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Objective: Prior studies have highlighted the risk of perioperative mortality due to catastrophic bleeding in patients receiving transoral surgery (TOS) for oropharyngeal squamous cell carcinoma (OPSCC). Although the 30-day mortality and morbidity remain low, understanding the risk factors associated with complications is still required. The goal of this study is to identify risk factors associated with complications after TOS for OPSCC using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database., Methods: A multi-institutional retrospective cohort analysis of the ACS-NSQIP database identified 3,489 patients undergoing TOS for OPSCC between 2010 and 2021. Preoperative risk factors were collected. The primary outcomes were 30-day readmission, reoperation, hemorrhage, and death. Univariate and multivariate analysis was used to identify preoperative risk factors associated with the primary outcomes., Results: The mean age was 60.6 years, and 81.5% were male. There were 24 deaths (0.7% 30-day mortality rate). The rates of readmission and reoperation were 8.9% and 5.8%, respectively. Smoking (OR = 1.440, 95% CI = 1.097-1.890) and CHF (OR = 3.525, 95% CI = 1.320-9.414) were associated with readmission. Diabetes and ASA 3+ increased the risk of both reoperation (diabetes: OR = 2.679, 95% CI = 1.110-6.468, ASA: OR = 1.701, 95% CI = 1.233-2.346) and hemorrhage (diabetes: OR = 3.488, 95% CI = 1.020-11.926, ASA: OR = 2.290, 95% CI = 1.394-3.764)., Conclusion: This study redemonstrated the safety of TOS for OPSCC, with low 30-day readmission and reoperation rates. Smoking, diabetes, CHF, and ASA 3+ were important preoperative risk factors for complications., Level of Evidence: 3: Laryngoscope, 2025., (© 2025 The American Laryngological, Rhinological and Otological Society, Inc.)

Introduction: Coronavirus disease 2019 (COVID-19) affects the vascular system, subjecting patients to a hypercoagulable state. This is of particular concern for the success of microvascular free flap reconstruction. This study aims to report head and neck free flap complications in patients with COVID-19 during the perioperative period. We believe these patients are more likely to experience flap complications given the hypercoagulable state., Methods: This is a multi-institutional retrospective case series of patients infected with COVID-19 during the perioperative period for head and neck free flap reconstruction from March 2020 to January 2022., Results: Data was collected on 40 patients from 14 institutions. Twenty-one patients (52.5%) had a positive COVID-19 test within 10 days before surgery and 7 days after surgery. The remaining patients had a positive test earlier than 10 days before surgery. A positive test caused a delay in surgery for 16 patients (40.0%) with an average delay of 44.7 days (9-198 days). Two free flap complications (5.0%) occurred with no free flap deaths. Four patients (10.0%) had surgical complications and 10 patients had medical complications (25.0%). Five patients (12.5%) suffered from postoperative COVID-19 pneumonia. Three deaths were COVID-19-related and one from cancer recurrence during the study period., Conclusion: Despite the heightened risk of coagulopathy in COVID-19 patients, head and neck free flap reconstructions in patients with COVID-19 are not at higher risk for free flap complications. However, these patients are at increased risk of medical complications., Level of Evidence: 4 Laryngoscope, 134:4521-4526, 2024., (© 2023 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer globally. Notably, human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) is on the rise, accounting for 70% of all OPSCC cases. Persistent high-risk HPV infection is linked to various cancers, but HPV infection alone is not sufficient to cause cancer. Advances in next-generation sequencing have improved our understanding of changes in the human microbiome of cancerous environments. Yet, there remains a dearth of knowledge on the impact of HPV-microbiome crosstalk in HPV-positive OPSCC. In this review, we examine what is known about the oropharyngeal microbiome and the compositional shifts in this microbiome in HPV-positive OPSCC. We also review potential mechanisms of crosstalk between HPV and specific microorganisms. Additional research is needed to understand these interactions and their roles on cancer development and progression., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Chung, Wong, Lin, Kokot, Sinha and Han.)

Background: Adolescents' mental health is influenced by childhood trauma, emotional regulation, and psychological symptoms. This study aimed to explore these interconnections among adolescents attending a child and adolescent clinic., Method: Adolescents aged 13-19 from a city were recruited through purposive sampling. Data were collected using the Child Behavior Checklist (CBCL), Childhood Trauma Questionnaire-Short Form (CTQ), Difficulties in Emotion Regulation Scale (DERS), and Toronto Alexithymia Scale-20. Adolescents with severe mental or physical illnesses were excluded., Results: A total of 100 participants were recruited aged 13-19. The CTQ scores positively correlated with DERS Scores ( r = 0.246, P < .05) and Internalizing scores ( r = 0.325, P < .01). DERS Scores strongly correlated with alexithymia ( r = 0.624, P < .001) and Internalizing scores( r = 0.556, P < .001). Regression analyses revealed CTQ, Alexithymia, and DERS scores significantly predicted Internalizing scores ( R 2 = 0.37). Mediation analysis showed that emotional regulation partially mediated the relationship between child trauma and Internalizing scores ( B = 0.059, 95% confidence interval [CI] = 0.011 to 0.133, t = 1.92, P = .01), as well as the relationship between Alexithymia and Internalizing scores( B = 0.255, 95% CI = 0.129 to 0.465, t = 3.31, P < .001)., Conclusion: Findings highlight the importance of emotional regulation as a mediator in the connections between childhood trauma, alexithymia, and psychological symptoms among adolescents. This complementary mediation underscores the dual impact of direct and indirect effects on psychological well-being. The findings reveal intricate links between childhood trauma, emotional regulation, and alexithymia in adolescents with psychological symptoms. Emotional regulation proved to have a pivotal role in influencing psychological well-being. These results emphasize the importance of considering emotional regulation when assessing and maintaining mental health in adolescents, further contributing to understanding treatment needs., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (© 2024 The Author(s).)

Upper aerodigestive squamous cell carcinoma (UASCC) is a common and aggressive malignancy with few effective therapeutic options. Here, we investigate amino acid metabolism in this cancer, surprisingly noting that UASCC exhibits the highest methionine level across all human cancers, driven by its transporter LAT1. We show that LAT1 is also expressed at the highest level in UASCC, transcriptionally activated by UASCC-specific promoter and enhancers, which are directly coregulated by SCC master regulators TP63/KLF5/SREBF1. Unexpectedly, unbiased bioinformatic screen identifies EZH2 as the most significant target downstream of the LAT1-methionine pathway, directly linking methionine metabolism to epigenomic reprogramming. Importantly, this cascade is indispensable for the survival and proliferation of UASCC patient-derived tumor organoids. In addition, LAT1 expression is closely associated with cellular sensitivity to inhibition of the LAT1-methionine-EZH2 axis. Notably, this unique LAT1-methionine-EZH2 cascade can be targeted effectively by either pharmacological approaches or dietary intervention in vivo. In summary, this work maps a unique mechanistic cross talk between epigenomic reprogramming with methionine metabolism, establishes its biological significance in the biology of UASCC, and identifies a unique tumor-specific vulnerability which can be exploited both pharmacologically and dietarily., Competing Interests: Competing interests statement:The authors declare no competing interest.

