Contralateral Nodal Relapse in Well-lateralised Oral Cavity Cancers Treated Uniformly with Ipsilateral Surgery and Adjuvant Radiotherapy With or Without Concurrent Chemotherapy: a Retrospective Study

AIMS

To evaluate the incidence and pattern of contralateral nodal relapse (CLNR), contralateral nodal relapse-free survival (CLNRFS) and risk factors predicting CLNR in well-lateralised oral cavity cancers (OCC) treated with unilateral surgery and adjuvant ipsilateral radiotherapy with or without concurrent chemotherapy.

MATERIALS AND METHODS

Consecutive patients of well-lateralised OCC treated between 2012 and 2017 were included. The primary endpoint was incidence of CLNR and CLNRFS. Univariable and multivariable analyses were carried out to identify potential factors predicting CLNR.

RESULTS

Of the 208 eligible patients, 21 (10%) developed isolated CLNR at a median follow-up of 45 months. The incidence of CLNR was 21.3% in node-positive patients. CLNR was most common at level IB (61.9%) followed by level II. The 5-year CLNRFS and overall survival were 82.5% and 57.7%, respectively. Any positive ipsilateral lymph node (P = 0.001), two or more positive lymph nodes (P < 0.001), involvement of ipsilateral level IB (P = 0.002) or level II lymph node (P < 0.001), presence of extranodal extension (P < 0.001), lymphatic invasion (P = 0.015) and perineural invasion (P = 0.021) were significant factors for CLNR on univariable analysis. The presence of two or more positive lymph nodes (P < 0.001) was an independent prognostic factor for CLNR on multivariable analysis. CLNR increased significantly with each increasing lymph node number beyond two compared with node-negative patients.

CONCLUSION

The overall incidence of isolated CLNR is low in well-lateralised OCC. Patients with two or more positive lymph nodes have a higher risk of CLNR and may be considered for elective treatment of contralateral neck.

Field evidence of brown carbon absorption enhancement linked to organic nitrogen formation in Indo-Gangetic Plain

Atmospheric brown carbon (BrC), a short-lived climate forcer, absorbs solar radiation and is a substantial contributor to the warming of the Earth's atmosphere. BrC composition, its absorption properties, and their evolution are poorly represented in climate models, especially during atmospheric aqueous events such as fog and clouds. These aqueous events, especially fog, are quite prevalent during wintertime in Indo-Gangetic Plain (IGP) and involve several stages (e.g., activation, formation, and dissipation, etc.), resulting in a large variation of relative humidity (RH) in the atmosphere. The huge RH variability allowed us to examine the evolution of water-soluble brown carbon (WS-BrC) diurnally and as a function of aerosol liquid water content (ALWC) and RH in this study. We explored links between the evolution of WS-BrC mass absorption efficiency at 365 nm (MAEWS-BrC-365) and chemical characteristics, viz., low-volatility organics and water-soluble organic nitrogen (WSON) to water-soluble organic carbon (WSOC) ratio (org-N/C), in the field (at Kanpur in central IGP) for the first time worldwide. We observed that WSON formation governed enhancement in MAEWS-BrC-365 diurnally (except during the afternoon) in the IGP. During the afternoon, the WS-BrC photochemical bleaching dwarfed the absorption enhancement caused by WSON formation. Further, both MAEWS-BrC-365 and org-N/C ratio increased with a decrease in ALWC and RH in this study, signifying that evaporation of fog droplets or bulk aerosol particles accelerated the formation of nitrogen-containing organic chromophores, resulting in the enhancement of WS-BrC absorptivity. The direct radiative forcing of WS-BrC relative to that of elemental carbon (EC) was ∼19 % during wintertime in Kanpur, and ∼ 40 % of this contribution was in the UV-region. These findings highlight the importance of further examining the links between the evolution of BrC absorption behavior and chemical composition in the field and incorporating it in the BrC framework of climate models to constrain the predictions.

Retraction of 'Ameliorating the Role of Aripiprazole in Memory Deficits Induced by Intracerebroventricular Streptozotocin-Induced Dementia of Alzheimer's Type'

[This retracts the article DOI: 10.1021/acsomega.3c02550.].

Renal dysfunction in routine proton-pump inhibitor use may be linked to comorbidities: A real-world observational study

INTRODUCTION

The use of proton-pump inhibitors (PPI) is linked with infrequent but serious adverse events, including acute kidney injury, chronic kidney disease (CKD) and progression of CKD. Data on renal safety in routine use of PPI are more relevant to clinical practice. We studied whether such use of PPI is associated with renal dysfunction.

METHODS

Patients taking PPI for at least six weeks had serum creatinine tested pre (n = 200) and post (n = 180) recruitment. These patients were then advised to follow-up: those taking PPI for at least 90 days in the next six months (n = 77) and at least another 90 days in the following six months (n = 50), had serum creatinine tested at such follow-up. Renal dysfunction was defined as any increase in serum creatinine level above baseline.

RESULTS

The 200 patients recruited had mean age 39.6 (SD 9.2) years. Ninety-eight (49%) patients had a history of previous PPI use (median six months; interquartile range [IQR] 3-24). Only 20 (11.1%) patients at six weeks, 11 (14.3%) at six months and six (12%) at one year had increase in creatinine level; a majority of them had less than 0.3 mg/dL increase. Ten of these 20 (six weeks), five of 11 (six months) and five of six (one year) had other risk factors for renal dysfunction. No patient developed CKD during the study period.

CONCLUSIONS

Mild and non-progressive increase in serum creatinine occurred in 10% to 15% of patients on routine PPI use. A majority of them had other risk factors. Small sample size and short follow-up duration are a few limitations of this study.

Neutral saccharides and hemicellulose over two urban sites in Indo-Gangetic Plain and Central Europe during winter

Saccharides are ubiquitous organic compounds that are omnipresent in nature and are considered tracers of aerosol sources. Saccharides and hemicellulose were analyzed in the aerosols of two polluted regions (Allahabad, India and Sosnowiec, Poland). The chemical compositions of the compounds and their abundances were significantly different at the two sites. Levoglucosan was the most dominant saccharide present at both sites. Galactosan, anhydroglucofuranose, mannosan, glucose, arabitol, D-pinitol, sucrose, and trehalose were found in Allahabad samples in high abundance but were significantly lower than levoglucosan. Mannosan, galactosan, arabinose, glycerol, and sucrose were significant compounds in Sosnowiec after dominating levoglucosan. The major sources of saccharides present in the Allahabad aerosols are hardwood and agricultural waste-burning emissions, whereas those at Sosnowiec are attributed to the burning of softwood (mainly gymnosperm trees), pine needles, or sporadically grass during the winter. Further, the chemical characteristics of hemicellulose remnants present in ambient aerosol at the Indian and European sites were analyzed and discussed. At both locations, hemicellulose was found using methanolysis of the filter samples; however, its state of preservation was poor. We believe that the primary sources of hemicellulose remnants are incomplete wood burning, crop straw, grass burning, or plant debris. Relatively poor preservation is associated with partial hemicellulose degradation when exposed to elevated temperatures or due to the oxidation and microbial degradation of plant fragments.

Anhedonia in adolescents at transdiagnostic familial risk for severe mental illness: Clustering by symptoms and mechanisms of association with behavior

BACKGROUND

Anhedonia is a transdiagnostic symptom of severe mental illness (SMI) and emerges during adolescence. Possible subphenotypes and neural mechanisms of anhedonia in adolescents at risk for SMI are understudied.

METHODS

Adolescents at familial risk for SMI (N = 81) completed anhedonia (e.g., consummatory, anticipatory, social), demographic, and clinical measures and one year prior, a subsample (N = 46) completed fMRI scanning during a monetary reward task. Profiles were identified using k-means clustering of anhedonia type and differences in demographics, suicidal ideation, impulsivity, and emotional processes were examined. Moderation analyses were conducted to investigate whether levels of brain activation of reward regions moderated the relationships between anhedonia type and behaviors.

RESULTS

Two-clusters emerged: a high anhedonia profile (high-anhedonia), characterized by high levels of all types of anhedonia, (N = 32) and a low anhedonia profile (low-anhedonia), characterized by low levels of anhedonia types (N = 49). Adolescents in the high-anhedonia profile reported more suicidal ideation and negative affect, and less positive affect and desire for emotional closeness than low-anhedonia profile. Furthermore, more suicidal ideation, less positive affect, and less desire for emotional closeness differentiated the familial high-risk, high-anhedonia profile adolescents from the familial high-risk, low-anhedonia profile adolescents. Across anhedonia profiles, moderation analyses revealed that adolescents with high dmPFC neural activation in response to reward had positive relationships between social, anticipatory, and consummatory anhedonia and suicidal ideation.

