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Fast growing arsenic menace is causing serious health hazards in Bihar, India, with an estimated 10 million people at risk. The exposed population is often unaware of the problem, which only amplifies the burden of arsenic health effects. In the present study, we have assessed the current situation of arsenic exposure in Chapar village of Samastipur district, Bihar. The health of the inhabitants was assessed and correlated with (1) arsenic concentrations in the groundwater of individual wells and (2) arsenic concentration found in their hair and urine. Altogether, 113 inhabitants were assessed, and 113 hair, urine and groundwater samples were collected. The health study reveals that the exposure to arsenic has caused serious health hazard amongst the exposed population with pronounced skin manifestations, loss of appetite, anaemia, constipation, diarrhoea, general body weakness, raised blood pressure, breathlessness, diabetes, mental disabilities, diabetes, lumps in the body and few cancer incidences. It was found that 52% of the total collected groundwater samples had arsenic levels higher than the WHO limit of 10 µg/l (with a maximum arsenic concentration of 1212 µg/l) and the reduced arsenite was the predominant form in samples tested for speciation (N = 19). In the case of hair samples, 29% of the samples had arsenic concentrations higher than the permissible limit of 0.2 mg/kg, with a maximum arsenic concentration of 46 µg/l, while in 20% exposed population, there was significant arsenic contamination in urine samples 50 µg/l. In Chapar village, the probability of carcinogenic-related risk in the exposed population consuming arsenic contaminated water is 100% for children, 99.1% for females and 97.3% for male subjects. The assessment report shared to the government enabled the village population to receive two arsenic filter units. These units are currently operational and catering 250 households providing arsenic-free water through piped water scheme. This study therefore identified a significant solution for this arsenic-exposed population.

The posterior parietal cortex (PPC) plays an important role in postural stability by adapting to changes in input from the visual, vestibular, and proprioceptive systems. However, it is little known whether transcranial electrical stimulation (tES) of the PPC affects reactive postural responses. The purpose of this study was to investigate changes in physical control responses to anodal and cathodal transcranial direct current stimulation (tDCS) and transcranial random noise stimulation (tRNS) of the right PPC using a simultaneous inertial measurement unit. The joint movements of the lower limb of 33 healthy volunteers were measured while standing on a soft-foam surface with eyes closed, during various stimulation modalities. These modalities included anodal, cathodal tDCS, and sham stimulation in Experiment 1 and tRNS and sham stimulation in Experiment 2. The results showed that cathodal stimulation significantly decreased the joint angular velocity in the hip rotation, ankle inversion-eversion, and abduction-adduction directions compared to anodal or sham stimulation in Experiment 1. In contrast, there were no significant differences in physical control responses with tRNS stimulation in Experiment 2. These findings suggest that tES of the right PPC may modulate physical control responses; however, the effect depends on the stimulus modality.

The present study aims to carry out the assessment of arsenic contamination in groundwater samples along with the health status of the exposed population of Buxar district of Bihar. In the present study, randomly 80 groundwater samples were collected from the handpumps across the village households. For the health assessment, blood samples from human subjects were collected from the same household to know the status of the arsenic contamination in their body and were analysed. The study showed significantly very high arsenic contamination in their handpumps as well as in the blood samples of the exposed subjects. The maximum arsenic concentration observed in the handpump water sample was 1908 μg/L, while in blood sample of an individual was 462.1 μg/L. Cancer in 12 subjects was also observed within 2 years. The mitigation intervention was carried out by installing an arsenic filter plant for this arsenic exposed village population. After one year of the usage of the installed arsenic filter, there was significant reduction in the disease symptoms in the exposed population. The present study deciphers the groundwater status as well as the health status of the arsenic exposed population of a village of Bihar along with an mitigation approach to overcome the disease burden.

