Assessment of neurovascular channels in lateral maxillary sinus wall using cone-beam computed tomography: An imperative clinicians guide for implant placements

Background

The aim of this study is to evaluate the location and radio morphometric features of the posterior superior alveolar artery (PSAA) in patients undergoing rehabilitation of posterior maxilla and other sinus augmentation surgical procedures by cone-beam computed tomography (CBCT).

Materials and Methods

A total of 816 CBCT scans were included. Various radio morphometric measurements were done to assess the PSAA location, diameter, and distances to the sinus floor and alveolar crest.

Results

The PSAA was mostly intraosseous in the maximum in the age group 31-51 years (56%), in males (53.4%), and in dentate patients (57.4%). The artery tends to be wider in older patients. Distances to the sinus floor or the alveolar crest tend to be shorter in women.

Conclusions

This study suggests that CBCT is a valuable pre-surgical tool and the evaluation of the PSAA on CBCT images could reduce the likelihood of excess bleeding during surgery in the maxillary posterior region.

Human Urinary Metabolomics as Biomarkers in Tobacco Users: A Systematic Review

Aim

Urine as a biofluid has been rarely used as a diagnostic fluid in oral diseases. The article aims to systematically review the utility of human urinary carcinogen metabolites as an approach for obtaining important information about tobacco and cancer.

Materials and Methods

The following article reviews the use of urine and its metabolites as biomarkers in various lesions of the oral cavity including oral squamous cell carcinoma and as a screening method in evaluating tobacco and its components. A bibliographic comprehensive search was carried out in the main databases: PUBMED, SciELO, Google Scholar, VHL, and LILACS for articles that were published from 1985 to 2020. The inclusion criteria were "urinary metabolites," "oral cancer/HNSCC," "body fluids," "tobacco," and "metabolomics." A total of 55 articles were collected which included laboratory studies, systematic reviews, and literature of urinary metabolites in tobacco users.

Results

Most of the studies carried out show accurate results with high sensitivity of urinary metabolite biomarkers in individuals with tobacco-based habits and lesions caused by them.

Conclusion

The review indicates that urinary metabolite analysis demonstrates its applicability for the diagnosis and prognosis of disease. Urine is a remarkable and useful biofluid for routine testing and provides an excellent resource for the discovery of novel biomarkers, with an advantage over tissue biopsy samples due to the ease and less invasive nature of collection.

Reliability of Grayscale Value for Bone Density Determination in Oral Rehabilitation using Dental Implants

Introduction

Quality and quantity of jaw bones have been previously classified in literature using different methods. Imaging modalities such as computed tomography (CT), successfully determine bone density of jaws. This study aims to establish the role of cone-beam CT (CBCT) in determining the density of cortical and cancellous bones at different jaw sites.

Materials and Methods

Eighty-three possible implant sites in healthy patients were evaluated using NewTomGiano CBCT machine. Cross-sections were obtained and cortical and cancellous bone densities on different aspects of the virtual implant in terms of Hounsfield unit (HU) were determined using New Net Technologies software version 6.1 and were classified according to software from D1 to D4. Data were entered into SPSS software (version 19.0) and were statistically analyzed.

Results

The mean HU showed the highest value for cortical and cancellous in the anterior mandible (mean HU 1874.01 and 1131.73, respectively) followed by the posterior mandible (mean HU 1789.20 and 872.95, respectively) and least in posterior maxilla (mean HU 1068.26 and 830.04, respectively). Maximum D1 bone type was found in cortical bone and D2 bone type was noted in cancellous bone area. Males showed very highly significant cortical bone thickness (P < 0.001) whereas females showed more cancellous bone thickness but the results were nonsignificant.

Conclusion

A high degree of concordance between different regions of jaw bones with a strong correlation between the four bone types was obtained. Bone density plays a pivotal role in determining the prognosis of the implant. CBCT has proven to be beneficial in bone density analysis.

Ventricular-arterial coupling predicts outcomes in adults with a systemic right ventricle

Background

Patients with a systemic right ventricle (SRV) and biventricular circulation experience high incidence of cardiovascular morbidities and decreased survival [1]. Non-invasive measures of subclinical ventricular dysfunction are needed to appropriately identify patients at increased risk for adverse outcomes. Ventricular-arterial coupling (VAC), the ratio between the effective arterial elastance (Ea) and ventricular end-systolic elastance (Ees), may predict clinical outcomes in patients with SRV [2].