Squamous cell carcinomas (SCCs) are common and aggressive malignancies. Immune check point blockade (ICB) therapy using PD-1/PD-L1 antibodies has been approved in several types of advanced SCCs. However, low response rate and treatment resistance are common. Improving the efficacy of ICB therapy requires better understanding of the mechanism of immune evasion. Here, we identify that the SCC-master transcription factor TP63 suppresses interferon-γ (IFNγ) signaling. TP63 inhibition leads to increased CD8 + T cell infiltration and heighten tumor killing in in vivo syngeneic mouse model and ex vivo co-culture system, respectively. Moreover, expression of TP63 is negatively correlated with CD8 + T cell infiltration and activation in patients with SCC. Silencing of TP63 enhances the anti-tumor efficacy of PD-1 blockade by promoting CD8 + T cell infiltration and functionality. Mechanistically, TP63 and STAT1 mutually suppress each other to regulate the IFNγ signaling by co-occupying and co-regulating their own promoters and enhancers. Together, our findings elucidate a tumor-extrinsic function of TP63 in promoting immune evasion of SCC cells. Over-expression of TP63 may serve as a biomarker predicting the outcome of SCC patients treated with ICB therapy, and targeting TP63/STAT/IFNγ axis may enhance the efficacy of ICB therapy for this deadly cancer., (© 2024. The Author(s).)

The Epstein-Barr virus (EBV) is accepted as a primary risk factor for certain nasopharyngeal carcinoma (NPC) subtypes, where the virus persists in a latent stage which is thought to contribute to tumorigenesis. Current treatments are sub-optimal, and recurrence occurs in many cases. An alternative therapeutic concept is aimed at triggering the lytic cycle of EBV selectively in tumor cells as a means to add clinical benefit. While compounds able to stimulate the lytic cascade have been identified, their clinical application so far has been limited. We are developing a novel anticancer molecule, NEO212, that was generated by covalent conjugation of the alkylating agent temozolomide (TMZ) to the naturally occurring monoterpene perillyl alcohol (POH). In the current study, we investigated its potential to trigger the lytic cycle of EBV in NPC cells in vitro and in vivo. We used the established C666.1 cell line and primary patient cells derived from the brain metastasis of a patient with NPC, both of which harbored latent EBV. Upon treatment with NEO212, there was an increase in EBV proteins Zta and Ea-D, key markers of the lytic cycle, along with increased levels of CCAAT/enhancer-binding protein homologous protein (CHOP), a marker of endoplasmic reticulum (ER) stress, followed by the activation of caspases. These effects could also be confirmed in tumor tissue from mice implanted with C666.1 cells. Towards a mechanistic understanding of these events, we used siRNA-mediated knockdown of CHOP and inclusion of anti-oxidant compounds. Both approaches blocked lytic cycle induction by NEO212. Therefore, we established a sequence of events, where NEO212 caused reactive oxygen species (ROS) production, which triggered ER stress and elevated the levels of CHOP, which was required to stimulate the lytic cascade of EBV. Inclusion of the antiviral agent ganciclovir synergistically enhanced the cytotoxic impact of NEO212, pointing to a potential combination treatment for EBV-positive cancers which should be explored further. Overall, our study establishes NEO212 as a novel agent able to stimulate EBV's lytic cycle in NPC tumors, with implications for other virus-associated cancers.

Unlike most cancer types, the incidence of esophageal adenocarcinoma (EAC) has rapidly escalated in the western world over recent decades. Using whole genome bisulfite sequencing (WGBS), we identify the transcription factor (TF) FOXM1 as an important epigenetic regulator of EAC. FOXM1 plays a critical role in cellular proliferation and tumor growth in EAC patient-derived organoids and cell line models. We identify ERBB2 as an upstream regulator of the expression and transcriptional activity of FOXM1. Unexpectedly, gene set enrichment analysis (GSEA) unbiased screen reveals a prominent anti-correlation between FOXM1 and immune response pathways. Indeed, syngeneic mouse models show that FOXM1 inhibits the infiltration of CD8 + T cells into the tumor microenvironment. Consistently, FOXM1 suppresses CD8 + T cell chemotaxis in vitro and antigen-dependent CD8 + T cell killing. This study characterizes FOXM1 as a significant EAC-promoting TF and elucidates its novel function in regulating anti-tumor immune response., (© 2024. The Author(s).)

Objectives: To determine the dysregulated signaling pathways of head and neck squamous cell carcinoma associated with circulating tumor cells (CTCs) via single-cell molecular characterization., Introduction: Head and neck squamous cell carcinoma (HNSCC) has a significant global burden and is a disease with poor survival. Despite trials exploring new treatment modalities to improve disease control rates, the 5 year survival rate remains low at only 60%. Most cancer malignancies are reported to progress to a fatal phase due to the metastatic activity derived from treatment-resistant cancer cells, regarded as one of the most significant obstacles to develope effective cancer treatment options. However, the molecular profiles of cancer cells have not been thoroughly studied., Methods: Here, we examined in-situ HNSCC tumors and pairwisely followed up with the downstream circulating tumor cells (CTCs)-based on the surrogate biomarkers to detect metastasis that is established in other cancers - not yet being fully adopted in HNSCC treatment algorithms., Results: Specifically, we revealed metastatic HNSCC patients have complex CTCs that could be defined through gene expression and mutational gene profiling derived from completed single-cell RNASeq (scRNASeq) that served to confirm molecular pathways inherent in these CTCs. To enhance the reliability of our findings, we cross-validated those molecular profiles with results from previously published studies., Conclusion: Thus, we identified 5 dysregulated signaling pathways in CTCs to derive HNSCC biomarker panels for screening HNSCC in situ tumors., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Many parts of the Uttarakhand state, situated in the hilly terrain of the Himalayan region of India are facing acute water crisis due to the drying up of the perennial springs which are the only source of potable water in those regions. Tritium ( 3 H), the radioactive isotope of hydrogen (half-life of 12.32 years) and also a part of water molecule (in the form of HTO) acts as a very useful tracer in estimating the transit time of the hydrological systems. Tritium concentrations of three springs (S-1, S-2 and S-3) were monitored consecutively for three years (2017-2019) to better constrain the transit time estimation. The tritium concentrations of the springs are found to vary between 3.66 and 4.15 TU. All the springs show gradual decrease in tritium concentration with the passage of time indicating the diminishing percentage of freshly recharged modern water component. Among various lumped parameter models, the piston-flow model (PFM), exponential mixing model (EMM), exponential piston-flow model (EPM) and partial exponential mixing model (PEM) have been employed in this study. The historical record of weighted mean concentration of tritium in precipitation available for the Uttarakhand region is taken as input function in the modelling procedure. The application of various LPMs (PFM, EMM, EPM and PEM) indicates that the transit time of the S-1 spring ranges from 1.26 to 1.46 years whereas for S-2 spring, the transit time is found to vary from 5 months to 1.1 years. The MTT of S-3 spring ranges from 5 months to 11 months. The relatively short residence time of these springs indicates the actively recharged system. The estimation of accurate transit time is thus very crucial for understanding the renewability of the spring water systems., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: As one of the most common malignancies, esophageal cancer has two subtypes, squamous cell carcinoma and adenocarcinoma, arising from distinct cells-of-origin. Distinguishing cell-type-specific molecular features from cancer-specific characteristics is challenging., Results: We analyze whole-genome bisulfite sequencing data on 45 esophageal tumor and nonmalignant samples from both subtypes. We develop a novel sequence-aware method to identify large partially methylated domains (PMDs), revealing profound heterogeneity at both methylation level and genomic distribution of PMDs across tumor samples. We identify subtype-specific PMDs that are associated with repressive transcription, chromatin B compartments and high somatic mutation rate. While genomic locations of these PMDs are pre-established in normal cells, the degree of loss is significantly higher in tumors. We find that cell-type-specific deposition of H3K36me2 may underlie genomic distribution of PMDs. At a smaller genomic scale, both cell-type- and cancer-specific differentially methylated regions (DMRs) are identified for each subtype. Using binding motif analysis within these DMRs, we show that a cell-type-specific transcription factor HNF4A maintains the binding sites that it generates in normal cells, while establishing new binding sites cooperatively with novel partners such as FOSL1 in esophageal adenocarcinoma. Finally, leveraging pan-tissue single-cell and pan-cancer epigenomic datasets, we demonstrate that a substantial fraction of cell-type-specific PMDs and DMRs identified here in esophageal cancer are actually markers that co-occur in other cancers originating from related cell types., Conclusions: These findings advance our understanding of DNA methylation dynamics at various genomic scales in normal and malignant states, providing novel mechanistic insights into cell-type- and cancer-specific epigenetic regulations., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Cambay rift basin is the only geothermal province in India that hosts several saline thermal water manifestations having EC values varying from 525 to 10,860 μS/cm. Various ionic ratios (Na/Cl, Br/Cl, Ca/(SO 4  + HCO 3 ), SO 4 /Cl) as well as boron isotopic composition (δ 11 B = 40.5 to 46 ‰) clearly ascribes the presence of fossil (relics of evaporated seawater) seawater as origin of increased salinity in the majority of thermal waters. Depleted isotopic (δ 18 O, δ 2 H) composition of these thermal waters also substantiates the presence of paleowater in these systems. In rest of the thermal waters, agricultural return flow is found to be source of dissolved solutes as confirmed from different bivariate plots such as B/Cl vs. Br/Cl and δ 11 B vs. B/Cl as well as from ionic ratios. This study thus provides the diagnostic tools to elucidate the source of variable salinity in the thermal waters circulating in the Cambay rift basin, India., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Introduction  Patients at public county hospitals often have poorer access to healthcare with advanced disease on presentation. These factors, along with limited resources at county hospitals, may have an impact on outcomes for patients requiring complex head and neck reconstruction. Objective  To delineate differences in the frequency of complications in two different care settings, a public county hospital and a private university hospital. Methods  Retrospective review of otolaryngology patients at a university hospital compared with a publicly-funded county hospital. The main outcome measure was major complications including total flap loss or unplanned reoperation in 30 days. Secondary outcome measures included medical complications, partial flap loss, and unplanned hospital readmission in 30 days. Results  In the county hospital sample ( n  = 58) free flap failure or reoperation occurred in 20.7% of the patients, and minor complications, in 36.2% of the patients. In the university hospital sample ( n  = 65) flap failure or reoperation occurred in 9.2% of the patients, and minor complications, in 12.3% of the patients. Patients at the private hospital who had surgery in the oropharynx were least likely to have minor complications. Conclusion  Patients at the county hospital had a higher but not statistically significant difference in flap failure and reoperation than those at a university hospital, although the county hospital experienced more minor postoperative complications. This is likely multifactorial, and may be related to poorer access to primary care preoperatively, malnutrition, poorly controlled or undiagnosed medical comorbidities, and differences in hospital resources., Competing Interests: Conflict of interests The authors have no conflict of interests to declare., (Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Competing Interests: Declaration of interests The authors disclose no conflicts.

