Background: Robot-assisted partial nephrectomy (RAPN) is increasingly being employed in the management of renal cell carcinoma (RCC) and it is expanding in the field of complex renal tumors. The aim of this systematic review was to consolidate and assess the results of RAPN when dealing with entirely central hilar masses and to examine the various methods used to address the surgical difficulties associated with them. Methods: A thorough literature search in September 2023 across various databases focused on RAPN for renal hilar masses, adhering to PRISMA guidelines. The primary goal was to evaluate RAPN\'s surgical and functional outcomes, with a secondary aim of examining different surgical techniques. Out of 1250 records, 13 full-text manuscripts were reviewed. Results: Evidence is growing in favor of RAPN for renal hilar masses. Despite a predominance of retrospective studies and a lack of long-term data, RAPN shows positive surgical outcomes and preserves renal function without compromising cancer treatment effectiveness. Innovative suturing and clamping methods are emerging in surgical management. Conclusions: RAPN is a promising technique for managing renal hilar masses in RCC, offering effective surgical outcomes and renal function preservation. The study highlights the need for more long-term data and prospective studies to further validate these findings.

Laparoscopic nephrectomy is a commonly performed procedure. As with any surgical procedure, this too has a significant learning curve. The management of renal hilum is the most critical part of this surgery. It requires a meticulous intra-hilar dissection to identify the renal artery and vein. The kidneys are extremely vascular structures and any injury to these vessels during dissection can result in life-threatening bleeding. Hence, it is obvious that beginners most often face difficulty and apprehension at this step of the laparoscopic nephrectomy. We describe a simple technique of laparoscopic nephrectomy which includes the creation of two windows, one at the lower pole and the second at the upper pole, isolation of the hilum, and en bloc stapling of the renal hilar vessels. This method safeguards against collateral damage to the surrounding structures. It also avoids the need for intra-hilar dissection, hence decreasing the chances of vascular injuries.

UNASSIGNED: Oral cancer is the most frequent type of cancer of the head and neck area, with squamous cell carcinoma (SCC) being the most common single entity. Worldwide, oral cancer accounts for 2%-4% of all cancer cases, the prevalence being highest in India. Lymph node metastases occur in about 40% of patients with oral cancer. Clinically, their manifestations are hidden in rates of 15% to 34%. More accurate imaging techniques can reduce the risk of undiagnosed metastasis. Ultrasonography has gained wide acceptance as a diagnostic aid in the evaluation of reactive and metastatic lymph nodes. The present study is an attempt to assess the earliest evaluation of the cervical lymph nodes by ultrasound-guided fine-needle aspiration cytology (FNAC).
UNASSIGNED: A descriptive diagnostic evaluation study was carried out to find out the sensitivity and specificity of ultrasound-guided FNAC in detecting metastasis to cervical lymph nodes from oral SCC in the Department of Oral Medicine and Radiology, Government Dental College, Thiruvananthapuram, in collaboration with the Department of Imageology, Regional Cancer Centre, Thiruvananthapuram during the time period from July 2015 to September 2016.
UNASSIGNED: A total of 112 patients with histologically proven oral SCC having palpable lymph nodes were evaluated clinically and ultrasonographically. In this study, sensitivity and specificity of >90% were obtained for ultrasonographic criteria such as the long axis to short axis ratio <2, the absence of hilum, heterogeneous architecture, and altered vascularity in the evaluation of metastatic lymph nodes. The diagnostic yield in the detection of metastatic lymph nodes was much higher in the ultrasonographic examination.
UNASSIGNED: Ultrasound-guided FNAC offers an opportunity to enhance patient prognosis through early detection and a specific diagnosis (92.5%) when compared to clinical examination (78.6%) in the current study.