Objectives

To assess VAC in adults with SRV and evaluate its correlation with clinical outcomes.

Methods

Consecutive cardiovascular magnetic resonance (CMR) examinations of adults with D-loop transposition of great arteries (TGA) after atrial switch operation and L-loop TGA performed at Boston Children's Hospital between 2005 and 2019 were analyzed. VAC was calculated as Ea/Ees (Ea = mean arterial blood pressure (MBP)/ventricular stroke volume; Ees = MBP/end-systolic volume). Global myocardial strain was measured by feature tracking analysis on cine steady-state free precession sequences. Cox proportional hazards regression analysis was performed to assess the association of SRV functional parameters with clinical outcomes. The analysis was adjusted for age, sex, and body mass index. The primary outcome was defined as a composite of death, cardiovascular arrest, hospitalizations for heart failure (HF); the secondary outcome as atrial arrhythmias; the tertiary outcome included other causes of cardiovascular hospitalizations (percutaneous or surgical interventions, device implantation, other cardiovascular disease). Cumulative incidence of the study outcomes was estimated using Kaplan-Meier method.

Results

One hundred sixty-seven adults (mean age 32±10 years, 59% men) with SRV were analyzed. Patients with HF (n=48, 29%) had higher VAC values as compared to those without HF (1.4±0.8 vs. 1.1±0.5, p=0.01). Over a mean follow-up of 6.5±4.2 years, 15 over 139 patients (11%) experienced the primary outcome with an incidence rate of 1.7 per 100 patient-years (95% confidence interval (CI), 1.04–2.85). Higher VAC values were significantly associated with an increased risk of the primary outcome (p for trend = 0.01, Figure 1). VAC was the only functional parameter associated with the primary outcome (hazard ratio (HR) 1.99, 95% CI: 1.06–3.73, p=0.031), secondary outcome (HR 2.33, 95% CI: 1.12–4.82, p=0.023) and tertiary outcome (HR 1.63, 95% CI: 1.09–2.44, p=0.018) in the adjusted analysis (Table 1). Ejection fraction (EF) was not associated with the study outcomes in the adjusted analysis (p&gt;0.05, Table 1) whereas global circumferential and radial strain showed an association limited to the tertiary endpoint (p=0.004, Table 1).

Conclusions

CMR-derived VAC is associated with adverse outcomes in SRV patients and may improve risk stratification of this unique population.

Funding Acknowledgement

Type of funding sources: None.

A novel approach in diagnosing multiple dentigerous cysts using CBCT illustration indicative of Mucopolysaccharidosis VI - a case report

Mucopolysaccharidosis VI is a genetic disorder affecting multiple organs with sundry clinical presentations. The main etiological factor reflects the disturbances in mucopolysaccharide metabolism leading to deposition of acid mucopolysaccharide in various tissues. The pathognomonic features of the disease include a large head, short neck, corneal opacity, open mouth associated with an enlarged tongue, enlargement of the skull, and long anteroposterior dimension with unerupted dentition, dentigerous cyst-like follicles, condylar defects, and gingival hyperplasia. An 18-year-old boy with Maroteaux-Lamy syndrome (mucopolysaccharidosis type VI) is described in this article, emphasizing the oral manifestations and radiographic illustration of lesions in the jaws. It also emphasizes the essential role of cone-beam computed tomography to identify and analyze multicentric pathologies in the jaws.

Significance of Morphometric and Anatomic Variations of Nasopalatine Canal on Cone-Beam Computed Tomography in Anterior Functional Zone - A Retrospective Study

Introduction:

Oral rehabilitation in maxillary anterior region has increased concerns in the dental fraternity to have detailed morphological examination in treatment planning. The nasopalatine canal (NPC) along with its contents plays an important role in determining the prognosis of implants and their associated surgeries. The present study was performed to evaluate morphometric anatomic variations of the NPC using focused small field of view on cone-beam computed tomography (CBCT).

Materials and Methods:

The study included 250 participants. CBCT examination was conducted using standard exposure and patient positioning protocols. Sagittal, coronal, and axial sections were reviewed to determine NPC morphology and dimensions.