Purpose: This study aims to elucidate any relationship between prior tonsillectomy and the presence of oropharyngeal HPV DNA found in screening mouth rinses., Materials and Methods: A cross sectional study was conducted using the 2011-2014 National Health and Nutrition Examination Survey (NHANES). Participants between 40 and 69 were included in the study and medical, surgical, and sexual health history were recorded. Multivariable analyses were conducted to examine factors associated with HPV prevalence in oral rinse samples., Results: A total of 4825 participants were recorded with 21.1 % having a history of tonsillectomy. In the no tonsillectomy group, 8.6 % of respondents had a positive oral rinse for HPV, while 7.2 % of those with a tonsillectomy had a positive rinse sample. There was no association between age and HPV prevalence (OR = 1.04, 95 % CI: [1.00-1.07]). When controlling for demographics, medical history, and sexual behaviors, tonsillectomy history was not shown to have an association with HPV (OR = 0.86, 95 % CI: [0.53-1.40]). However, men, Hispanics, smokers, and those with higher lifetime sexual partners had increased odds of having a positive HPV oral rinse sample which was statistically significant., Conclusion: Our data showed that a history of tonsillectomy was not significantly associated with the presence of HPV in an oral rinse. However, a significant relationship was seen between the presence of HPV in oral rinses and certain demographic factors such as male gender, Hispanic race, smoking history, and increased sexual partners., Competing Interests: Declaration of competing interest None., (Copyright © 2022 Elsevier Inc. All rights reserved.)

In this article, strontium distribution in sedimentary coastal aquifers of Eastern India was studied and its association with groundwater particles has been ascertained using hydrochemical and morphological tools. Groundwater contains Sr 2+ in the range of 0.08-4.0 mg/L with higher concentrations in Cretaceous formation. The particle number in groundwater varies from 4.5 × 10 5 to 3.3 × 10 6 per liter and follows the power law distribution with respect to the particle diameter. The calculated β values (2.54 and 4.03) signify the abundance of smaller particles over larger ones. The particle concentration of size range 0.45-8 μm is found to be 0.64-2.6 mg/L. Elemental data of groundwater particles clearly suggest their origin from the host rock minerals. Zeta potential data indicates diverse nature of colloids suggesting prevalence of both positive and negative charged species in the groundwater. The hydrochemical interpretation along with speciation studies infers that high Sr 2+ in groundwater is a result of incongruent dissolution of carbonate minerals and the dissolved Sr 2+ partitions into both dissociated and un-dissociated forms. Based on the Sr 2+ /Ca 2+ ratio and mineral saturation indices, it can be inferred that the Sr 2+ is preferentially associated with colloids over large particles and the migration takes place through sorption of Sr 2+ onto clay-bound (extrinsic) colloids in groundwater. This study describes the mechanism of strontium release into groundwater and provides insights into the role of groundwater particles in controlling the strontium migration to deep aquifers., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Organoid modeling is a powerful, robust and efficient technology faithfully preserving physiological and pathological characteristics of tissues of origin. Recently, substantial advances have been made in applying genetically engineered organoid models to study early tumorigenesis and premalignant biology. These efforts promise to identify novel avenues for early cancer detection, intervention and prevention. Here, we highlight significant advancements in the functional characterization of early genomic and epigenomic events during neoplastic evolution using organoid modeling, discuss the application of the lineage-tracing methodology in organoids to study cancer cells-of-origin, and review future opportunities for further development and improvement of organoid modeling of cancer precursors., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 Published by Elsevier B.V. on behalf of Research Network of Computational and Structural Biotechnology.)