Mediastinal tuberculous lymphadenitis (MTL) is mostly observed in primary tuberculosis in infants, children and adolescents, and is not found commonly in adults. Mediastinal tuberculous lymphadenitis cases may present with an insidious progression of tuberculous symptoms, including gradual deterioration in the lungs and a variety of clinical characteristics; however, initial symptoms are rarely only chronic back pain. We present the case of a 33-year-old man with mediastinal tuberculous lymphadenitis misdiagnosed as myofascitis. Since such individuals do not develop respiratory symptoms in the initial stages, they often go undiagnosed and can potentially spread tuberculosis.

Starch is a water-insoluble polymer of glucose synthesized as discrete granules inside the stroma of plastids in plant cells. Starch reserves provide a source of carbohydrate for immediate growth and development, and act as long term carbon stores in endosperms and seed tissues for growth of the next generation, making starch of huge agricultural importance. The starch granule has a highly complex hierarchical structure arising from the combined actions of a large array of enzymes as well as physicochemical self-assembly mechanisms. Understanding the precise nature of granule architecture, and how both biological and abiotic factors determine this structure is of both fundamental and practical importance. This review outlines current knowledge of granule architecture and the starch biosynthesis pathway in relation to the building block-backbone model of starch structure. We highlight the gaps in our knowledge in relation to our understanding of the structure and synthesis of starch, and argue that the building block-backbone model takes accurate account of both structural and biochemical data.

OBJECTIVE: To investigate local control and survival after bronchial artery embolization (BAE) using N-butyl-2-cyanoacrylate (NBCA) for pulmonary hilar or mediastinal tumors that are refractory to chemotherapy or chemoradiotherapy.
METHODS: This is a single center retrospective study involving 42 patients treated between 2015 and 2018 for pulmonary hilar or mediastinal tumors (primary tumors in 5 and metastatic ones in 37). Tumor histology was sarcoma in 22 and carcinoma in 20 patients. All patients had shown tumor progression regardless of previous chemotherapy (n = 37) or chemoradiotherapy (n = 5). Thirty-seven patients (88 %) had respiratory symptoms, such as cough, dyspnea, and hemoptysis. BAE was performed using NBCA to shrink tumors for extending life expectancy. Target tumors were followed with computed tomography at 1,3, and 6 months after BAE. Endpoints included the best tumor response within 6 months as well as overall survivals in patients with and without tumor responses.
RESULTS: Best local responses within 6 months were complete response (CR) in 1 patient, partial response (PR) in 16, stable disease (SD) in 24, and progressive disease (PD) in 1; the CR/PR rate was 40 % (17/42). Median follow-up period was 13 months (range:1-43). Overall survival in patients with CR/PR was significantly better than in those with SD/PD (p = 0.006); with 3-year survival rates of 45 % (8/17) and 0% (0/25), respectively.
CONCLUSIONS: BAE using NBCA has potential promise for shrinking hilar and/or mediastinal tumors that are refractory to chemotherapy or chemoradiotherapy, and may also improve overall survival in patients who respond.

The systematic analysis of chest radiographic examinations involves the sequential assessment of various anatomic structures and interfaces and allows for a high level of confidence in the detection of abnormalities. The radiologist’s detection, localization, and characterization of abnormal chest radiographic findings help guide the clinician to the appropriate follow-up imaging study or proper clinical evaluation. An additional benefit of using a systematic approach is the creation of a structured report for all chest radiographic studies, which provides a consistent format for communicating findings. This chapter will review the key components of a systematic analysis of frontal chest radiographs by demonstrating normal and abnormal radiographic findings in the various anatomic compartments demonstrated on chest radiographic examinations.