Results:

Single, round, incisive foramen with mean mesiodistal diameter of 3.23 (±1.00) mm, and mean anteroposterior dimension of 3.03 (±0.96) mm was found. Single Stenson's foramen along with funnel shaped, slanted NPC with mean angulation of 81.97 (±42.19), and mean length of 12.67 (±2.69) mm was found. Mean mesiodistal diameter at nasal fossa of NPC was 3.27 (±1.75) mm, at mid-level was 2.23 (±1.02) mm, at palate was 3.46 (±1.12) mm. At least one additional foramen was found.

Discussion:

Anatomy of the NPC is highly variable. Age-wise and gender-wise correlations revealed statistically significant results for different parameters. The present study highlighted significance of NPC along with its variations. Therefore, a methodical three-dimensional presurgical assessment is mandatory before any surgical intervention in this region.

A Numerical Approach to the Modeling of Thomson and Troian Slip on Nonlinear Radiative Microrotation of Casson Carreau Nanomaterials in Magnetohydrodynamics

The goal of the current work is to explore the influence of Thompson and Troian slip on the hydromagnetic microrotations of Carreau nanomaterials over a linearly stretched surface subject to NLTR, viscous dissipation, Newtonian heating, homogenous and heterogeneous reactions. Effect of non linear slip (Thompson and Troian slip) on non Newtonian nanofluid (Carreau nanofluid) subject to microrotation is the novelty of the investigation. Shooting technique is the instrumental to get appropriate numerical solution. The significant outcomes of the current study are that Casson parameter and Weissenberg number exhibit opposite results for velocity and heat transfer rate due to flow of micropolar Carreau nanofluid. Further, more and more Thompson and Troian slip yields diminution of flow velocity as well as microrotations. Amplifying Casson parameter intensifies the HTR from the stretched surface.

Interplay between spin proximity effect and charge-dependent exciton dynamics in MoSe2/CrBr3 van der Waals heterostructures

Semiconducting ferromagnet-nonmagnet interfaces in van der Waals heterostructures present a unique opportunity to investigate magnetic proximity interactions dependent upon a multitude of phenomena including valley and layer pseudospins, moiré periodicity, or exceptionally strong Coulomb binding. Here, we report a charge-state dependency of the magnetic proximity effects between MoSe2 and CrBr3 in photoluminescence, whereby the valley polarization of the MoSe2 trion state conforms closely to the local CrBr3 magnetization, while the neutral exciton state remains insensitive to the ferromagnet. We attribute this to spin-dependent interlayer charge transfer occurring on timescales between the exciton and trion radiative lifetimes. Going further, we uncover by both the magneto-optical Kerr effect and photoluminescence a domain-like spatial topography of contrasting valley polarization, which we infer to be labyrinthine or otherwise highly intricate, with features smaller than 400 nm corresponding to our optical resolution. Our findings offer a unique insight into the interplay between short-lived valley excitons and spin-dependent interlayer tunneling, while also highlighting MoSe2 as a promising candidate to optically interface with exotic spin textures in van der Waals structures.

Cone-beam computed tomography assessment of bone using grayscale values in patients with diabetes mellitus. A case-control observational study

Background:

The density of cortical and cancellous bone is a key reason for implant anchorage which might be severely affected during diabetes.

Aim:

The aim of the study was to establish the role of cone-beam computed tomography (CBCT) using grayscale values in determining bone density in different jaw sites and in comparing the values in healthy with diabetic patients.

Materials and Methods:

Bone densities in 322 possible implant sites in healthy and diabetic patients were evaluated using NewTomGiano CBCT machine. Cross-sections obtained were assessed for bone densities in terms of Hounsfield Unit on different sites using New Net Technologies software version 6.1.

Statistical Analysis:

Data were statistically analyzed using SPSS software (version 19.0).

Results:

Age-wise cortical and cancellous bone densities were compared and no statistical significance was obtained. Gender-wise bone density was compared and significant results were found in males. Jaw-wise bone density was compared and was found to be significantly high in the mandible. The mean cortical bone density in control group was 1608.572 (±380.36), whereas in diabetic group was 1395.368 (±296.97), and the mean cancellous bone density in control was 906.918 (±185.40) and in diabetic was 559.868 (±128.16). Teeth wise in cortical bone significant values were found at premolar region (P = 0.046) and in cancellous bone significant values were found at canine and premolar region (P = 0.012) and highly significant values were found at molar region (P = 0.001).

