage, DNA fragmentation, LDH activity and nitric oxide levels. These findings may have relevance to radiation therapy of cancer as the elevated antioxidant status of irradiated tumors is likely to limit the effectiveness of radiation dose and adversely affect the therapeutic gain.

Modulation of radioresponse of glyoxalase system by curcumin

Human beings have been exposed to radiation for many years. It is quite possible that antioxidant phytochemicals consumed in their diet might be providing a variable degree of radioprotection. However, their radiomodifying ability is not well understood. In the present work, curcumin (diferuloyl methane), a phytochemical present in the rhizome of Curcuma longa Linn. has been examined for its radioprotective property using the glyoxalase system which is vital for various biological functions. Curcumin (5, 25 and 50 mg/kg body weight) in olive oil was given orally to Swiss albino male mice (7-8 weeks old) daily for 2 weeks and irradiated with different doses of gamma-radiation (0-6 Gy) at 0.027 Gy per second dose rate on last day of the treatment. The specific activities of glyoxalase I and II were determined in the liver and spleen. The treatment of curcumin prior to irradiation restored the specific activity of glyoxalase system to almost the control level which was suggestive of the radioprotective ability of curcumin. Free radical scavenging and electron/hydrogen donation are probable attributes for the protective effect of curcumin.

Effect of high linear energy transfer radiation on biological membranes

Cellular membranes are vital elements, and their integrity is extremely essential for the viability of the cells. We studied the effects of high linear energy transfer (LET) radiation on the membranes. Rabbit erythrocytes (1 x 10(7) cells/ml) and microsomes (0.6 mg protein/ml) prepared from liver of rats were irradiated with 7Li ions of energy 6.42 MeV/u and 16O ions of energy 4.25 MeV/u having maximum LET values of 354 keV/microm and 1130 keV/microm, respectively. 7Li- and 16O-induced microsomal lipid peroxidation was found to increase with fluence. The 16O ions were more effective than 7Li ions, which could be due to the denser energy distribution in the track and the yield of free radicals. These findings suggested that the biological membranes could be peroxidized on exposure to high-LET radiation. Inhibition of the lipid peroxidation was observed in the presence of a membrane-active drug, chlorpromazine (CPZ), which could be due to scavenging of free radicals (mainly HO* and ROO*), electron donation, and hydrogen transfer reactions. The 7Li and 16O ions also induced hemolysis in erythrocytes. The extent of hemolysis was found to be a function of time and fluence, and showed a characteristic sigmoidal pattern. The 16O ions were more effective in the lower fluence range than 7Li ions. These results were compared with lipid peroxidation and hemolysis induced by gamma-radiation.

Influence of methylglyoxal on antioxidant enzymes and oxidative damage

The effect of different doses of methylglyoxal (50-400 mg/kg body wt.) were examined using enzymes involved in the antioxidant function, glutathione (GSH) content and lipid peroxidation in the liver and spleen of Swiss albino mice (7-8 week old) after 6, 12 and 24 h. Significant changes were observed predominantly in the liver. The specific activities of superoxide dismutase (SOD), glutathione-S-transferase (GST), catalase, glyoxalase I (gly I) and glyoxalase II (gly II) were found to decrease in the liver. The mode and magnitude of change in the specific activities was seen to depend on the dose of methylglyoxal and the time after its administration. Methylglyoxal also decreased the GSH content and enhanced the lipid peroxidation in the liver. These findings are suggestive of the adverse effect of methylglyoxal on the antioxidant defence system. It is likely that methylglyoxal undergoes a redox cycle and generates the free radicals which in turn lower the antioxidant status in animals. The increased levels of lipid peroxidation provide support for the involvement of free radical processes in the detrimental effects of methylglyoxal. The response of DT-diaphorase (DTD) seems to be adaptive.