Hilar tumors pose unique challenges during partial nephrectomy. We present the characteristics and outcomes of 263 patients with hilar tumors undergoing robot-assisted partial nephrectomy (RPN) in the largest series to date. Perioperative, pathologic, functional, and oncological outcomes were compared between 1467 (84.8%) patients with a non-hilar tumor and 263 (15.2%) patients with a hilar tumor undergoing RPN. Variables were compared in univariable (unadjusted) analysis and using multivariable linear, logistic, poisson, cox proportional hazards and linear mixed effects regression models adjusting for tumor diameter and RENAL Nephrometry score. Hilar tumors were larger (3.7 vs. 3.0 cm, p < 0.001) and more complex (RENAL Score 9 vs. 7, p < 0.001), leading to longer operative time (186 vs. 161 min, p < 0.001), ischemia time (18 vs. 15, p < 0.001), greater blood loss (150 vs. 100 ml, p < 0.001), eGFR decline at discharge (∆ = 3.9%, p = 0.035) and eGFR decline per month up to 36 months post-RPN (β = - 0.25; p = 0.017). In multivariable analysis, hilar tumors were only associated with a 10% increase in operative time (p ≤ 0.001) and marginally worse eGFR decline over time (β = - 0.19, p = 0.076), with no differences in other outcomes analyzed including ischemia time, blood loss, complication rate, recurrence-free survival, or eGFR decline at discharge. Although hilar tumors were found to be larger and more anatomically complex, there were only marginal differences in outcome when compared to non-hilar tumors. A hilar renal tumor should be considered for partial nephrectomy when feasible without an expected increase in complications or adverse events.

Seed micromorphology of 13 species, belonging to four genera of subfamily Alsinoideae (Caryophyllaceae) were investigated with scanning electron microscopy (SEM), in order to assess their diagnostic significance at generic level and provide additional evidence on species delimitation, as well as correct identification and phylogenetic position. Genera and species of subfamily Alsinoideae exhibit great variation in ultrastructure and a high diversity of novel micromorphological characters were observed. Variation in seed shape, color, hilum, anticlinal wall, epidermal cell, cell surface, margins, and quantitative characters as length and width were studied in detail, compared, illustrated, and their taxonomic significant were discussed. Seed shapes of the species were classified as reniform, round, angular, subcircular, subreniform, and elliptical pyriform, with sub-central, central, basal, and nearly basal hilum. Wavy, irregular, tetragonal, and elongated epidermal cells structure has been observed as an exomorphological character. The present findings show that the micromorphology of subfamily Alsinoideae provides taxonomic information and is helpful to distinguish different species. The results also explained that SEM morphology of seeds provide important data about affinity among taxa and give potential characters in delimitation of members of subfamily Alsinoideae at generic and species level. A principal component analysis allowed to highlight the most outsiders among seed micromorphology with a possible explanation. Taxonomic keys were developed based on micromorphological characters to delimit the species and useful for their quick identification within subfamily Alsinoideae.

Different structures have been shown to act as a water gap in seeds with physical dormancy (PY), and in Fabaceae they are commonly located in the hilar region. However, the function of the pleurogram, a structure in the extra-hilar region that is common in legume seeds, remains unknown. Our aims were to review the literature for occurrence of the pleurogram in Fabaceae, determine if the pleurogram can open, and compare the functional morpho-anatomy of water gaps in seeds of 11 Senna species.
Imbibition tests showed that all 11 species had PY. Structural features of the hilar and extra-hilar regions of the seeds were investigated using light and scanning electron microscopy, and dye-tracking was performed to trace the pathways of water through the seed coat.
A pleurogram has been reported for 37 legume genera. Water gaps differed among Senna species, with lens, hilum, micropyle and pleurogram taking up water after PY was broken. In Senna alata seeds, only the pleurogram acted as a water gap, whereas in S. reniformis and S. silvestris water entered the seed through both the pleurogram and the hilar region. In the pleurogram of S. alata and S. reniformis, the palisade layer moved outward, exposing the hourglass cells, whereas in S. silvestris the palisade layer was broken.
The pleurogram acts as a water gap in some of the 11 Senna species examined, but it is non-functional in others. Opening the pleurogram occurs due to the formation of a linear slit in the palisade layer. The pleurogram is of functional significance by creating a wide opening, whereby water can reach the embryo and start germination. This is the first report of the pleurogram functioning as a water gap. Because this structure is shared by at least 37 genera, it also may be a water gap in many other legume species.