OBJECTIVE Galvanic vestibular stimulation (GVS) enhances vestibular sensory inputs in vestibular afferents. However, it is unclear whether noisy and conventional GVS activate different regions of the brain. The purpose of this study was to investigate the differences in activated brain regions between those two interventions using functional MRI (fMRI). METHODS Twenty-four healthy volunteers who met the inclusion/exclusion criteria were randomly assigned to the noisy GVS or conventional GVS groups. Brain activity was measured during stimulation and compared with that during resting fMRI. This study used a blocked design comprising four task-rest blocks, each consisting of a 30-s period of vestibular stimulation followed by a 30-s period of rest. We evaluated the differences in contrast images between the noisy and conventional GVS groups. RESULTS The noisy GVS group showed significantly increased activation in the vestibular system-related brain regions, including the insula and central operculum. The conventional GVS group showed significant activity in multisensory areas, including the supramarginal gyrus, central operculum and opercular part of the inferior frontal gyrus. Thus, the noisy GVS group showed significantly increased activity in the insula, putamen and central operculum compared with the conventional GVS group. CONCLUSIONS Noisy GVS could increase brain activity in the insular peripheral region compared to conventional GVS. Our results extend the literature about the importance of the stochastic resonance of noise addition for the vestibular system.

This study revealed the status of 2833 Kanchan Arsenic Filters (KAFs), aged 2 months to over 10 years, distributed in Nepal. Thirty percent of the filters were being used, but usage status generally declined 4 years after installation. Lack of use was mostly due to breakage or leaks (74%), which users did not know how to repair. Some 1283 filters (65%) were abandoned, and users returned to drinking arsenic-contaminated water. Water quality tests showed that the average KAF arsenic removal rate was 75%, and 87 and 62% of the samples met Nepal's drinking water quality standards and World Health Organization guidelines, respectively. The KAF arsenic removal amount was significantly influenced by the arsenic and iron concentrations of influent water and KAF type. The concrete square type showed the best performance in usage status and arsenic removal capacity, namely 57 and 83%, respectively. Long-term use of KAFs (more than 4 years) was assumed to be a cause of the decreasing capacity of iron nails to supply ferric hydroxide to influent water, which led to decreased arsenic removal capacity. Thus, replacement of older iron nails may restore the arsenic removal capacity of KAFs.

BackgroundIn recent times Gallbladder cancer (GBC) incidences increased many folds in India. Majority of GBC cases are being reported from arsenic hotspots identified in Bihar. MethodsIn this prospective study volunteers were selected who underwent surgery in our cancer institute. There were 11 control benign gallbladder cases and 28 confirmed gallbladder cancer cases. Their biological samples such as blood, gallbladder tissue, gallbladder stone, bile and hair samples were collected for arsenic estimation. Moreover, n=512 gallbladder cancer patients blood samples were evaluated for the presence of arsenic to understand exposure level in the population. ResultsA significantly high arsenic concentration (pConclusionsThe study shows very high arsenic concentration observed in the blood, gallbladder tissue, gallbladder stone, bile and hair samples in GBC cases in comparison to the benign control cases indicates the correlation between chronic arsenic exposure and gallbladder cancer incidences in eastern Indo-Gangetic plains region. The study also makes an attempt to establish the likely correlation/association between arsenic exposure and gallbladder cancer disease.

The effects of electromyography-triggered neuromuscular electrical stimulation and tilt sensor functional electrical stimulation on ankle dorsiflexion during walking are unclear. This study investigated whether combined electrical stimulation training affects gait performance in patients with stroke. Thirty-six patients were randomly assigned to a control (n = 13), electromyography-triggered neuromuscular electrical stimulation training (single electrical stimulation group, n = 12), or a combined electromyography-triggered neuromuscular electrical stimulation and tilt sensor functional electrical stimulation training (combined electrical stimulation group, n = 11) group. Both experimental groups undertook 60-minute interventions for two weeks. All patients' gait performances were evaluated according to walking speed and trunk acceleration during 10-meter walking tests undertaken pre-intervention and at two weeks post-intervention. A wireless triaxial accelerometer measured trunk acceleration, and the root mean square values of the vertical, mediolateral, and anterioposterior planes were calculated from randomly selected 10-step sequences. Compared with baseline, the 10-meter walking tests improved significantly after two weeks in the single and combined electrical stimulation groups. In the combined electrical stimulation group, the 10-meter walking tests scores and root mean square of the mediolateral plane improved significantly compared with those in the control group. Electromyography-triggered neuromuscular electrical stimulation and tilt sensor functional electrical stimulation training may improve body perturbation stability and walking quality.