Conclusion:

CBCT unveils a distinct pattern of cortical and cancellous bone density. A high degree of concordance between different regions of the mouth in cortical and cancellous bones was obtained in different study groups. CBCT could be used for bone density analysis.

COVID-19 in people living with diabetes: An international consensus

The COVID-19 pandemic has added an enormous toll to the existing challenge of diabetes care world-wide. A large proportion of patients with COVID-19 requiring hospitalization and/or succumbing to the disease have had diabetes and other chronic conditions as underlying risk factors. In particular, individuals belonging to racial/ethnic minorities in the U.S. and other countries have been significantly and disproportionately impacted. Multiple and complex socioeconomic factors have long played a role in increasing the risk for diabetes and now for COVID-19. Since the pandemic began, the global healthcare community has accumulated invaluable clinical experience on providing diabetes care in the setting of COVID-19. In addition, understanding of the pathophysiological mechanisms that link these two diseases is being developed. The current clinical management of diabetes is a work in progress, requiring a shift in patient-provider interaction beyond the walls of clinics and hospitals: the use of tele-medicine when feasible, innovative patient education programs, strategies to ensure medication and glucose testing availability and affordability, as well as numerous ideas on how to improve meal plans and physical activity. Notably, this worldwide experience offers us the possibility to not only prepare better for future disasters but also transform diabetes care beyond the COVID-19 era.

Body fat, metabolic syndrome and hyperglycemia in South Asians

The prevalence of overweight and obesity is escalating in South Asian countries. South Asians display higher total and abdominal obesity at a lower BMI when compared to Whites. Consequently, metabolic dysfunction leading to metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM) will account for a majority of the health burden of these countries. In this review, we discuss those factors that contribute to MetS and T2DM in South Asians when compared to whites, focusing on adiposity. Abdominal obesity is the single-most important risk factor for MetS and its predisposition to T2DM. Excessive ectopic fat deposition in the liver (non-alcoholic fatty liver disease) has been linked to insulin resistance in Asian Indians, while the effects of ectopic fat accumulation in pancreas and skeletal muscle need more investigation. South Asians also have lower skeletal muscle mass than Whites, and this may contribute to their higher risk T2DM. Lifestyle factors contributing to MetS and T2DM in South Asians include inadequate physical activity and high intakes of refined carbohydrates and saturated fats. These are reflective of the recent but rapid economic transition and urbanization of the South Asian region. There is need to further the research into genetic determinants of dysmetabolism as well as gene x environment interactions. Collectively, MetS and T2DM have multi-factorial antecedents in South Asians and efforts to combat it through low-cost and socio-culturally appropriate lifestyle interventions need to be supported.

Palatal Mucormycosis Masquerading as Bacterial and Fungal Osteomyelitis: A Rare Case Report

Mucormycosis is an acute, fulminating, fungal disease that frequently involves oral, cranial, and facial structures. It is an opportunistic fatal infection which occurs in debilitating and immunosuppressive states. This report documents a rare case of localized maxillary mucormycosis in a patient with uncontrolled diabetes, with emphasis on early and prompt diagnosis of the same.

Management of obesity in adult Asian Indians

The prevalence of obesity in India is increasing and ranges from 8% to 38% in rural and 13% to 50% in urban areas. Obesity is a risk factor for development of type 2 diabetes mellitus (T2DM), hypertension, dyslipidemia, coronary heart disease and many cancers. In Asian Indians excess abdominal and hepatic fat is associated with increased risk for T2DM and cardiovascular disease. There is higher risk for development of obesity related non-communicable diseases at lower body mass index levels, compared to white Caucasians. Despite being a commonly encountered medical problem, obesity poses challenges in treatment. Many Indian physicians find themselves to be lacking time and expertise to prepare an appropriate obesity management plan and patients experience continuous weight gain over time despite being under regular medical supervision. In this article, we outline approaches to obesity management in ‘real life mode’ and in context to Asian Indian patients.

Prevalence and trends of metabolic syndrome among adults in the asia-pacific region: a systematic review

Background

The Asia-Pacific region is home to nearly half of the world’s population. The region has seen a recent rapid increase in the prevalence of obesity, type-2 diabetes and cardiovascular disease. The present systematic review summarizes the recent prevalence and trends of Metabolic Syndrome (MetS) among adults in countries of the Asia-Pacific Region.