Objectives/hypothesis: To formally document online support community (OSC) use among patients with vestibular symptoms and gain an appreciation for the perceived influence of participation on psychosocial outcomes and the impact on medical decision-making., Study Design: Self reported internet-based questionnaire., Methods: The Facebook search function was paired with a comprehensive list of vestibular diagnoses to systematically collect publicly available information on vestibular OSCs. Next, a survey was designed to gather clinicodemographic information, OSC characteristics, participation measures, perceived outcomes, and influence on medical decision-making. The anonymous instrument was posted to two OSCs that provide support for patients with general vestibular symptoms., Results: Seventy-three OSCs were identified with >250,000 cumulative members and >10,000 posts per month. The survey was completed by 549 participants, a cohort of primarily educated middle-aged (median = 50, interquartile range 40-60), non-Hispanic white (84%), and female (89%) participants. The participants' most cited initial motivation and achieved goal of participants was to hear from others with the same diagnosis (89% and 88%, respectively). Daily users and those who reported seeing ≥5 providers before receiving a diagnosis indicated that OSC utilization significantly influenced their requested medical treatments (72% daily vs. 61% nondaily, P = .012; 61% <5 providers vs. 71% ≥5 providers P = .019, respectively). Most participants agreed that OSC engagement provides emotional support (74%) and helps to develop coping strategies (68%). Membership of ≥1 year was associated with a higher rate of learned coping skills (61% membership <1-year vs. 71% ≥1-year P = .016)., Conclusions: The use of OSCs is widespread among vestibular diagnoses. A survey of two OSCs suggests these groups provide a significant source of peer support and can influence users' ability to interface with the medical system., Level of Evidence: NA Laryngoscope, 132:1835-1842, 2022., (© 2021 The American Laryngological, Rhinological and Otological Society, Inc.)

Northwest part of India is an agriculturally active region experiencing rapid rise in food production and steep decline in groundwater levels. The freshwater requirement is mostly met by regional aquifers which are inherently heterogeneous and undergoing extensive human inducted perturbations. These factors pose great challenge in planning sustainable groundwater management. In this study, environmental isotopes ( 2 H, 18 O, 13 C, 3 H and 14 C) were applied to understand the regional recharge mechanism during the last 30 ka and hydrogeological controls impacting the aquifer dynamics and inter-aquifer connectivity of the Ghaggar River basin. Rayleigh distillation modeling indicates that major groundwater recharge is through monsoonal rains while rainfall during other seasons is lost either through evaporation or surface runoff. The evaporation loss is estimated to be 1.5 to 10% and more pronounced in the southern part of the study area. Regional recharge from Siwalik foothills contributes to groundwater up to a depth of 250 m below ground level (bgl). The lumped parameter modeling (LPM) using 3 H data estimated groundwater ages 34.7 ± 12.1 and 95.8 ± 11.3 years for shallow and deep aquifers respectively. Radiocarbon dating indicates presence of paleogroundwater (0.4 to 28.6 ka before present, BP) in the deeper aquifer of central part of the study area. Interpretation of the paleowater and paleoprecipitation isotope data in conjunction with available paleogeomorphologic information suggests two different recharge phases. Phase I extending from ~28.6 to 10.1 ka, showed ~48-61% contribution from isotopically depleted perennial river system. Phase II spanning from ~12.5 to 0.4 ka BP showed insignificant contribution from river recharge, which can be attributed to the decreased strength of the perennial river flows. The research methodology proposed in this study will be beneficial in improving the understanding of groundwater storage and its variability with changes in regional climatic conditions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

In this work, sediments collected from a 150-m deep litho-section of a coastal region and encompassing Quaternary, Tertiary and Cretaceous sedimentary formations were studied for arsenic distribution and other trace and redox sensitive elements. Arsenic concentration in the sediments is found to vary from <0.5 to 30 mg·kg -1 and showed an increasing trend with the depth. The highest As content is observed at a depth of 129-131 m bgl belonging to Cretaceous formation. Though XRD studies do not indicate any arsenic mineral in sediments, positive correlations between As-Fe and S, as well as ESEM-EDS and TXRF studies confirm the presence of As sorbed to FeS mineral. The organic matter and As correlations suggest microbial mediated reduction process, which may pose future risk to water quality of this prolific coastal fresh water aquifer system. The elemental profiles infer that Cretaceous and Tertiary formations demonstrate inner shelf and marginal marine condition respectively., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

An attempt has been made in this study to evaluate the factors favoring the uranium mobilization into the groundwater of Northwest India using uranium isotope activity ratio ( 234 U/ 238 U), radon ( 222 Rn) and environmental isotopes of water ( 2 H, 18 O and 3 H). The values range from 23 - 597 µg/L for total uranium and 634-3210 Bq/m 3 for radon and the corresponding annual effective dose is estimated to be 18.9-490 µSv/a and 6.2-31.5 μSv/a respectively. Uranium activity ratio (UAR) varies from 0.68 - 1.17 and maximum samples indicate secular equilibrium. Environmental isotopic data indicates that the source to groundwater is vertical percolation of rainwater in the case of shallow zone while regional flows from outcrop areas recharge the deep groundwater. A wide scatter is noticed in environmental 3 H content (0.23-6.62 TU) indicating both fast and sluggish water flows. The UAR phase diagram suggests that leaching process controls the uranium mobilization into the groundwater. The correlations among UAR, uranium and U excess further indicate oxidative nature of leaching process. Statistical treatment of the obtained data along with available geochemical and isotope evidences suggest that source of uranium is common but the driving processes are different for shallow and deep zone. Influences of root zone CO 2 , oxic species from irrigation return flows and water level fluctuations are also evaluated. Low uranium, low UAR, low 3 H and high 222 Rn activity in deep zone suggest uranium being released from the roll front as well as transported from outcrop regions. This study highlights the application of uranium isotope ratio, radon and environmental isotopes in assessing vulnerability of alluvial aquifers towards uranium contamination., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

The purpose of this study is to analyze outcomes of combined antegrade-retrograde dilations (CARD). This retrospective study was conducted on 14 patients with a history of head and neck cancer, treated with radiation therapy that was complicated by either complete or near-complete esophageal stenosis. All patients had minimal oral intake and depended on a gastrostomy tube for nutrition. Swallow function before and after CARD was assessed using the Functional Oral Intake Scale, originally developed for stroke patients and applied to head and neck cancer patients. Patients undergoing CARD demonstrated a quantifiable improvement in swallow function (p = 0.007) that persisted at last known follow-up (p = 0.015) but only a minority (23.1%) achieved oral intake sufficient to obviate the need for tube feeds. Complication rates were 24% per procedure or 36% per patient, almost all complications required procedural intervention, and all complications occurred in patients with complete stenosis. Our study suggests further caution when considering CARD, careful patient selection, and close post-operative monitoring., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.)