LIMITATIONS

Small subsample with fMRI data.

CONCLUSION

Profiles of anhedonia emerge transdiagnostically and vary on clinical features. Anhedonia severity and activation in frontostriatal reward areas have value for clinically important outcomes such as suicidal ideation.

Effectiveness, perceptions and environmental benefits of remote consultation for adults referred with recurrent tonsillitis

INTRODUCTION

We evaluate remote consultation for adult patients referred with recurrent sore throat, measuring the effectiveness of the consultation, satisfaction and environmental impact.

METHODS

Eligible patients were invited to telephone clinics, undertaking a satisfaction survey after consultation, focusing on perceived convenience, satisfaction, cost and travel arrangements (used to calculate potential environmental benefit). Provider opinion was also captured.

RESULTS

Forty-eight of 60 patients attended, with 38 (63%) eligible for inclusion. Thirty-six of these 38 patients (95%) had a definitive outcome of tonsillectomy (27/38) or discharge (9/38). Thirty-three of the 38 patients (87%) responded to the survey and reported high satisfaction in all arms of questioning (mean Likert ranking = 4.7/5). A mean of 3.76 hours of missed work and 5.17kg carbon dioxide emission equivalents were saved per patient. Provider responses were positive towards ongoing remote consultation use.

CONCLUSIONS

Telephone consultation for adult patients considered for tonsillectomy is convenient to patients in terms of cost and time, reduces environmental harm and is associated with high patient and provider satisfaction.

Investigating the temporal dynamics of sub-micron particles and particle-bound transition metals in indoor air of a metropolitan city

The present study portrays an association between particle-bound transition metals and children's health. The indoor air quality of the urban metropolitan city households was monitored for four PM sizes, namely PM1.0-2.5, PM0.50-1.0, PM0.25-0.50 and PM<0.25, in major seasons observed in the city; summer and winter. Further transition/heavy metals, viz. Cr, Cu, Fe, Mn, Ni, Pb and Zn, were analysed in PM1-2.5 samples. In order to evaluate the effect, health risk assessment was performed using mathematical and computational model for assessing dermal exposure and dose estimation (multiple path particle dosimetry model version3.0). The study principally targeted the children aged 2-15 years for the health risk assessment. According to the results, for the largest particle size i.e. PM1.0-2.5 the highest deposition was in the head region (49.1%) followed by pulmonary (43.6%) and tracheobronchial region (7.2%), whereas, for the smallest particle size i.e. PM<0.25 the highest deposition was obtained in the pulmonary region (73.0%) followed by the head (13.6%) and TB region (13.2%). Also, the most imperilled group of children with highest dose accumulation was found to be children aged 8-9 years for all particle sizes. Moreover, the dermal exposure dose as evaluated was found to be preeminent for Ni, Zn and Pb. Besides, seasonal variation gesticulated towards elevated concentrations in winter relative to the summer season. Altogether, the study will provide a conception to the researchers in the fields mounting season-specific guidelines and mitigation approaches. Conclusively, the study commends future work focussing on defining the effects of other chemical components on particles and associated transition metal composition along with proper extenuation of the same.

Facial nerve communication with ansa cervicalis - An unusual anatomical variation

Neural connections of the seventh cranial nerve with its neighboring nerves are common and well documented; however, communication with ansa cervicalis is as yet unknown. We present a case with such a connection found during cadaveric dissection, with hitherto unknown consequences. In this specimen, after giving the marginal mandibular and cervical branches, the cervicofacial division continued distally to communicate with the distal loop of ansa cervicalis. Presence of such connection may result in facial muscle paralysis on injury to the ansa or strap muscle paralysis on injury to the facial nerve, depending on the direction of nerve fibers. Such unusual connections bring to light the need for extreme care during surgeries in the neck to safeguard any such connections and when using the ansa as donor.

Highly purified charge variants of a proposed biosimilar to Omalizumab: impact on in vitro potency and stability under thermal stress

Biosimilars are highly complex and similar biological drugs are developed with different manufacturing processes which are not similar to originator manufacturing process. Due to this, biosimilar products inherently have quality differences in comparison to innovator molecule which may be related to size, charge and glycosylation. Despite these differences they are supposed to demonstrate similar behaviour in safety and efficacy profile to the reference product and these differences should not be clinically meaningful. Charge variants are one of the critical quality attributes and sources of heterogeneity. In this study, highly purified charge variants cluster (acidic, main peak and basic) of biosimilar product of Xolair were assessed for their impact on in vitro potency and stability at different thermal stress conditions (2-8 °C and - 20 °C). The study data indicating purified charge variants (> 90%) have no impact on in vitro potency and are stable at different thermal stress conditions up to a week.

Charge variants of proposed biosimilar to Omalizumab: Isolation, purification and analysis by HPLC methods

Omalizumab (Xolair) is a humanized monoclonal antibody derived by recombinant DNA technology. It binds specifically to immunoglobulin E (IgE) which plays a major role in allergic reaction by releasing histamine and other inflammatory factors from mast cells. Omalizumab binds circulatory IgE with high affinity and prevents from its binding to mast cell receptor. Charge variants are one of the critical quality attributes (CQAs) in biological drug development and sources of heterogeneity which needs to be considered in biosimilarity assessment. In this study, biosimilar product of Xolair was expressed in mammalian cell culture process in laboratory to isolate charge variants (acidic, main peak and basic). Different charge variants were isolated from intermediate purified biosimilar product of Xolair. Isolated charge variants were purified with preparative cation exchange chromatography technique and characterized with different analytical tools includes size exclusion chromatography (SEC-HPLC) and cation exchange chromatography (CEX-HPLC). Purity of acidic, main peak and basic variants was 99.58%, 99.98% and 98.64% respectively as per SEC-HPLC and according to CEX-HPLC purity was 94.25%, 95.58% and 91.33% respectively. The study data indicates that isolated charge variants were purified with desired purity and can be further used for process characterization, in vitro potency and in vivo kinetics studies.

Injection medialisation laryngoplasty: an alternative approach for challenging cases

OBJECTIVE

Conventional injection medialisation laryngoplasty techniques may be compromised by patient-specific factors such as marked kyphosis, an anteriorly positioned larynx or intolerance to nasendoscopy. This paper describes a technique for successful injection medialisation laryngoplasty where conventional methods are precluded, in an 88-year-old man with presbyphonia on a background of Parkinson's disease.

METHODS

After induction of general anaesthesia, a transoral introducing needle, shaped by tactile manipulation to match the curvature of a 'C-MAC' intubating video-laryngoscope 'D-blade' attachment, was introduced until visible above the glottis. The implant material was then injected into the paraglottic space as normal until satisfactory medialisation of the vocal fold was achieved.

RESULTS

When reviewed in the out-patient clinic four weeks later, the patient's post-operative Voice Handicap Index score fell to 6, from a pre-operative score of 21.

CONCLUSION

By utilising commonly available equipment and anaesthetic support to recreate the views and access conventional nasendoscopy and laryngoscopy facilitate, this novel procedure provides a viable and proven alternative in uncommon but challenging cases.

PM2.5 pollution exceeding Indian standard over a semi-urban region at eastern IGP: Chemistry, meteorological impact, and long-range transport

A year-long study (January-December 2019) on the chemical characterization and meteorological impact on PM2.5 was conducted over a semi-urban station, Shyamnagar, in the easternmost part of the Indo-Gangetic Plains (IGP). PM2.5 concentrations (Mean = 81.69 ± 66.27 μgm-3; 7.10-272.74 μgm-3), the total carbonaceous aerosols (TCA) (Mean = 22.85 ± 24.95 μgm-3; 0.77-102.97 μgm-3) along with differential carbonaceous components like organic carbon (OC) (Mean = 11.28 ± 12.48 μgm-3; 0.48-53.01 μgm-3) and elemental carbon (EC) (Mean = 4.83 ± 5.28 μgm-3; 0.1-22.13 μgm-3) exhibited prominent seasonal variability with the highest concentrations during winter, followed by post-monsoon, pre-monsoon and lowest during monsoon. A similar seasonal variation was observed for the total water-soluble ionic species (Mean = 31.91 ± 20.12 μgm-3; 0.1-126.73 μgm-3). We observed that under the least favorable conditions (low ventilation coefficient), high PM2.5 pollution (exceeding Indian standard) was associated with a high increase in secondary components of PM2.5. Eastern, central and western parts of IGP, as well as Nepal, were the major long-distant source regions whereas the northern part of West Bengal and parts of Bangladesh were the major regional source region for high PM2.5 pollution over Shyamnagar. The ratios like char-EC/soot-EC, non-sea-K+/EC and non-sea-SO42-/EC strongly indicated the dominance of fossil fuel burning over biomass burning. Compared with other studies, we observed that the PM2.5 pollution over this semi-urban region was comparable (and even higher in some cases) with other parts of IGP. The high exceedance of PM2.5 over the Indian standard in Shyamnagar strongly demands an immediate initiation of systematic and regular based air pollution monitoring over semi-urban/non-urban regions in India, especially IGP, in addition to the polluted cities.