Methods

Data on MetS in Asia-Pacific countries were obtained using a stepwise process by searching the online Medline database using MeSH terms ‘Metabolic Syndrome X’ and ‘Epidemiology/EP’. For the purpose of describing prevalence data for the individual countries, studies that were most recent, nationally representative or with the largest sample size were included. When evaluating secular trends in prevalence in a country we only considered studies that evaluated the temporal change in prevalence between similar populations, prospective studies based on the same population or National surveys conducted during different time periods.

Results

This literature search yielded a total of 757 articles, and five additional article were identified by screening of reference lists. From this total, 18 studies were eligible to be included in the final analysis. Of the 51 Asia-Pacific countries (WHO) we only located data for 15. There was wide between country variation in prevalence of MetS. A national survey from Philippines conducted in 2003 revealed the lowest reported prevalence of 11.9% according to NCEP ATP III criteria. In contrast, the highest recorded prevalence in the region (49.0%) came from a study conducted in urban Pakistan (Karachchi, 2004). Most studies reported a higher prevalence of MetS in females and urban residents. Data on secular trends were available for China, South Korea and Taiwan. An increase in the prevalence of MetS was observed in all three countries.

Conclusion

Despite differences in methodology, diagnostic criteria and age of subjects studied, the Asia-Pacific region is facing a significant epidemic of MetS. In most countries nearly 1/5th of the adult population or more were affected by MetS with a secular increase in prevalence. Strategies aimed at primary prevention are required to ameliorate a further increase in the epidemic and for the reduction of the morbidity and mortality associated with MetS.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4041-1) contains supplementary material, which is available to authorized users.

Obesity, Diabetes and Cardiovascular Diseases in India: Public Health Challenges

Non-communicable diseases (NCDs; including coronary heart disease and type 2 diabetes) are rapidly increasing in India causing nearly 5.8 million deaths per year. Primary reasons for rise in NCDs in India are nutrition and lifestyle transitions. Further, presence of higher body fat, abdominal fat, liver and pancreatic fat and lower lean mass than whites, contribute to heightened metabolic and cardiovascular risk in Asian Indians. Importantly, conversion from pre-diabetes to diabetes occurs more rapidly, and reversion to normal glucose regulation with appropriate lifestyle measures is more difficult in Asian Indians than white population. Huge number of patients with diabetes and with complications increase morbidity, mortality and pose substantial economic burden. It is difficult, though not impossible, to decrease pace of rapidly expanding juggernaut of NCDs in India. Only concerted efforts from multiple stakeholders, consistently sincere efforts and intensely focused attention from health officialdom and clear political will may help counter this increasingly difficult challenge. Finally, all prevention and management approaches should be cost-effective, pragmatic, and focused on children and underprivileged populations.

Vascular Cells in Blood Vessel Wall Development and Disease

The vessel wall is composed of distinct cellular layers, yet communication among individual cells within and between layers results in a dynamic and versatile structure. The morphogenesis of the normal vascular wall involves a highly regulated process of cell proliferation, migration, and differentiation. The use of modern developmental biological and genetic approaches has markedly enriched our understanding of the molecular and cellular mechanisms underlying these developmental events. Additionally, the application of similar approaches to study diverse vascular diseases has resulted in paradigm-shifting insights into pathogenesis. Further investigations into the biology of vascular cells in development and disease promise to have major ramifications on therapeutic strategies to combat pathologies of the vasculature.

Phonon-Assisted Resonant Tunneling of Electrons in Graphene-Boron Nitride Transistors

We observe a series of sharp resonant features in the differential conductance of graphene-hexagonal boron nitride-graphene tunnel transistors over a wide range of bias voltages between 10 and 200 mV. We attribute them to electron tunneling assisted by the emission of phonons of well-defined energy. The bias voltages at which they occur are insensitive to the applied gate voltage and hence independent of the carrier densities in the graphene electrodes, so plasmonic effects can be ruled out. The phonon energies corresponding to the resonances are compared with the lattice dispersion curves of graphene-boron nitride heterostructures and are close to peaks in the single phonon density of states.