A survey was conducted in an As-affected village of Bangladesh&mdash, the first discovery of As contamination in the country&mdash, to assess the current situation and how implementation activities have worked to mitigate the problem. The As testing showed that the levels were less than the Bangladesh standard (50 &micro, g/L) in all shallow tube-wells throughout the village. The questionnaire survey was conducted in the village as well as a neighboring As-affected village for comparison. The results revealed that there was a significant number of people using shallow tube-wells in both villages despite knowing that these wells could be contaminated with As and that safe water was available through a pipeline water supply. About 70% of responding households possessed their own water sources, mostly shallow tube-wells, and owners were less likely to choose tap water for drinking purpose than nonowners. In the village where As contamination was first reported, those individuals with a higher level of education and strong ties with neighbors were more likely to use shallow tube-well water for drinking purposes rather than tap water. This study suggests several measures to mobilize people to get safe water, namely providing subsides to install private taps, supplying public taps, and marketing and distributing handy water quality tests for households.

Aim This study aimed to evaluate the potential preventive effects of a water-based exercise program on disability in community-dwelling older adults. Methods The study design was a propensity score-matched retrospective study. Older adults were contacted through a mail survey carried out by City Hall, and those who scored ≥3 points on the physical domain of the Kihon Checklist were encouraged to participate in the water-based exercise program. The program consisted of aerobic and walking exercises in the water for 1 h, once a week for 6 months. Propensity scores were used to match individuals who participated in the exercise program with control individuals based on age, sex, height, weight, body mass index and Kihon Checklist score. Among matched pairs, the study included 278 participants (control group 139, intervention group 139). The main outcome was the number of participants who received a new long-term care insurance certification during the first follow-up year, which was used to indicate disability. Results Of the 278, 13 participants (5.5%) required long-term care insurance certification. A significantly smaller proportion of intervention group members required long-term care insurance certification (intervention group 0.7% [1/139 participants] vs control group 8.6% [12/139 participants], P = 0.003). Conclusions Water-based exercise program appears to effectively prevent disability in community-dwelling older adults. Because water-based exercise program is associated with a minimal burden on joints and lower risk of falling, it might particularly enable the prevention of disability in older adults with chronic pain and restricted mobility. Geriatr Gerontol Int 2019; 19: 1282-1288.

Second allogeneic stem cell transplantation (allo-SCT) is a potentially curative therapy for patients who relapse after first allo-SCT. Human leukocyte antigen (HLA)-haploidentical related donors provide the broad opportunity to conduct second SCT at the appropriate time, but the efficacy of second SCT from haploidentical donors after relapse has not been established. We retrospectively analyzed the records of 33 patients who underwent second SCT. Twenty patients underwent haplo-SCT with low-dose antithymocyte globulin (ATG), and the other 13 patients underwent conventional- SCTs, including HLA-matched related peripheral blood, unrelated bone marrow or cord blood. Three years after the second SCT, the overall survival (OS) and progression-free survival (PFS) of all patients were 32.5% and 23.9%. Multivariate analyses indicated that non-complete response at second SCT, less than 1-year interval to relapse after first- SCT, and total score ≥ 3 on the hematopoietic cell transplantation-specific comorbidity index were significantly associated with a lower PFS rate. The haplo- and conventional- SCT groups showed equivalent results regarding OS, PFS, cumulative incidences of relapse, non-relapse mortality and graft-versus-host disease. The neutropenic period after transplantation was significantly shorter in haplo- SCT than conventional- SCT (10.5 days vs. 16 days, p=0.001). Our analysis revealed that haplo-SCT could be an alternative therapeutic option for relapsed patients after first SCT.