Self-reported food intolerances in an Indian population: Need for individualization rather than a universal low-FODMAP diet

Background and Aim

Low-fermentable oligo-, di-, and monosaccharides and polyol (FODMAP) diets have been recommended for individuals with food intolerance and irritable bowel syndrome (IBS). Individual food intolerances may, however, not correspond to the FODMAP content alone.

Methods

We conducted a survey on self-reported intolerance to articles of food commonly identified as high FODMAP in 400 healthy Indian subjects (median age 40 years; 69% men) and 204 consecutive consenting patients with IBS (median age 36 years; 58% men).

Results

One-hundred seventy-nine (44.8%) healthy subjects and 147 (72.1%) patients with IBS reported some food intolerance (P < 0.00001); the latter reported intolerance to all items (except nuts) more frequently than healthy subjects. The prevalence, however, varied from 2.5 to 32%. Milk intolerance was reported equally commonly by healthy subjects and patients (23% vs 29.9%). Twenty-three (11.3%) patients and no healthy subjects reported wheat sensitivity. The IBS diarrhea subgroup reported intolerance to milk, pulses, capsicum, cauliflower, leafy vegetables, and dry fruits more frequently than the constipation subgroup.

Conclusion

From among a list of high-FODMAP items, individuals' intolerance varied widely, suggesting that individuals should be the final judge in deciding their elimination diets rather than devise them based on the FODMAP content alone. As in the West, food intolerance was reported more commonly by patients with IBS, especially those with diarrhea, than by healthy individuals. Also noteworthy is the low prevalence of milk intolerance in a subcontinent labeled as high in lactose intolerance. Unlike in the West, wheat intolerance was not reported by any healthy individual.

Short-course Palliative Hypofractionated Radiotherapy in Patients with Poor-prognosis High-grade Glioma: Survival and Quality of Life Outcomes from a Prospective Phase II Study

AIMS

To report longitudinal quality of life (QoL) outcomes and survival in patients with poor-prognosis high-grade glioma (HGG) treated with palliative hypofractionated radiotherapy.

MATERIALS AND METHODS

Patients with poor-prognosis HGG were accrued on a prospective study of short-course palliative hypofractionated radiotherapy (35 Gy/10 fractions/2 weeks). The European Organization for Research and Treatment of Cancer QoL core questionnaire (QLQ-C30) and brain cancer module (BN20) were used in English or validated Indian vernacular languages (Hindi and Marathi) for QoL assessment at baseline (before radiotherapy), the conclusion of radiotherapy, 1 month post-radiotherapy and subsequently at 3-monthly intervals until disease progression/death. Baseline QoL scores were compared with corresponding scores from a historical HGG cohort. Summary QoL scores were compared longitudinally over time by related samples Friedman's two-way test. Progression-free survival and overall survival were calculated using the Kaplan-Meier method and reported as 1-year estimates with 95% confidence intervals.

RESULTS

Forty-nine (89%) of 55 patients completed the planned course of hypofractionated radiotherapy. Longitudinal QoL data were available in 42 (86%) of 49 patients completing radiotherapy, comprising the present cohort. The median age of included patients, comprised mainly of glioblastoma patients (81%), was 57 years, with an interquartile range (IQR) of 50-66 years and a median baseline Karnofsky score of 60 (IQR = 50-60). Baseline QoL scores were significantly worse for several domains compared with a historical institutional cohort of HGG patients treated previously with conventionally fractionated radiotherapy, indicating negative selection bias. QoL scores remained stable for most domains after palliative hypofractionated radiotherapy, with statistically significant improvements in fatigue (P = 0.032), dyspnoea (P = 0.042) and motor dysfunction (P = 0.036) over time. At a median follow-up of 8 months, Kaplan-Meier estimates of 1-year progression-free survival and overall survival were 33.3% (95% confidence interval 21.7-51.1%) and 38.1% (95% confidence interval 25.9-56%), respectively.

CONCLUSION

Short-course palliative hypofractionated radiotherapy in patients with poor-prognosis HGG is associated with stable and/or improved QoL scores in several domains, making it a viable resource-sparing regimen.

Multiple Sessions vs. Single Session Image-Based Intracavitary Brachytherapy for Locally Advanced Cervical Cancer: A Randomized Control Trial

PURPOSE/OBJECTIVE(S)

The objectives of this study are: 1) To compare the acute toxicity caused in the treatment of locally advanced cervical cancer (LACC) treated with weekly multiple applications vs. a single application for image-guided intracavitary High Dose Rate (HDR) brachytherapy (BT) after External Beam Radiation Therapy (EBRT) 2) To compare the loco-regional control of cancer at six months in the two arms MATERIALS/METHODS: In a prospective study, 40 patients with biopsy-proven LACC with FIGO-2018 stage IIB-IIIC1 disease, underwent EBRT to the pelvis at a dose of 50.4 Gy/ 28 fractions over 5.5 weeks with weekly concurrent cisplatin. After completion of EBRT, they were randomized into two arms with 20 patients each. In the Control arm (Arm-A), BT sessions were given with weekly 3 applications whereas, in the experimental arm (Arm-B), all the sessions were given with a single application at 6-12 hours intervals with aim of the high-risk clinical target volume receiving >80 Gy EQD2 and 2 cm3 of the bladder and rectum/sigmoid receiving <85 Gy and <75 Gy, respectively. The OAR contouring was done on CT RESULTS: All 40 patients were treated as per protocol. The mean duration of treatment including EBRT and BT was 73.15 days [95% CI 68.63-77.66] in Arm A and 55.85 days [95% CI 52.11-59.58] in Arm B which was significant. After 6 months, 37 patients came for follow-up, all 19 patients in Arm A had Grade 1 or Grade 2 rectal toxicity. In Arm B as well all 18 patients had Grade 1 or Grade 2 rectal toxicity. Bladder toxicity was Grade 1 or Grade 2 in 18 patients and Grade 3 severity in 1 patient among Arm A. Among 18 patients of Arm B, bladder toxicity of Grade 1 or Grade 2 was seen in 16 patients, and 2 patients had grade 3 toxicity. 2 patients in Arm A and 3 in Arm B complained of Grade 1 urinary incontinence. Moreover, Abdominal pain at 6 months was of Grade 1 in around 6 patients in Arm A but 14 patients had abdominal pain in Arm B which was of Grade 1 in 8, 4 had grade 2 and 2 patients had grade 3 severity abdominal pain. In the monthly analysis of acute toxicity, none of the patients showed Grade 3 or 4 toxicity at the 1st, 2nd, or 3rd month of completion of treatment. When comparing local control in both arms at 6 months, 2 patients had treatment failure in the Experimental Arm compared to only 1 patient in the Control Arm CONCLUSION: Single Application Multiple Fraction Intracavitary Brachytherapy post concurrent CTRT is a safe option for the treatment of locally advanced cervical cancer. When compared to the weekly application arm, single-application ICRT showed a comparable acute toxicity profile and comparable local control rates as well. Some patients in Single Application Arm showed abdominal pain which needs to be investigated with further trials. The overall treatment time in the single application arm is significantly lower than the standard weekly application arm.

A review on potential approach for in silico toxicity analysis of respirable fraction of ambient particulate matter

Epidemiological and toxicological studies have shown the adverse effect of ambient particulate matter (PM) on respiratory and cardiovascular systems inside the human body. Various cellular and acellular assays in literature use indicators like ROS generation, cell inflammation, mutagenicity, etc., to assess PM toxicity and associated health effects. The presence of toxic compounds in respirable PM needs detailed studies for proper understanding of absorption, distribution, metabolism, and excretion mechanisms inside the body as it is difficult to accurately imitate or simulate these mechanisms in lab or animal models. The leaching kinetics of the lung fluid, PM composition, retention time, body temperature, etc., are hard to mimic in an artificial experimental setup. Moreover, the PM size fraction also plays an important role. For example, the ultrafine particles may directly enter systemic circulations while coarser PM10 may be trapped and deposited in the tracheo-bronchial region. Hence, interpretation of these results in toxicity models should be done judiciously. Computational models predicting PM toxicity are rare in the literature. The variable composition of PM and lack of proper understanding for their synergistic role inside the body are prime reasons behind it. This review explores different possibilities of in silico modeling and suggests possible approaches for the risk assessment of PM particles. The toxicity testing approach for engineered nanomaterials, drugs, food industries, etc., have also been investigated for application in computing PM toxicity.