The Indo-Gangetic multi-aquifer system provides water supplies to the most populous regions of the Indian subcontinent, however precise knowledge on the sources and dynamics of groundwater is still missing. Environmental isotopes ( 2 H, 18 O, 13 C, 3 H and 14 C) and hydrochemical modeling tools were used in this study in the multi-tiered aquifers underlying the Middle Gangetic Plains (MGP) to investigate the source of recharge, aquifer dynamics and inter-connectivity among aquifers. Within a depth span of 300 m, three aquifers, with contrasting recharge sources and dynamics, were delineated in this Sone-Ganga-Punpun interfluve region, with limited cross-aquifer hydraulic interconnections. The chemistry evolves from Ca-HCO 3 to Na-Ca-HCO 3 in the shallow semiconfined Aquifer-I with a mean transit time of 20-23 years. The dominant recharge to Aquifer-I is from the river inflows and rainwater percolation through paleochannels. The semi-confined to confined Aquifer-II holds fresh quality groundwater with mixed water facies (Mg/Ca-Na-HCO 3 ). The modeled age of Aquifer-II groundwater is found to be 205-520 years, which is supported by presence of negligible tritium and minor variations in stable isotopes. Outcrop regions of Aquifer-II sediments in the marginal alluvial areas and deep-seated paleochannels in the southwestern part are the potential zones for Aquifer-II recharge. A deep confined Aquifer-III with fresh quality of groundwater is identified below 220 m. This aquifer is characterized by old age (~3.5 to 4.7 ka BP) and enriched δ 18 O (-5.7‰). These results along with the existing paleoclimate records of this region infer that Aquifer-III is recharged during an arid climate. The marginal alluvial plains are the probable recharge zones for Aquifer-III. This study helped in conceptualizing the groundwater flow paths in multi-tiered aquifers of MGP. The knowledge and understanding would extend crucial inputs for the sustainable development of deep aquifers not only in the MGP but also in other regions of Indo-Gangetic Plains., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objectives: We implement a novel enhanced recovery after surgery (ERAS) protocol with pre-operative non-opioid loading, total intravenous anesthesia, multimodal peri-operative analgesia, and restricted red blood cell (pRBC) transfusions. 1) Compare differences in mean postoperative peak pain scores, opioid usage, and pRBC transfusions. 2) Examine changes in overall length of stay (LOS), intensive care unit LOS, complications, and 30-day readmissions., Methods: Retrospective cohort study comparing 132 ERAS vs. 66 non-ERAS patients after HNC tissue transfer reconstruction. Data was collected in a double-blind fashion by two teams., Results: Mean postoperative peak pain scores were lower in the ERAS group up to postoperative day (POD) 2. POD0: 4.6 ± 3.6 vs. 6.5 ± 3.5; P = .004) (POD1: 5.2 ± 3.5 vs. 7.3 ± 2.3; P = .002) (POD2: 4.1 ± 3.5 vs. 6.6 ± 2.8; P = .000). Opioid utilization, converted into morphine milligram equivalents, was decreased in the ERAS group (POD0: 6.0 ± 9.8 vs. 10.3 ± 10.8; P = .010) (POD1: 14.1 ± 22.1 vs. 34.2 ± 23.2; P = .000) (POD2: 11.4 ± 19.7 vs. 37.6 ± 31.7; P = .000) (POD3: 13.7 ± 20.5 vs. 37.9 ± 42.3; P = .000) (POD4: 11.7 ± 17.9 vs. 36.2 ± 39.2; P = .000) (POD5: 10.3 ± 17.9 vs. 35.4 ± 45.6; P = .000). Mean pRBC transfusion rate was lower in ERAS patients (2.1 vs. 3.1 units, P = .017). There were no differences between ERAS and non-ERAS patients in hospital LOS, ICU LOS, complication rates, and 30-day readmissions., Conclusion: Our ERAS pathway reduced postoperative pain, opioid usage, and pRBC transfusions after HNC reconstruction. These benefits were obtained without an increase in hospital or ICU LOS, complications, or readmission rates., Level of Evidence: 3 Laryngoscope, 131:E792-E799, 2021., (© 2020 The American Laryngological, Rhinological and Otological Society, Inc.)

Exposure to fluoride concentrations above a threshold of 1.5 mg/L can cause joint pains, restricted mobility, skeletal and dental fluorosis. This study aims to determine the hydrochemical evolution of the fluoride-rich groundwater and estimate the risk of fluoride exposure to the residents of semi-arid northeastern part of Rajasthan, India. The methodology involves measurement of fluoride and other ionic concentrations in groundwater using ion chromatography, followed by an estimation of the cumulative density function and fluorosis risk. The fluoride concentration in water samples varied from 0.04 to 8.2 mg/L with 85% samples falling above the permissible limit. The empirical cumulative density function was used to estimate the percentage and degree of health risks associated with the consumption of F - contaminated water. It is found that 55% of the samples indicate risk of dental fluorosis, 42% indicate risk of deformities to knee and hip bones, and 18% indicate risk of crippling fluorosis. In addition, instances of high nitrate concentrations above the permissible limit of 45 mg/L are also found in 13% of samples. The fluoride rich groundwater is mainly associated with the Na-HCO 3 -Cl type water facies while low fluoride groundwater shows varied chemical facies. The saturation index values indicate a high probability of a further increase in F - concentration in groundwater of this region. The calculated fluoride exposure risk for the general public in the study area is 3-6 times higher than the allowed limit of 0.05 mg/kg/day. Based on the results of this study, a fluorosis index map was prepared for the study area. The northern and northeastern parts are less prone to fluorosis, whereas the south-central and southwestern parts are highly vulnerable to fluorosis. The inferences from this study help to prioritize the regions that need immediate attention for remediation.

An increasing number of reports indicate that mesenchymal stem cells (MSCs) play an essential role in promoting tumorigenesis and progression of head and neck squamous cell carcinoma (HNSCC). However, the molecular mechanisms underlying this process remain unclear. Using the MSC model system, this study analyzes the molecular pathway by which differentiation resistant MSCs promote HNSCC. MSCs were cultured in osteogenic differentiation media and harvested on days 12 and 19. Cells were stained for cell differentiation analysis using Alizarin Red. The osteogenesis-resistant MSCs (OR-MSCs) and MSC-differentiation-derived osteoblasts (D-OSTBs) were identified and subjected to the single-cell transcriptome analysis. Gene-specific analyses of these two sub-populations were performed for the patterns of differential expression. A total of 1 780 differentially expressed genes were determined to distinguish OR-MSCs significantly from D-OSTB. Notably, AJUBA, β-catenin, and CDH4 expression levels were upregulated considerably within the OR-MSCs compared to D-OSTBs. To confirm their clinical relevance, a survey of a clinical cohort revealed a high correlation among the expression levels of AJUBA, β-catenin and CDH4. The results shed new light that OR-MSCs participate in the development of HNSCC via a pathway mediated by AJUBA, β-catenin, CDH4, and CTNNB1, thereby implying that MSC-based therapy is a promising therapeutic approach in the management of HNSCC., Competing Interests: Conflict of interests: The authors declared no conflict of interests.

Objectives: To investigate the differences in oral HPV infection and sexual behaviors by race in the US., Materials and Methods: We analyzed data from the 2011-2014 US National Health and Nutrition Examination Survey during which participants aged 18-69 years completed oral rinse exam for HPV detection (n = 8,229). Logistic regression was used to examine the associations of race with various types of oral HPV infection and sexual behaviors., Results: The prevalence of overall oral HPV infection and HPV type16 infection was 7.5% [95% CI: 6.6-8.4] and 1.1% [95% CI: 0.7-1.3], respectively. Blacks were more likely to have any oral HPV infection [OR: 1.22, 95% CI: 1.01-1.47] and Asian Americans were less likely to have any oral HPV infection [OR: 0.33, 95% CI: 0.24-0.49] than Whites. In a multivariate model, Whites were less likely to have any oral HPV infections than Blacks while having higher order of impact by the number of lifetime sex partners. Overall, Asian Americans were less likely to have type16 infection [OR: 0.21, 95% CI: 0.06-0.67] than Whites; however, that difference disappears when adjusting for sexual behaviors., Conclusions: In this nationally representative sample of US adults, the prevalence of overall oral HPV infections was higher among Blacks and lower among Asians in comparison to Whites. Further analysis with sexual behavior data suggested that the racial differences in prevalence are likely due to different sexual behaviors., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. All rights reserved.)