Functional role of apoptosis in oral diseases: An update

Cell death appears to be a basic biological phenomenon which is maintained by the human body. The term apoptosis, also known as programmed cell death, is characterized by several unique morphological and biochemical features. Apoptosis and its different forms are essential for tissue homeostasis. Alteration in molecular mechanisms involved in apoptotic signaling contributes to a vast range of oral diseases. An understanding of the regulation of apoptosis has led to the development of many therapeutic approaches and better management of oral diseases. The review updates us the correlation between apoptosis in normal oral tissues and oral diseases.

Vegetation indices mapping for Bhiwani district of Haryana (India) through LANDSAT-7ETM+ and remote sensing techniques

This study describes the VIs Vegetation Condition Index in term of vegetation health of wheat crop; with help of LANDSAT-7ETM+ data based NDVI and LAI for Bhiwani District of Haryana states (India) and gave the spatial development pattern of wheat crop in year 2005 over the study area of India. NDVI is found to vary from 0.3 to 0.8. In northern and southern parts of study area NDVI varied from 0.6 to 0.7 but in western part of Bhiwani showed NDVI 0.2 to 0.4 due to fertility of soil and well canal destitution. LAI showed variation from 1 to 6 accordingto the health of crop as the same manner of NDVI because LAI VI is NDVI dependent only change the manner of representation of vegetation health, due to this fact relation curve (r2=) between NDVI and LAI of four different growing date of sates are in successively increasing order 0.509, 0.563, 0.577 and 0.719. The study reveals that VIs can be mapped with LANDSAT-7ETM+ through remote sensing, which can be further used for many studies like crop yield or estimating evaptranspiration on regional basis for water management because satellite observations provide better spatial and temporal coverage, the VIs based system will provide efficient tools for monitoring health of crop for improvement of agricultural planning. VIs based monitoring will serve as a prototype in the other parts of the world where ground observations are limited or not available.

Quantification of dislocation nucleation stress in TiN through high-resolution in situ indentation experiments and first principles calculations

Through in situ indentation of TiN in a high-resolution transmission electron microscope, the nucleation of full as well as partial dislocations has been observed from {001} and {111} surfaces, respectively. The critical elastic strains associated with the nucleation of the dislocations were analyzed from the recorded atomic displacements, and the nucleation stresses corresponding to the measured critical strains were computed using density functional theory. The resolved shear stress was estimated to be 13.8 GPa for the partial dislocation 1/6 <110> {111} and 6.7 GPa for the full dislocation ½ <110> {110}. Such an approach of quantifying nucleation stresses for defects via in situ high-resolution experiment coupled with density functional theory calculation may be applied to other unit processes.

Experimental Quantification of Resolved Shear Stresses for Dislocation Motion in TiN

Experimental quantification of the critical resolved shear stress (CRSS) at the level of unit dislocation glide is still a challenge. By using in situ nanoindentation in a high-resolution transmission electron microscope and strain analysis of the acquired structural images, the CRSS for the motion of individual dislocations on {110}⟨011⟩ slip system and glide dislocation re-emission from a tilt grain boundary in TiN are quantified. This work offers an approach to measure the local stresses associated with dislocation motion in high-strength materials.

Decadal changes in the land use/land cover and shoreline along the coastal districts of southern Gujarat, India

The coastal zone along the districts of Surat, Navsari, and Valsad in southern Gujarat, India, is reported to be facing serious environmental challenges in the form of shoreline erosion, wetland loss, and man-made encroachments. This study assesses the decadal land use/ land cover (LULC) changes in these three districts for the years 1990, 2001, and 2014 using satellite datasets of Landsat TM, ETM, and OLI. The LULC changes are identified by using band ratios as a pre-classification step, followed by implementation of hybrid classification (a combination of supervised and unsupervised classification). An accuracy assessment is carried out for each dataset, and the overall accuracy ranges from 90 to 95%. It is observed that the spatial extents of aquaculture, urban built-up, and barren classes have appreciated over time, whereas the coverage of mudflats has depreciated due to rapid urbanization. The changes in the shoreline of these districts have also been analyzed for the same years, and significant changes are found in the form of shoreline erosion. The LULC maps prepared as well as the shoreline change analysis done for this study area will enable the local decision makers to adopt better land-use planning and shoreline protection measures, which will further aid in sustainable future developments in this region.