Ameliorating the Role of Aripiprazole in Memory Deficits Induced by Intracerebroventricular Streptozotocin-Induced Dementia of Alzheimer's Type

Alzheimer's disease (AD) is a progressive neurodegenerative disorder causing immense suffering for the patients. Dopamine D2 and 5-hydroxytryptamine receptor 1A (5-HT1A) receptors' activation has been reported to play a crucial role in managing neurological outcomes in the brain and other health disorders. This study aimed to investigate the role of aripiprazole, a dopamine D2 and 5-HT1A selective receptors' activator, in the restoration of memory deficit induced by streptozotocin in mice. The cognitive functions of animals were determined using the Morris water maze. Brain sections were stained with hematoxylin and eosin and Congo red to examine the structural deviations. Brain oxidative stress (thiobarbituric acid reactive substance and glutathione), acetylcholinesterase activity, IL-6, and IL-10 were measured to assess biochemical alterations. Activation of D2 and 5-HT1A with aripiprazole attenuated STZ-induced cognitive deficit, increased brain GSH levels, reduced TBARS levels, AChE activity, IL-6 levels, and IL-10 levels and prevented STZ-induced brain anomalies in mice. Hence, the present study concluded that aripiprazole mitigated STZ-induced memory impairment and can be used as an efficacious therapeutic target for the management of AD.

A prospective, randomised, single-blinded controlled trial comparing ultrasound versus nerve stimulator guidance for interscalene block for ambulatory upper limb surgeries

Background

Interscalene block is usually performed using either ultrasound (US) or nerve stimulator (NS) guidance. This single-blinded, prospective, randomised study was performed to find out whether US was able to offer distinct advantages over conventional NS guidance.

Methods

100 patients in the American Society of Anaesthesiology (ASA) physical status I to III, aged 18-70 years were randomised into US guided or NS guided group for interscalene block with 15 ml 0.5% bupivacaine and 5 ml 2% lignocaine. Patients were premedicated with midazolam 0.03 mg/kg (maximum 2 mg) and fentanyl 2 mcg/kg (max 100 mcg) was used as rescue analgesia.

Result

Mean time of onset of sensory block in the NS group was 6.2 min (3.1), the US group 4.7 min (1.1), p value (<0.001). Mean duration of post-operative analgesia in NS group 323.6 min (98.6), US group 558.6 min (144.3), (p < 0.001). Mean time for performance of block NS Group 7.3 min (2.0), and in the US group 4.9 min (1.3), (p < 0.001). Number of needle passes NS group 1.7(0.9), US group 1.3 (1.0), (p < 0.005). Total cost per surgery with NS was Rs 363.10 less than in the US-guided block. Incremental cost effectiveness ratio for ultrasound group for onset of block was Rs -242.07, Rs 92.0 for duration of block and Rs -151.29 for time for performance of block. No incident of post-operative neurological complications seen in either group.

Conclusion

Ultrasound use offers faster onset, longer duration of block, reduces time for performance of blocks with comparable complication rates. For most of the measured parameters it was superior but more costly than nerve stimulator for directly measured costs.

Trace elements in ambient aerosols and size-resolved fog droplets: Trends, enrichment, and risk assessment

Ambient particulate matter (PM) is composed of inorganic and organic components. The contribution of each component is impacted by various factors such as emission sources, atmospheric aging process, and size of the PM or droplets. This study mainly focuses on the effect of the PM and droplet size on trace elemental concentrations, for which various size fractions of ambient PM (PM₁, PM_2.5) were collected on quartz filters along with fog water (FW) samples during winter. Simultaneous, online measurements of the mass concentrations of PM₁ and PM_2.5 were also carried out. At the time of the collection, the mass concentration of PM_2.5 ranged from 19 to 890 μg/m³, and its mean value was 227 μg/m³. During the sampling period, 17 fog events occurred and caused a 27% reduction in the mean pre-fog PM_2.5 concentration. All the PM and FW samples were analyzed for 12 trace elements: Ca, Cr, Cu, Fe, K, Mg, Mn, Na, Ni, Pb, Zn, V. The concentrations of the various trace elements in the PM₁, PM_2.5, and FW samples encompassed a wide range: 10 (V)-2432 (Na) ng/m³, 34 (Mn)-13810 (Na) ng/m³, and 8 (Cr)-19870 (Ca) μg/l, respectively. The concentrations of the trace elements in the FW samples indicated a droplet-size-dependent trend: the small droplets (diameter <16 μm) had several times (3-10 times) higher concentrations than the coarser droplets (diameter >22 μm). The enrichment factor (EF) analysis revealed that the EF values for almost all the trace elements were an order of magnitude higher in the FW samples than in PM₁ and PM_2.5. Risk assessment based on toxic elements suggested a very high inhalation carcinogenic risk (231 per million) for the exposed population during foggy periods. This study will facilitate decision-making by policymakers regarding air quality and health concerns.

Investigation of sources and atmospheric transformation of carbonaceous aerosols from Shyamnagar, eastern Indo-Gangetic Plains: Insights from δ13C and carbon fractions

This study reports the chemical characterization of the carbonaceous component of PM_2.5 (particulate matter with aerodynamic diameter ≤2.5 μm) collected over a year-long campaign from a regional site in Shyamnagar, West Bengal, in the Indo-Gangetic Plains (IGP), India. The carbonaceous fractions (elemental and organic carbon), mass concentrations, and stable carbon isotopic composition (δ¹³C value) of aerosols were measured and utilized to characterize the sources and understand the atmospheric processing of aerosols. Cluster analysis, Potential Source Contribution Function (PSCF) modeling, and fire count data were analyzed to decipher the pattern of air masses, source contributions, and extent of burning activities. The PM_2.5 mass concentrations were significantly higher during winter (168.3 ± 56.3 μg m^-3) and post-monsoon (109.8 ± 59.1 μg m^-3) compared to the monsoon (29.8 ± 10.7 μg m^-3) and pre-monsoon (55.1 ± 23.0 μg m^-3). Organic carbon (OC), elemental carbon (EC), and total carbon (TC) concentrations were also several factors higher during winter and post-monsoon compared to monsoon and pre-monsoon. The winter and post-monsoon experienced the impact of air masses from upwind IGP. On the other hand, long-range transported air masses from the South-West direction dominated during monsoon and pre-monsoon, which are also relatively cleaner periods. The average δ¹³C during post-monsoon and winter was ∼1‰ higher compared to monsoon and pre-monsoon. The vehicular exhaust and biomass/biofuel burning contributed dominantly in winter and post-monsoon. In comparison, lower δ¹³C in pre-monsoon and monsoon might be attributed to the dominance of biomass/biofuel combustion. Photochemical-induced aging of the anthropogenic aerosols resulted in a higher δ¹³C of TC in winter and post-monsoon, whereas the mixing of different local sources in pre-monsoon and monsoon resulted in lower δ¹³C values. These findings benefit policymakers in strategizing proper and effective management of biomass/biofuel burning in the IGP to minimize air pollution.

A prospective study of inflammatory bowel disease phenotypes in extremes of age and comparison with adults

BACKGROUND AND AIMS

Pediatric and elderly inflammatory bowel disease (IBD) are less explored, often in retrospective studies. The pediatric group has a more extensive and aggressive disease phenotype requiring aggressive treatments, whereas the elderly group may have less aggressive diseases.

METHODS

We prospectively compared disease characteristics of a single center cohort of IBD patients (pediatric age ≤ 16 years; adults 17 to 59 years; and elderly ≥ 60 years) seen between September 2018 and November 2019 with at least six months of follow-up.

RESULTS

Total 266 IBD patients (137 males) included 47 pediatric, 175 adults and 44 elderly patients. Among ulcerative colitis (UC) patients, pancolitis was more common in the pediatric group (p = 0.018), while the elderly group had more indolent behaviors and infrequent extraintestinal manifestations (p = 0.005). Among patients with Crohn's disease (CD), the pediatric group had more often colonic diseases (p = 0.02) and the elderly, ileal diseases (p = 0.04). The disease behavior was similar in the three age groups. Perianal disease was least common in elderly CD patients (p = 0.03). There was no treatment difference among different age groups in UC. In CD, pediatric patients needed biologics more frequently (p = 0.005), while elderly CD patients less frequently required steroids, biologics, immunosuppressants and surgery (p < 0.05).