Objectives: Evaluate an enhanced recovery after surgery (ERAS)-based free flap management protocol implemented at our center., Study Design: Prospective cohort study of patients after implementation of an ERAS-based perioperative care protocol for patients undergoing free flap reconstruction of the head and neck as compared with a historical control group., Setting: Tertiary care academic medical center., Participants and Methods: All patients undergoing free flap reconstruction were prospectively enrolled in the ERAS protocol group. A retrospective control group was identified by randomly selecting an equivalent number of patients from a records search of those undergoing free flap surgery between 2009 and 2015. Blood transfusion, complications, 30-day readmission rates, intensive care unit (ICU) and hospital length of stay, and costs of hospitalization were compared., Results: Sixty-one patients were included in each group. Patients in the ERAS group underwent less frequent flap monitoring by physicians and had lower rates of intraoperative (70.5% vs 86.8%, P = .04) and postoperative (49.2% vs 27.2%, P = .026) blood transfusion, were more likely to be off vasopressors (98.3% vs 50.8%, P < .01) and ventilator support (63.9% vs 9.8%, P < .01) at the conclusion of surgery, and had shorter ICU stays (2.11 vs 3.39 days, P = .017). Length of stay, readmissions, and complication rates did not significantly differ between groups., Conclusion: ERAS-based perioperative practices for head and neck free flap reconstruction can reduce time on the ventilator and in the ICU and the need for vasopressors, blood transfusions, and labor-intensive flap monitoring, without adverse effects on outcomes., (© The Authors 2020.)

Herein, interfacial reconstruction in a series of La 0.7 Sr 0.3 MnO 3 (LSMO) films grown on a (001) oriented LaAlO 3 (LAO) substrate using the pulsed plasma sputtering technique is demonstrated. X-ray diffraction studies suggested that the LSMO film on LAO was stabilized in a tetragonal structure, which was relaxed in-plane and strained along the out-of-plane direction. The interfacial reconstruction of the LSMO-LAO interface due to the reorientation of the Mn ion spin induced spin-glass behavior due to the presence of non-collinear Mn ion spins. Consequently, the interface effect was observed on the Curie temperature, temperature-dependent resistivity, metal-to-semiconductor transition temperature, and magnetoresistance (MR). At a magnetic field of 7 T, MR decreased from 99.8% to 7.69% as the LSMO film thickness increased from 200 Å to 500 Å. A unique characteristic of the LSMO films is the large low-field MR after a decrease in the field from the maximum field. The observed temperature-dependent magnetization and low-temperature resistivity upturn of the LSMO films grown on LAO provide direct evidence that the low-field MR is due to the non-collinear interfacial spins of Mn. The present work demonstrates the great potential of interface and large low-field MR, which might advance the fundamental applications of orbital physics and spintronics., Competing Interests: The authors declare no competing financial interest., (This journal is © The Royal Society of Chemistry.)

Objective: Survival differences in oral cancer between black and white patients have been reported, but the contributing factors, especially the role of stage, are incompletely understood. Furthermore, the outcomes for Hispanic and Asian patients have been scarcely examined., Study Design: Retrospective, population-based national study., Setting: Surveillance, Epidemiology, and End Results 18 Custom database (January 1, 2010, to December 31, 2014)., Subjects and Methods: In total, 7630 patients with primary squamous cell carcinoma in the oral cavity were classified as non-Hispanic white (white), non-Hispanic black (black), Hispanic, or Asian. Cox regression was used to obtain unadjusted and adjusted hazard ratios (HRs) of 5-year mortality for race/ethnicity with sequential adjustments for stage and other covariates. Logistic regression was used to examine the relationship between race/ethnicity and stage with adjusted odds ratios (aORs)., Results: The cohort consisted of 75.0% whites, 7.6% blacks, 9.1% Hispanics, and 8.3% Asians. Compared to whites, the unadjusted HR for all-cause mortality for blacks was 1.68 ( P < .001), which attenuated to 1.15 ( P = .039) after adjusting for stage and became insignificant after including insurance. The unadjusted HRs for all-cause mortality were not significant for Hispanics and Asians vs whites. Compared to whites, blacks and Hispanics were more likely to present at later stages (aORs of 2.63 and 1.42, P < .001, respectively)., Conclusion: The greater mortality for blacks vs whites was largely attributable to the higher prevalence of later stages at presentation and being uninsured among blacks. There was no statistically significant difference in mortality for Hispanics vs whites or Asians vs whites., (© The Authors 2019.)

Introduction Dysphagia is common following treatment for head and neck cancers, and self-esophageal dilation is a safe and effective treatment method. Prior studies on self-dilation have reported only qualitative results and included heterogeneous populations with dysphagia. The objective of this study is to quantitatively assess the safety and efficacy of a self-esophageal dilation program for patients with oropharyngeal squamous cell cancer with treatment-induced dysphagia. Materials and Methods This is a retrospective review of patients with oropharyngeal squamous cell cancer treated at the University of Southern California from 2009 to 2013 with dysphagia following radiation treatment that persisted after swallow therapy. The treatment program consisted of swallow therapy in conjunction with weekly self-esophageal dilation at home with increasing size bougie dilators. Oral intake was monitored using the Functional Oral Intake Scale (Crary, Mann, & Groher, 2005), Modified Barium Swallow Impairment Profile Pharyngoesophageal opening score, and Penetration-Aspiration Scale (Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996) pre- and posttreatment. Results Thirty-three patients met study criteria and completed the program. Twenty-five patients required nutrition via a gastrostomy tube prior to starting therapy, and 84% (21/25) of these patients were able to have the feeding tube removed. Median Functional Oral Intake Scale (Crary et al., 2005) predilation was 1 (range: 1-5), and postdilation was 6 (range: 3-6, p < .05). In addition, there was improvement of the Modified Barium Swallow Impairment Profile Pharyngoesophageal opening score from 2 to 1 after treatment (p < .05). No complications were encountered. Discussion Home self-dilation with concurrent swallowing therapy is a safe and feasible procedure to be used in motivated patients with dysphagia following head and neck cancer treatment.

Aims: Chronic stress is associated with increased risk of type 2 diabetes. Oxidative stress and inflammation are potential mediators of this risk. This study was conducted to investigate the association of oxidative stress and inflammatory markers with chronic stress and newly diagnosed type 2 diabetes., Methods: Oxidative stress/antioxidant status (malondialdehyde [MDA], reduce glutathione [GSH], glutathione reductase [GR], glutathione peroxidase [GPx], catalase [CAT], superoxide dismutase [SOD]), inflammatory markers (highly sensitive C-reactive protein [hsCRP], adiponectin, leptin), chronic stress levels as assessed by stress scales-presumptive stressful life events scale (PSLES), perceived stress scale (PSS), sense of coherence (SOC) and stress biomarker-salivary cortisol in 125 subjects with newly detected diabetes mellitus (NDDM) were compared with an equal number of age and sex matched subjects with normal glucose tolerance (NGT)., Results: NDDM subjects as compared with NGT had significantly increased MDA (P < 0.001), hsCRP (P < 0.001), and leptin (P = 0.014) levels and increased GR (P = 0.043) and SOD (P < 0.001) activity along with decreased GSH (P < 0.001) and adiponectin (P < 0.001) levels. They also had significantly higher PSLES-LT and PSS and lower SOC scores along with elevated levels of 10:00 pm salivary cortisol and post dexamethasone salivary cortisol as compared with NGT. In stepwise logistic regression analysis, variables GSH (OR: 0.805), SOD (OR: 1.004), and adiponectin (OR: 0.771) along with PSLES-LT (OR: 1.007), PSS (OR: 1.147), SOC (OR: 0.667), salivary cortisol 10:00 pm (OR: 1.382), WC (OR: 1.087), and HOMA-IR (OR: 2.721) emerged as significant predictors of NDDM., Conclusion: The findings of this study indicate that chronic psychological stress and stress responses are associated significantly with inflammation and oxidative stress, which could act as mediating stress related risk factors for type 2 diabetes., (© 2019 John Wiley & Sons, Ltd.)