CONCLUSIONS

We noted differences compared to western literature such as colonic location in pediatric CD and ileal location in elderly CD. Perianal disease was less frequent in the elderly CD group. There was no difference in treatment in the three age groups in UC, while there were no inter-age-group disease behavioral differences for UC and CD.

Wintertime aerosol properties of urban desert region of western India: Implications in regional climate assessment

This study assessed the inter-relation between physiochemical and optical characteristics of aerosols measured at a desert-urban region affected by anthropogenic sources and desert dust during October 2020 to January 2021. Based on horizontal visibility and measured PM_2.5 concentration, clear (37 %), light (33 %) and high (31 %) pollution periods were identified. Elemental and organic carbon (50 ± 15 μgm^-3_; 31 %) and secondary inorganics (53 ± 21 μgm^-3; 33 %) dominated the PM_2.5 mass (160 ± 4 μgm^-3) during high pollution period with low dust (14 ± 7 μgm^-3; 8 %) content. Interestingly, the clear pollution period was also influenced by carbonaceous fraction (19 ± 8 μgm^-3; 32 %) and secondary inorganics (19 ± 5 μgm^-3; 32 %), but the PM_2.5 concentrations (59 ± 9 μgm^-3) were ∼ one-third as compared to high pollution period. High scattering coefficients were observed which were comparable to highly polluted Indian city like Delhi. An exponential increase in non-absorbing material was observed and showed clear influence on light absorption capacity of EC and dust due to coating/mixing. High absorption Ångström exponent (AAE) >0.6 was observed for the ratio of non-absorbing to light absorbing components (LAC) in the range of 1-2.5 and EC/PM_2.5 fraction of 7-14 %. While further increase in non-absorbing to absorbing components ratio > 4 and low amount of EC (<4 %) tend to decrease AAE below 0.4. Higher mass absorption cross-section (>30 m²g^-1 of EC) was observed when 4-10 % EC fraction of PM_2.5 associated with 1.5-3.5 times non-absorbing components to total absorbing components. Likewise, absorption enhanced by three to five folds compared to uncoated EC for low EC fraction (3-6 %) in PM_2.5, but high non-absorbing to absorbing component ratio (>2.5). Interestingly, absorption was minimally amplified for nominal coating fraction associated with significant core materials or vice-versa. These findings have implications not only in regional climate assessment but also for other regions with comparable geography and source-mixes.

How Reliable Are YouTube Videos for General Surgery Residents Learning?

Introduction  YouTube is one of the top-searched online video streaming platforms. However, the content of YouTube may not match the standards required for clinical skills learning. Therefore, we investigated the quality of top-viewed YouTube videos related to three basic surgical procedures that need to be performed by general surgery residents in their first year of training in our institute. Methods  We searched YouTube for the top 10 viewed demonstration videos related to ultrasound-guided abscess drainage, chest tube insertion, and central line insertion. For the eligible videos, we calculated the likes ratio, view ratio, and video power index. The videos' quality was assessed using LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) scores. The videos were categorized into high-quality (LAP-VEGaS score ≥ 11) and low-quality videos (LAP-VEGaS score < 11). The different descriptive (view counts, duration, and likes-dislikes) and calculated parameters stated above were compared between the two video quality-based groups. Results The selected videos were uploaded between July 2008 and March 2022. Their mean view counts were 460391.13±373760.19. Their mean video duration was 8.12±4.26 minutes. Their mean likes and dislikes were 2578.38±2977.43 and 144.10±129.80, respectively. The mean like ratio and the mean view ratio were 93.42±13.53 and 317.76±827.79, respectively. The mean video power index was 310.67±827.96. The mean LAP-VEGaS scores for ultrasound-guided abscess drainage, chest tube insertion, and central line insertion-related videos were 6.80, 11.10, and 11.20, respectively. The numbers of likes and dislikes were significantly higher for high-quality videos. Conversely, the view counts, the view ratio, and the video power index were significantly lower for high-quality videos. Conclusion  Top-viewed videos related to general surgery procedural demonstrations are of low quality. The video view counts, popularity, and likes-dislikes are highly unreliable indicators of surgical video's usefulness. There is a need for regulatory mechanisms to screen the YouTube content suitable for general surgery residents learning. The residents should therefore be cautious while making inferences based on YouTube videos.

Outcomes of remote versus face-to-face ear, nose and throat outpatient consultation on patient pathways

INTRODUCTION

Remote consultation has potential benefits in increasing patient pathway efficiency and has been found to reduce costs and carbon emissions. Previous studies of remote consultation in ear, nose and throat (ENT) practice have reported mixed results and used relatively small sample sizes. The aim of this article is to study the impact of remote telephone consultation on ENT clinic outcomes and pathway efficiency, compared with in-person review, within new and follow-up patient cohorts and subspeciality, where previous studies demonstrate mixed and inconclusive results.

METHODS

This was a comparison of remote clinic appointment outcomes over a 2-month period from a single ENT referral centre (426) with an equivalent data set of face-to-face clinic appointments over a similar time frame (1,533). Statistical analysis included chi-squared test for clinic outcomes and two-sample t-squared test for mean hand-off between both cohorts (p < 0.05).

RESULTS

For new referrals, remote consultation was associated with statistically significantly greater rates of follow-up (p < 0.00001), investigation (p = 0.00251) and hand-off (p < 0.00013) than patients seen face-to-face - particularly where presenting with head and neck symptoms. For follow-up patients, remote consultation had similar rates of investigation (p = 0.11071) or further follow-up (p = 0.08) and mean hand-off (p < 0.11764) to those seen face-to-face.

CONCLUSIONS

Remote consultation in ENT could become the norm for follow-up patients, but should be used with caution in the initial consultation of new patients.

Tracing the predominant sources of carbon in PM2.5 using δ13C values together with OC/EC and select inorganic ions over two COALESCE locations

As part of the COALESCE (Carbonaceous Aerosol Emissions, Source apportionment and Climate Impacts) campaign, ambient PM_2.5 was collected at two regional sites (Bhopal and Mysuru) in India during 2019. We utilized organic carbon (OC), elemental carbon (EC) and water-soluble inorganic ions together with δ¹³C values, to better understand total carbon (TC) sources at these locations. The annual average δ¹³C values (-26.2 ± 0.6‰) at Mysuru and Bhopal (-26.6 ± 0.6‰) were comparable. However, at Mysuru, except during winter, day-to-day variability was much lower (narrow range of -26.8 to -26.0‰) than that at Bhopal (range: -28.1 to -24.7‰), suggesting that TC was contributed by few sources, likely dominated by vehicular emissions. Seasonal average δ¹³C values at Bhopal increased slightly (-25.8 ± 0.5‰) during the winter (Jan-Feb) and decreased (-27.0 ± 0.3‰) during the monsoon (Jun-Sep) season compared to the annual average. The decrease in δ¹³C values during the monsoon season was likely driven by enhanced secondary organic aerosol formation. Further, based on MODIS derived fire spots and back trajectories, we infered that the δ¹³C values (-27.5 to -26.0‰) in Bhopal during the post-monsoon season (Oct-Dec) were indicative of dominant biomass burning contributions. The inorganic ions/TC ratio during this season suggested that biomass burning aerosol was aged and may have been transported from crop residue burning in the Indo-Gangetic plains. At Mysuru, like the trend at Bhopal, the δ¹³C values during the monsoon season were lower than those during the winter season. Finally, δ¹³C values were input to a Bayesian model-MixSIAR to demonstrate the usefulness of such models in apportioning TC. In its simplest implementation, the model separated TC sources into fossil fuel emissions and non-fossil fuel sources . Fossil fuel combustion emissions accounted for 47 ± 19% and 62 ± 22% of the TC at Bhopal and Mysuru, respectively.

Does loneliness before the age of twelve indirectly affect impaired control over drinking, alcohol use, and problems through perceived stress?

Loneliness is the pain of feeling socially isolated from others (Russell et al., 1980). The Stress-Dampening Hypothesis (Marlatt, 1987; Sayette, 1993; Sher, 1987) posits that individuals drink to alleviate negative affect. To date, it has not been determined whether loneliness experienced as a child can indirectly influence at-risk patterns of alcohol use through the mediating mechanism of stress and impaired control. Impaired control over alcohol use (IC) is the difficulty adhering to one's own self-proscribed limits on drinking behaviors (Heather et al., 1993). Impaired control is an at-risk pattern of use that is particularly relevant to emerging adults. Methods: We examined the direct and indirect relationships between childhood loneliness, stress, IC, and alcohol-related problems with a structural equation model. In a college student sample, we utilized a (k = 20,000) bootstrap technique and a model indirect command in Mplus to examine potential mediational pathways. Cisgender sex was included as a covariate. Results: Loneliness was directly linked to stress as well as to alcohol-related problems. Higher levels of loneliness were indirectly linked to both more alcohol use and alcohol-related problems through more stress and in turn, more impaired control over drinking. Conclusions: The current study is consistent with the Stress Dampening Hypothesis (Marlatt, 1987; Sayette, 1993; Sher, 1987). Our findings suggest that therapeutic interventions combating loneliness in childhood may disrupt the stress-dampening pathway to dysregulated alcohol use in emerging adulthood.

Light absorption potential of water-soluble organic aerosols in the two polluted urban locations in the central Indo-Gangetic Plain

PM_2.5 (particulate matter having aerodynamic diameter ≤2.5 μm) samples were collected during wintertime from two polluted urban sites (Allahabad and Kanpur) in the central Indo-Gangetic Plain (IGP) to comprehend the sources and atmospheric transformations of light-absorbing water-soluble organic aerosol (WSOA). The aqueous extract of each filter was atomized and analyzed in a high-resolution time-of-flight aerosol mass spectrometer (HR-ToF-AMS). Water-soluble organic carbon (WSOC) and WSOA concentrations at Kanpur were ∼1.2 and ∼1.5 times higher than that at Allahabad. The fractions of WSOC and secondary organic carbon (SOC) to total organic carbon (OC) were also significantly higher ∼53% and 38%, respectively at Kanpur compared to Allahabad. This indicates a higher abundance of oxidized WSOA at Kanpur. The absorption coefficient (b_abs-365) of light-absorbing WSOA measured at 365 nm was 46.5 ± 15.5 Mm^-1 and 73.2 ± 21.6 Mm^-1 in Allahabad and Kanpur, respectively, indicating the dominance of more light-absorbing fractions in WSOC at Kanpur. The absorption properties such as mass absorption efficiency (MAE₃₆₅) and imaginary component of refractive index (k_abs-365) at 365 nm at Kanpur were also comparatively higher than Allahabad. The absorption forcing efficiency (Abs SFE; indicates warming effect) of WSOA at Kanpur was ∼1.4 times higher than Allahabad. Enhancement in light absorption capacity was observed with the increase in f44/f43 (fraction of m/z 44 (f44) to 43 (f43) in organic mass spectra) and O/C (oxygen to carbon) ratio of WSOA at Kanpur while no such trend was observed for the Allahabad site. Moreover, the correlation between carbon fractions and light absorption properties suggested the influence of low-volatile organic compounds (OC3 + OC4 fraction obtained from thermal/optical carbon analyzer) in increasing the light absorption capacity of WSOA in Kanpur.

Comparative evaluation of efficacy of different irrigation devices in removal of calcium hydroxide in teeth with simulated internal resorption cavities - An in vitro study

Aim

The aim of this in vitro study was to compare the efficacy of newly developed irrigation systems, i.e., XP-endo Finisher file (XP-endo), EndoActivator (EA), and Endo-Irrigator Plus (EI) with gold standard passive ultrasonic irrigation (PUI) tip and in removal of calcium hydroxide (CH) from single-rooted teeth with artificial simulated internal resorption cavities.

Materials and Methods

One hundred and twenty single-rooted mandibular premolars were decoronated and prepared using the ProTaper Gold system up to F5. Samples were buccolingually sectioned and resorption cavities were prepared. Twenty specimens were served as Group 1 - negative control. In the remaining specimens, CH was delivered and root halves were brought together. Twenty specimens were served as Group 2 - positive control. The remaining specimens were randomly divided into four experimental groups (n = 20), where NaOCl and EDTA were activated using PUI, XP-endo, EA, and EI for 1 min. The remnants of CH were scored and analyzed by employing Kruskal-Wallis H- and Mann-Whitney U-tests.

Results

PUI and XP-endo removed more CH than other devices (P < 0.05), showing no significant difference between them.

Conclusion

None of the tested systems were able to remove CH completely from resorption cavities. PUI and XP-endo were superior to other tested devices.

Variabilities of δ13C and carbonaceous components in ambient PM2.5 in Northeast India: Insights into sources and atmospheric processes

A year-long sampling campaign of ambient PM_2.5 (particulate matter with aerodynamic diameter ≤2.5 mm) at a regional station in the North-Eastern Region (NER) of India was performed to understand the sources and formation of carbonaceous aerosols. Mass concentration, carbon fractions (organic and elemental carbon), and stable carbon isotope ratio (δ¹³C) of PM_2.5 were measured and studied along with cluster analysis and Potential Source Contribution Function (PSCF) modelling. PM_2.5 mass concentration was observed to be highest during winter and post-monsoon seasons when the meteorological conditions were relatively stable compared to other seasons. Organic carbon (OC) concentration was more than two times higher in the post-monsoon and winter seasons than in the pre-monsoon and monsoon seasons. Air mass back trajectory cluster analysis showed the dominance of local and regional air masses during winter and post-monsoon periods. In contrast, long-range transported air masses influenced the background site in pre-monsoon and monsoon. Air mass data and PSCF analysis indicated that aerosols during winter and post-monsoon are dominated by freshly generated emissions from local sources along with the influence from regional transport of polluted aerosols. On the contrary, the long-range transported air masses containing aged aerosols were dominant during pre-monsoon. No significant variability was observed in the range of δ¹³C values (-28.2‰ to -26.4‰) during the sampled seasons. The δ¹³C of aerosols indicates major sources to be combustion of biomass/biofuels (C3 plant origin), biogenic aerosols, and secondary aerosols. The δ¹³C variability and cluster/PSCF modelling suggest that aged aerosols (along with enhanced photo-oxidation derived secondary aerosols) influenced the final δ¹³C during the pre-monsoon. On the other hand, lower δ¹³C in winter and post-monsoon is attributed to the freshly emitted aerosols from biomass/biofuels.

Self-supervised learning for macromolecular structure classification based on cryo-electron tomograms

Macromolecular structure classification from cryo-electron tomography (cryo-ET) data is important for understanding macro-molecular dynamics. It has a wide range of applications and is essential in enhancing our knowledge of the sub-cellular environment. However, a major limitation has been insufficient labelled cryo-ET data. In this work, we use Contrastive Self-supervised Learning (CSSL) to improve the previous approaches for macromolecular structure classification from cryo-ET data with limited labels. We first pretrain an encoder with unlabelled data using CSSL and then fine-tune the pretrained weights on the downstream classification task. To this end, we design a cryo-ET domain-specific data-augmentation pipeline. The benefit of augmenting cryo-ET datasets is most prominent when the original dataset is limited in size. Overall, extensive experiments performed on real and simulated cryo-ET data in the semi-supervised learning setting demonstrate the effectiveness of our approach in macromolecular labeling and classification.

788 Caecal Duplication Cyst: An Unexpected Cause of Bowel Obstruction in a 12-Year-Old

We report the case of a rare cause of bowel obstruction in a 12-year-old girl who presented with a short history of abdominal distension and vomiting after a month of unexplained urinary frequency and weight loss. Abdominal radiographs demonstrated small bowel obstruction with an unknown pelvic mass. A raised CA125 suggested a possible ovarian lesion and a magnetic resonance scan was interpreted as supportive of this pathology. Intra-operatively a 120x90x70mm cystic mass was found attached to the caecal serosa, immediately adjacent to the ileocaecal valve. There was an associated 180-degree twist of the terminal ileum and ascending colon. A limited right hemicolectomy was performed, and histopathology confirmed the diagnosis of a caecal intestinal duplication cyst. Post-operatively she has recovered well, with resolution of her obstructive and urinary symptoms. Given the unusual age of presentation, uncommon location of the cyst and the diagnostic challenges incurred, the authors wish to share their experience of managing an atypical duplication cyst.

Impact of Chemical Properties of Human Respiratory Droplets and Aerosol Particles on Airborne Viruses' Viability and Indoor Transmission

The airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been identified as a potential pandemic challenge, especially in poorly ventilated indoor environments, such as certain hospitals, schools, public buildings, and transports. The impacts of meteorological parameters (temperature and humidity) and physical property (droplet size) on the airborne transmission of coronavirus in indoor settings have been previously investigated. However, the impacts of chemical properties of viral droplets and aerosol particles (i.e., chemical composition and acidity (pH)) on viability and indoor transmission of coronavirus remain largely unknown. Recent studies suggest high organic content (proteins) in viral droplets and aerosol particles supports prolonged survival of the virus by forming a glassy gel-type structure that restricts the virus inactivation process under low relative humidity (RH). In addition, the virus survival was found at neutral pH, and inactivation was observed to be best at low (<5) and high pH (>10) values (enveloped bacteriophage Phi6). Due to limited available information, this article illustrates an urgent need to research the impact of chemical properties of exhaled viral particles on virus viability. This will improve our fundamental understanding of indoor viral airborne transmission mechanisms.