The Manuguru geothermal area, located in the Telangana state, is one of the least explored geothermal fields in India. In this study, characterization of the soil samples is carried out by laser-induced breakdown spectroscopy (LIBS) coupled with analytical spectral-dependent principal component analysis. A total of 20 soil samples were collected both from near the thermal discharges as well as away from the thermal manifestations. LIBS spectra were recorded for all the collected soil samples and principal component analysis (PCA) was applied to easily identify the emission lines majorly responsible for variety classification of the soil samples. In this submission, a modified PCA was developed which is based on the spectral truncation method to reduce the huge number of spectral data obtained from LIBS. The PCA bi-plot on the LIBS data reveals the presence of two different clusters. One cluster represents the soil samples collected from the close vicinity of the thermal manifestations whereas the other cluster contains the soil samples collected away from the thermal sprouts. PCA performed on the chemical dataset of the soil samples also reveals the same clustering of the soil samples. Both LIBS and chemical analysis data shows that soil samples near the thermal waters are found to be enriched in B, Sr, Cs, Rb, Fe, Co, Al, Si, Ti, Ru, Mn, Mg, Cu, and Eu concentrations compared to the soil samples located away from thermal manifestations. This study demonstrates the potential use of LIBS coupled with PCA as a tool for variety discrimination of soil samples in a geothermal area. LIBS is shown to be a viable real-time elemental characterization technology for these samples, avoiding the rigorous dissolution required by other analytical techniques.

Head and neck carcinomas (HNCs) collectively are the sixth most common cancer with an annual incidence of about 400,000 cases in the US. The most well-established risk factors for HNCs are tobacco and alcohol abuse. With the increasing public awareness, the incidence of HNCs is decreasing. But there is an increasing incidence of oropharyngeal squamous cell carcinoma (OPSCC) has been observed during the last decade. This phenomena is associated with persistent infection with high-risk HPV. HPV associated OPSCC patients tend to be younger males of high socioeconomic status. The increasing incidence causes a significant loss to social resources, given that it's reported that HPV associated OPSCC represents about 60% of OPSCC cases. There is a growing amount of data supporting the hypothesis that HPV-associated OPSCC has a better survival rate due to a higher sensitivity to chemotherapy and radiotherapy as compared to HPV-unrelated OPSCC. Although the HPV positivity is associated with increased radio-sensitivity, the underlying mechanisms are not yet fully understood. This review summarizes the current knowledge on the effects of HPV infection and its carcinogenesis on the radiosensitivity of OPSCC, from the molecular to histologic level, providing a comprehensive insight of this special tumor entity.

Tritium concentration in rivers, groundwater, precipitation and mine pits water, all over Goa state was characterized to find out spatial and temporal variability of tritium. Twenty four water samples were collected during pre-monsoon and post-monsoon and analyzed for their tritium concentration. The mean tritium concentration in surface and sub-surface hydrosphere is 2.5 (±0.6) TU. The mean concentration of tritium in rivers, groundwater, mines pits water and rain water are 2.9 (±0.5) TU, 1.95 (±0.5) TU, 2.5(±0.3) TU and 3.1(±0.1) TU respectively. The tritium distribution in all the samples shows modern precipitation (post-1950) component in surface and sub-surface hydrosphere of Goa. The HYSPLIT4.0 air mass trajectory model and atmospheric circulation pattern suggest that the moisture origin was from the Arabian Sea and this low tritium moisture is diluting the tritium concentration of surface hydrosphere near the coastal area. The tritium concentration in surface hydrosphere shows more and more enrichment as one move inland (i.e. away from the coast). Significant seasonal change is observed in the surface hydrosphere. The pre-monsoon samples showed higher tritium concentration than post-monsoon samples. This may be due to high rate of re-evaporation of water and a reduction in the supply of oceanic moisture during the summer (pre-monsoon)., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Introduction: Human papillomavirus (HPV)-positive and HPV-negative oropharyngeal squamous cell carcinomas (OPSCCs) are 2 distinct cancers, with HPV-positivity conferring a better prognosis. Smoking status is a complicating factor for both patient populations. There have been scattered literature that have reported on incomplete information regarding the profiles of their patient population. Details including age and sex distributions, TNM staging, histology grading, recurrence time and types, death rates, and the direct causes of deaths have been reported incompletely in the literature. Here, based on the experience at our university medical centers, we explored all the details of the important clinical profiles of HPV-negative OPSCC, HPV-positive OPSCC in smokers and nonsmokers., Objective: In this article, we compare detailed clinical profiles of HPV-negative OPSCC and HPV-positive OPSCC in both smokers and nonsmokers. The clinical profiles we elucidated here include patients' age and sex distribution, general health conditions, histology grading, TNM staging, perineural invasion (PNI), and lymphovascular invasion (LVI), extracapsular extension (ECE), recurrence rate and types, death rate, and direct causes. Specifically, we divided HPV-positive OPSCC into smokers and nonsmokers and compared the different clinical profiles between these groups to give a better idea of the complicating role of smoking in the development of HPV-positive OPSCC., Method: All patients with OPSCC at a tertiary care publicly funded county hospital and a tertiary care university hospital from June 2009-July 2015 were retrospectively reviewed. The attending physicians were the same at both hospitals. The primary outcome measure was posttreatment 2-year follow-up status (locoregional recurrence, distant recurrence, death rate). Other measures included HPV status based on p16 staining, smoking history, age, sex, comorbidities, tumor size, nodal and distant metastasis information, LVI, PNI, ECE, and tumor histology grade., Results: A total of 202 patients with OPSCC were identified. They were categorized into 3 groups: HPV-negative OPSCC group (HPV-), HPV-positive smoker group (HPV+SMK+), and HPV-positive nonsmoker group (HPV+SMK-). Patients of HPV- group are older (61.1 ± 11.6 years) than the other groups on average. The HPV- group has the highest percentage of women (22.7%). The HPV- patients with OPSCC have more comorbidities than the HPV+SMK+ group and the HPV+SMK- group, although there is no statistical difference. Grade 2 tumor is the most common histology grade for HPV- patients with OPSCC, whereas grade 3 is the most common grade for HPV+SMK+ and HPV+SMK- groups. Both PNI and LVI are positive at around 40% for all groups without any significant difference, but ECE is very common for HPV- OPSCC, at 86.7%, which is significantly higher than that of the HPV+SMK+ and HPV+SMK- groups. There was no difference of bilateral neck metastases noticed among different groups. For T staging and N staging, although HPV+SMK- and HPV+SMK+ patients have relatively lower T stages and higher N stages, there is no significant difference. HPV+SMK- group has highest TNM stages. All death rates and recurrence rates increase with time, but the death rate of HPV- group is about 4 times higher than that of the HPV+SMK+ group and 6 times higher than that of the HPV+SMK+ group. The major recurrence type of HPV- OPSCC and HPV+SMK+ is locoregional, and the major recurrence type of HPV+SMK+ is distant metastasis., Conclusions: Our data confirmed that HPV+ OPSCC normally presents with more advanced stage, however, it has better prognosis. In comparison, HPV- OPSCC presents at an earlier stage, but the prognosis is worse. Based on their clinical profiles, we noted that HPV-positive OPSCC cells are more "mobile"; they metastasize sooner and further. However, HPV-negative OPSCC cells are more locally infiltrative, leading to more locoregional recurrence. The HPV-positive patients usually are younger and healthier at diagnosis. Although HPV-positive OPSCC tend to be histologically higher grades, there was no statistical difference noticed. Metastatic and recurrent patterns are very different between HPV-positive and HPV-negative patients, but the death rate of HPV-negative patients is way higher, and it is mainly due to locoregional recurrences, which is the major recurrence type for HPV-negative patients. Of our note, smoking is a complicating factor for HPV-positive OPSCC, and it makes the death rate, recurrence rate, histology grade, and TNM staging shift toward HPV-negative OPSCC. How smoking makes HPV-positive OPSCC behave more like OPSCC-negative OPSCC deserves more translational research for further elucidation., Competing Interests: Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Menstruation-related hormonal alteration can be detrimental to the professional singing voice of women. Resonance Voice Therapy (RVT) has been proven to improve vocal production. However, no research to date has been conducted examining the subjective, acoustic, and stroboscopic effects of RVT on professional female singers having premenstrual or postmenopausal voice disorders., Aim: The aim of this study is to compare the vocal effects of RVT with a control cervical-thoracic intervention in healthy female singers during the premenstrual phase as well as in postmenopausal singers and to evaluate which intervention will allow singers to improve vocal performance regardless of changes in hormonal status., Design: A randomized study was designed for this research. The research subjects were 20 professional female singers from the Southern California area, USA, with 10 premenstrual subjects in one group and 10 postmenopausal subjects in the other group. Among each group, 5 subjects were randomly selected to receive RVT and the remaining subjects received cervical-thoracic-focused exercises. The therapies consisted of 1 month of daily 15-minute sessions. For premenstrual subjects, voice data were collected at days 25 to 27 of the premenstrual phase during a scheduled initial voice evaluation. Follow-up data were collected during the same phase of the menstrual cycle (days 25-27) after 1 month of exercises. For postmenopausal subjects, voice data were collected at an initial voice evaluation with follow-up after 1 month of the assigned voice treatment. Outcomes were assessed with the singer's voice handicap index (VHI), laryngeal videostroboscopic examination, maximum phonation time (MPT), relative average perturbation (RAP), and pitch range before and following completion of therapies. Alleviation or deterioration percentages were used for statistical analysis. Student t test was used for statistical comparison between therapies., Results: The RVT decreased singer's VHI for both premenstrual and postmenopausal subjects by an average of 67%, compared with 7.8% for the cervical-thoracic therapy. The RVT also effectively decreased RAP by an average of 57% when combining the premenstrual and postmenopausal groups. The RVT increased MPT and pitch range among both premenstrual and postmenopausal subjects. The stroboscopic examination did not detect any significant differences between the 2 interventions., Conclusions: The RVT is effective for professional female singers with hormone-related premenstrual and postmenopausal vocal changes. The RVT is suggested as one of the therapeutic approaches for vocal abnormalities in such a population. A larger cohort may be needed for future research., Level of Evidence: 1b ., Competing Interests: Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The design, fabrication, and performance of an apparatus for the deposition of complex oxides with highly uniform thicknesses at controllable deposition rates over large area, even on the native amorphous SiO 2 layer of (001) oriented single crystal Si, are described. The apparatus makes use of the lateral port of a spherical chamber. The port is maintained at uniform temperature, and it houses a substrate heater. The deposition process is controlled by varying different parameters such as target-to-substrate distance, sputtering power, sputtering gas atmosphere, substrate temperature, and pulsed plasma growth. The system has been tested by growing a series of La 0.7 Sr 0.3 MnO 3 thin films on Si. The systematic strain relaxation and thus the tunable magnetic properties along with the presence of high-quality surface morphology of the films indicate that the designed system could be used to fabricate different components of oxide electronics-based devices over larger area.