Genomic Degeneration and Reduction in the Fish Pathogen Mycobacterium shottsii

Mycobacterium shottsii is a dysgonic, nonpigmented mycobacterium originally isolated from diseased striped bass (Morone saxatilis) in the Chesapeake Bay, USA. Genomic analysis reveals that M. shottsii is a Mycobacterium ulcerans/Mycobacterium marinum clade (MuMC) member, but unlike the superficially similar M. pseudoshottsii, also isolated from striped bass, it is not an M. ulcerans ecovar, instead belonging to a transitional group of strains basal to proposed "Aronson" and "M" lineages. Although phylogenetically distinct from the human pathogen M. ulcerans, the M. shottsii genome shows parallel but nonhomologous genomic degeneration, including massive accumulation of pseudogenes accompanied by proliferation of unique insertion sequences (ISMysh01, ISMysh03), large-scale deletions, and genomic reorganization relative to typical M. marinum strains. Coupled with its observed ecological characteristics and loss of chromogenicity, the genomic structure of M. shottsii is suggestive of evolution toward a state of obligate pathogenicity, as observed for other Mycobacterium spp., including M. ulcerans, M. tuberculosis, and M. leprae. IMPORTANCE Morone saxatilis (striped bass) is an ecologically and economically important finfish species on the United States east coast. Mycobacterium shottsii and Mycobacterium pseudoshottsii were originally described in the early 2000s as novel species from outbreaks of visceral and dermal mycobacteriosis in this species. Biochemical and genetic characterization place these species within the Mycobacterium ulcerans/M. marinum clade (MuMC), and M. pseudoshottsii has been proposed as an ecovar of M. ulcerans. Here, we describe the complete genome of M. shottsii, demonstrating that it is clearly not an M. ulcerans ecovar; however, it has undergone parallel genomic modification suggestive of a transition to obligate pathogenicity. As in M. ulcerans, the M. shottsii genome demonstrates widespread pseudogene formation driven by proliferation of insertion sequences, as well as genomic reorganization. This work clarifies the phylogenetic position of M. shottsii relative to other MuMC members and provides insight into processes shaping its genomic structure.

Emerging Major Role of Organic Aerosols in Explaining the Occurrence, Frequency, and Magnitude of Haze and Fog Episodes during Wintertime in the Indo Gangetic Plain

Aerosols are an important part of Earth's atmosphere. They can absorb, scatter, or reflect the incoming solar radiation, which results in heating or cooling of Earth, thus impacting its climate. It affects the health of exposed human population adversely, reduces visibility, disturbs environmental systems, and causes material damage. This study summarizes the research carried out to understand the role of aerosol load and its physicochemical characteristics on occurrence, frequency, and magnitude of haze and fog events during wintertime within the Indo Gangetic Plain (IGP) in the past decade. For most species, the highest concentration was measured during foggy events at night-time over the winter season. A few species such as water-soluble organic and inorganic carbon (WSOC and WSIC), K⁺, SO₄ ^2-, and NO₃ ^-, owing to their hygroscopic nature, were efficiently scavenged, resulting in their lower concentration within the interstitial aerosol during fog episodes. Oligomerization with hydroxy and carbonyl functional groups during AFP (activating fog period) and DFP (dissipating fog period), respectively, accompanied by acidic aerosol (having catalytic ability) and high aerosol liquid water content conditions was found to be significant. Whereas the fragmentation process was dominant along with functionalization of -RCOOH or carbonyl (aldehyde/ketone) and -RCOOH moieties during FP (fog period) and PoFP (post-fog period), respectively. Transition metals play an important role in aqueous production of secondary organic aerosol (SOA) especially during the night-time. Crustal sources had the highest scavenging efficiency along with WSOC playing an important role in nucleation scavenging. Fine droplets had a higher concentration of species with a larger fraction of highly oxidized organic matter (OM) as compared to coarse or medium size droplets. Also, a new approach to calculate absorption by black carbon (BC) and brown carbon (BrC) was proposed, which found the water-soluble brown carbon (WSBrC) absorption value in aerosol to be up to 1.8 times higher than that measured in their corresponding aqueous extracts. Organic aerosol plays a vital role in facilitating fog formation and is responsible for the longer residence time in the ambient atmosphere. Ammonia plays an important role in stabilizing organic aerosol and aids to this recurring haze-fog-haze cycle that is dominant during wintertime in the IGP. Therefore, controlling the major anthropogenic sources of organic aerosol and ammonia should be our top priority in this part of the world.

Post-cricoid and Upper Oesophagus Cancers Treated with Organ Preservation Using Intensity-modulated Image-guided Radiotherapy: a Phase II Prospective Study of Outcomes, Toxicity and Quality of Life

AIMS

To prospectively examine the outcomes, toxicity and quality of life (QoL) of patients with post-cricoid and upper oesophagus (PCUE) cancers treated with an organ-preservation approach of (chemo)-radiotherapy using intensity-modulated image-guided radiotherapy (IM-IGRT).

MATERIALS AND METHODS

This phase II prospective study was conducted at a tertiary cancer centre from February 2017 to January 2020. Forty patients with squamous cell carcinoma of PCUE of stage T1-3, N0-2, M0 were accrued. Gross exolaryngeal extension/dysfunctional larynx were major exclusion criteria. Patients received 63-66 Gy in once-daily fractions using volumetric modulated arc therapy with daily IGRT. Outcome measures included disease-related outcomes, patterns of failure, Radiation Therapy Oncology Group toxicities, feeding tube dependency and QoL.

RESULTS

The median follow-up was 22 months. Twenty-six (87.5%) patients had locoregionally advanced disease and 34 (85%) patients received (chemo)-radiotherapy. A complete response was observed in 26 (65%) patients. The 2-year locoregional control, event-free survival and cause-specific survival were 59.6%, 40.2% and 44.8%, respectively. The volume of primary tumour (GTVPvol) exceeding 28 cm³ had inferior overall survival (P = 0.005) on univariate analysis. Multivariable analysis showed GTVPvol and positron emission tomography-computed tomography maximum standardised uptake value to be independently predictive for event-free and overall survival. A feeding tube requirement at presentation was seen in 11 (27.5%) patients, whereas long-term feeding tube dependency at 6 months was seen in 10 (37%) patients. For QoL, a statistical improvement in pain, appetite loss and swallowing was observed over time.

CONCLUSION

Although the outcomes of PCUE cancers remain dismal, the use of state of the art diagnostic modalities, careful case selection and modern radiotherapy techniques improved outcomes as compared with before in this exclusive analysis of PCUE cancers.

Lipid peroxidation index of particulate matter: Novel metric for quantifying intrinsic oxidative potential and predicting toxic responses

Using particulate matter (PM) mass as exposure metric does not reveal the intrinsic PM chemical characteristics or toxic potential, which is crucial for monitoring the sources of emission causing adverse health effects and developing risk mitigating strategies. Oxidative stress and ensuing lipid peroxidation (LPO) in the lung are crucial underlying mechanisms of action by which PM drives cardiorespiratory disease. In the current study, we have postulated and demonstrated that the intrinsic potential of PM to elicit LPO, defined as "LPO index" as a novel approach for characterizing oxidative potential of PM (PMOP) and predicting biological toxicity. First, we exposed unsaturated phosphatidylcholine (PC), an abundant phospholipid in the cell membrane, pulmonary surfactant, and lipoproteins to PM and analyzed the total burden of LPO byproducts generated as a measure of LPO index using a LPO reporter dye, BODIPY-C11. PM exposure resulted in a concentration-dependent increase in LPO. Second, we developed a novel method to expose the captured serum apoB100 lipoprotein particles to PM or its constituents and assessed the levels of specific oxidized-phospholipid on apoB100 particles by immunoassay using E06 monoclonal antibody (mab) that recognizes only PC containing oxidized-phospholipids (Ox-PCs). The immunoassay was highly sensitive to evaluate the PM LPO index and was modifiable by metal quenchers and exogenous antioxidant and radical quenchers. Third, to prove the pathophysiological relevance of Ox-PCs, we found that PM exposure generates Ox-PCs in mice lungs, pulmonary surfactant and lung cells. Fourth, we observed that treatment of macrophages with BAL fluid from PM exposed mice or PM-exposed pulmonary surfactant stimulated IL-6 production, which was abrogated by neutralization of Ox-PCs by mab E06 suggesting that Ox-PCs in lungs are proinflammatory. Overall, our study suggests that Ox-PCs as a probe of PM LPO index is a biologically relevant pathogenic biomarker and has a high value for evaluating PMOP.

Self-reported Wheat Sensitivity in Irritable Bowel Syndrome and Healthy Subjects: Prevalence of Celiac Markers and Response to Wheat-free Diet

Background/Aims

Most patients with irritable bowel syndrome (IBS) report food-related aggravation of symptoms. Wheat/gluten is one of the most commonly incriminated. We studied the prevalence of self-reported wheat sensitivity in patients with IBS and in a healthy population from a region in India consuming mixed-cereal diets, correlated it with serological and human leukocyte antigen (HLA) markers of celiac disease, and evaluated the response to a wheat-free diet.

Methods

We surveyed 204 patients with IBS and 400 healthy persons for self-reported wheat sensitivity. Testing for IgA anti-tissue transglutaminase and HLA DQ2 or DQ8 was done in individuals who reported wheat sensitivity. Consenting persons with wheat sensitivity were put on wheat-free diet and monitored for symptom change.

Results

Twenty-three of 204 patients with IBS (11.3%) and none of the healthy subjects self-reported wheat sensitivity. Of 23 patients, 14 (60.9%) were positive for HLA DQ2 or DQ8 and none for anti-tissue transglutaminase antibody. After 6 weeks on wheat-free diet, all 19 participating patients reported clinical improvement; fewer patients had bloating, diarrhea, constipation, and easy fatigue.

Conclusions

Eleven percent of patients with IBS self-reported wheat sensitivity. None of them had positive celiac serology; 60.9% were positive for HLA DQ2 and DQ8, suggesting a possible genetic basis. All of them improved symptomatically on a wheat-free diet.

Interferon-Gamma-Producing CD8+ Tissue Resident Memory T Cells Are a Targetable Hallmark of Immune Checkpoint Inhibitor-Colitis

BACKGROUND & AIMS

The pathogenesis of immune checkpoint inhibitor (ICI)-colitis remains incompletely understood. We sought to identify key cellular drivers of ICI-colitis and their similarities to idiopathic ulcerative colitis, and to determine potential novel therapeutic targets.

METHODS

We used a cross-sectional approach to study patients with ICI-colitis, those receiving ICI without the development of colitis, idiopathic ulcerative colitis, and healthy controls. A subset of patients with ICI-colitis were studied longitudinally. We applied a range of methods, including multiparameter and spectral flow cytometry, spectral immunofluorescence microscopy, targeted gene panels, and bulk and single-cell RNA sequencing.

RESULTS

We demonstrate CD8⁺ tissue resident memory T (T_RM) cells are the dominant activated T cell subset in ICI-colitis. The pattern of gastrointestinal immunopathology is distinct from ulcerative colitis at both the immune and epithelial-signaling levels. CD8⁺ T_RM cell activation correlates with clinical and endoscopic ICI-colitis severity. Single-cell RNA sequencing analysis confirms activated CD8⁺ T_RM cells express high levels of transcripts for checkpoint inhibitors and interferon-gamma in ICI-colitis. We demonstrate similar findings in both anti-CTLA-4/PD-1 combination therapy and in anti-PD-1 inhibitor-associated colitis. On the basis of our data, we successfully targeted this pathway in a patient with refractory ICI-colitis, using the JAK inhibitor tofacitinib.

CONCLUSIONS

Interferon gamma-producing CD8⁺ T_RM cells are a pathological hallmark of ICI-colitis and a novel target for therapy.

Wintertime chemical characteristics of aerosol and their role in light extinction during clear and polluted days in rural Indo Gangetic plain

This paper reports the chemical and light extinction characteristics of fine aerosol (PM_2.5) during the winter period (2017-18) at Lumbini, Nepal, a rural site on the Indo Gangetic Plains. A modified IMPROVE algorithm was employed to reconstruct light extinction by chemical constituents of aerosol. The fine aerosol levels impacted visibility adversely during daytime, but during nighttime visibility was controlled by fog droplets rather than by aerosols. The PM_2.5 chemical constituents showed varying characteristics during clear and polluted days. The average NO₃^-/SO₄^2- concentration ratio was 0.57 during clear and 1.36 and polluted days, signifying a change in secondary inorganics and formation processes mainly due to decreasing photochemical production and due to increased partitioning of nitrate particles at a lower temperature. The increased secondary organics contribution and the higher OM/OC ratio (2.2) during polluted days showed the vital role of aqueous processing and biomass burning emissions in determining the concentration of organics. Total light extinction was 2.3 times higher on polluted days compared to clear days, while the PM_2.5 mass concentration was 1.5 times higher. This variation in mass and extinction order signifies that various chemical components in fine particles have a more considerable impact on light extinction. On clear days we found that carbonaceous particles (OM and EC) made a major contribution to light extinction. In contrast, the extinction contribution by secondary inorganic (especially NH₄NO₃) increased significantly during polluted days, with hygroscopic growth and enhanced scattering efficiency at higher RH conditions playing a major role. The comparison between clear and polluted days altogether suggests that regulating the nitrate sources can help significantly in improving the visibility levels and restrict fog haze development during wintertime in rural IGP.

Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019

BACKGROUND

Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control.

METHODS

We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period.

FINDINGS

In 2019, 273·9 million (95% uncertainty interval 258·5 to 290·9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4·72% (4·46 to 5·01). 228·2 million (213·6 to 244·7; 83·29% [82·15 to 84·42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global age-standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1·21% [-1·26 to -1·16]), similar progress was not observed for chewing tobacco (0·46% [0·13 to 0·79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0·94% [-1·72 to -0·14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period.

INTERPRETATION

Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence.

FUNDING

Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.

Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019

BACKGROUND

Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally.

METHODS

We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available.

FINDINGS

Globally in 2019, 1·14 billion (95% uncertainty interval 1·13-1·16) individuals were current smokers, who consumed 7·41 trillion (7·11-7·74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27·5% [26·5-28·5] reduction) and females (37·7% [35·4-39·9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0·99 billion (0·98-1·00) in 1990. Globally in 2019, smoking tobacco use accounted for 7·69 million (7·16-8·20) deaths and 200 million (185-214) disability-adjusted life-years, and was the leading risk factor for death among males (20·2% [19·3-21·1] of male deaths). 6·68 million [86·9%] of 7·69 million deaths attributable to smoking tobacco use were among current smokers.

INTERPRETATION

In the absence of intervention, the annual toll of 7·69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a clear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens.

FUNDING

Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.

Lactobacillus fermentum (MTCC-5898) alleviates Escherichia coli-induced inflammatory responses in intestinal epithelial cells by modulating immune genes and NF-κB signalling

AIM

Dietary intervention using probiotic bacteria has emerged as a promising preventive strategy in addressing foodborne infections or gastrointestinal disorders. This study investigated the immunomodulatory effects of Lactobacillus fermentum (MTCC-5898) on Escherichia coli-induced inflammatory responses in intestinal epithelial cells.

METHODS AND RESULTS

The immune response of intestinal cells (Caco-2) in the presence of probiotic Lact. fermentum was determined during exclusion, competition and displacement of E. coli as the inflammatory agent. To achieve this objective, transcriptional modulation of key immune-related genes (cytokines, pattern recognition receptors and NF-κB), release of cytokines and nuclear translocation of the NF-κB subunit p-65 were studied. Expression of pro-inflammatory cytokines IL-8, TNF-α, IFN-ϒ and IL-23 was high in E. coli-exposed intestinal cells. However, overexpression of these E. coli-induced pro-inflammatory cytokines was prevented by Lact. fermentum during exclusion and competition assays. It also modulated the transcriptional expression of regulatory cytokines (IL-10 and TGF-β), pattern recognition receptors (TLR-2 and TLR-4) and genes associated with master inflammatory regulators (NF-κB and SIGIRR) to reduce E. coli-induced inflammation. The protective effect of Lact. fermentum was further confirmed by suppression of nuclear translocation of cytoplasmic NF-κB subunit (p-65).

CONCLUSION

Lactobacillus fermentum alleviated E. coli-induced inflammatory responses by modulating the NF-κB signalling besides pro-inflammatory and regulatory cytokines expression.

SIGNIFICANCE AND IMPACT OF THE STUDY

Lactobacillus fermentum holds significant promise as a potent nutraceutical that prevents and manages inflammatory gut-associated dysfunctions.