Groundwater samples collected from the alluvial aquifers of southwest Punjab, both shallow and deep zones were measured for environmental tritium ( 3 H) and stable isotopes ( 2 H and 18 O) to evaluate the source of recharge and aquifer dynamics. The shallow groundwater shows wide variation in isotopic signature (δ 18 O: -11.3 to -5.0‰) reflecting multiple sources of recharge. The average isotopic signature of shallow groundwaters (δ 18 O: -6.73 ± 1.03‰) is similar to that of local precipitation (-6.98 ± 1.66‰) indicating local precipitation contributes to a large extent compared to other sources. Other sources have isotopically distinct signatures due to either high altitude recharge (canal sources) or evaporative enrichment (irrigation return flow). Deep groundwater shows relatively depleted isotopic signature (δ 18 O: -8.6‰) and doesn't show any evaporation effect as compared to shallow zone indicating recharge from precipitation occurring at relatively higher altitudes. Environmental tritium indicates that both shallow ( 3 H: 5 - 10 T.U.) and deeper zone ( 3 H: 1.5 - 2.5 T.U.) groundwaters are modern. In general the inter-aquifer connections seem to be unlikely except a few places. Environmental isotope data suggests that shallow groundwater is dynamic, local and prone to changes in land use patterns while deep zone water is derived from distant sources, less dynamic and not impacted by surface manifestations. A conceptual groundwater flow diagram is presented., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Purpose of Review: To provide clinicians with a critical review of outcomes for endolaryngeal surgery and intensity-modulated radiation therapy (IMRT) for early-stage supraglottic cancer., Recent Findings: A total of 971 potential articles were reviewed, with inclusion of 14 studies comparing IMRT with transoral surgery. One study analyzed IMRT, one transoral robotic surgery, and the remaining were transoral laser microsurgery studies. A weighted average and 95% confidence interval of all surgery patients showed a local control of 90.36 ± 1.14% (n = 118) for T1 lesions, 83.09 ± 1.36% (n = 232) for T2 lesions, and 86.38 ± 0.82% (n = 429) overall. The one study examining IMRT outcomes reported a local control of 70 ± 10.07% and overall survival of 63% over 5 years for T2 lesions (n = 78), with no reported T1 data or secondary outcomes., Summary: Endolaryngeal surgery as definitive therapy for T1 and T2 supraglottic cancer has excellent local control. Although endolaryngeal surgery performed better than IMRT, the data are limited, and a definitive comparison with surgery cannot be made. Additional studies are required.

Chyle leak formation is an uncommon but serious sequela of head and neck surgery when the thoracic duct is inadvertently injured, particularly with the resection of malignancy low in the neck. The thoracic duct is the primary structure that returns lymph and chyle from the entire left and right lower half of the body. Chyle extravasation can result in delayed wound healing, dehydration, malnutrition, electrolyte disturbances, and immunosuppression. Prompt identification and treatment of a chyle leak are essential for optimal surgical outcome. In this article we will review the current treatment options for iatrogenic cervical chyle leaks., Competing Interests: The authors declare that they have no competing interests.

Radiation therapy plays an essential role in the treatment of head and neck squamous cell carcinoma (HNSCC), yet therapeutic efficacy is hindered by treatment-associated toxicity and tumor recurrence. In comparison to other cancers, innovation has proved challenging, with the epidermal growth factor receptor (EGFR) antibody cetuximab being the only new radiosensitizing agent approved by the FDA in over half a century. This review examines the physiological mechanisms that contribute to radioresistance in HNSCC as well as preclinical and clinical data regarding novel radiosensitizing agents, with an emphasis on those with highest translational promise., (Copyright © 2016 Elsevier Ltd. All rights reserved.)