Here we present the first report of solitary primary peripheral nerve onset cytotoxic molecule (CM)-positive peripheral T-cell lymphoma (PTCL) diagnosed after nerve biopsy. An 84-year-old female with rheumatoid arthritis (RA) complained of asymmetric severe tenderness in her upper limbs. The biopsy pathology revealed a direct invasion of CM-positive PTCL. When RA patients complain of numbness, tenderness, or weakness, lymphomatic peripheral nerve invasion should be considered.

Detailed information of the effects of age and long-term HIV infection on various neurocognitive function have not been fully evaluated yet. In a prospective Japanese nationwide multicenter study of 17 facilities (J-HAND study), 728 HIV-infected individuals completed 14 neuropsychological (NP) tests; Verbal Fluency (VF; category and letter), Digit Span (DS; forward and backward), Trail Making Test (TMT) A-B, Rey-Osterrieth Complex Figure Test (ROCFT; copy, immediate and delayed recall), Story Memory Test (SMT; immediate and delayed recall), Digit Symbol Subset (DSS), and the Grooved Pegboard (GP; dominant and non-dominant). Multivariate analysis identified older age (≥ 50 years) to be associated with lower scores in all three ROCFT and GP dominant [odds ratio (OR) [95% confidence interval (CI)] 1.801 (1.217-2.664), 2402 (1.366-3.055), 2.691 (1.720-4.211), and 2.302 (1.145-4.628), respectively], whereas longer time since diagnosis was associated with a lower score in ROCFT (delayed recall) (OR 1.224, 95%CI 1.045-1.434). In VF letter, older age and longer time since diagnosis were associated with a better score [OR (95%CI) 0.449 (0.234-0.861) and 0.831 (0.692-0.997)]. In DSS and TMT-A, longer time since diagnosis was associated with a better score [OR (95%CI): 0.808 (0.670-0.973) and 0.795 (0.665-0.949), respectively]. Older patients in later years since diagnosis are at higher risk of visuospatial and motor impairments despite ART, whereas they are less likely to develop verbal impairment, suggesting that verbal function is relatively resistant to aging and long history of HIV infection under ART. These findings suggest that customtailored supports should be established based on the individual background.

Arsenic poisoning through groundwater is the world's greatest normal groundwater catastrophe which got an immense effect on worldwide general wellbeing. India is confronting the outcomes of arsenic poisoning in the zone of Ganga Brahmaputra alluvial plains. In Bihar out of 38 districts, 18 districts are exceptionally influenced with groundwater arsenic defilement. In the present study, we have assessed the current situation of arsenic exposure in Sabalpur village of Saran district of Bihar after reporting of breast, renal, skin and thyroid cancer cases from this village along with typical symptoms of arsenicosis. Such cancer patients were identified at our institute and were taken for the study. The present investigation deals with the quantification of arsenic in groundwater, hair and nail samples as well as the survey of entire village to know the overall health status of the village people. Altogether, 128 groundwater samples through handpumps, 128 human hair and nail samples respectively were collected from over 520 households. Using the Graphite Furnace Atomic Absorption Spectrophotometer (GF-AAS), all the samples were analysed. The investigation resulted that the 61% of the analysed samples particularly the groundwater had the arsenic levels more than the permissible limit of WHO (>10µg/L) with 244.20µg/L as the greatest arsenic contamination in one of the groundwater sample. The exposure effect of hair sample was worst as 88% of all the collected samples were having high arsenic levels more than the permissible limit (>0.2mg/Kg). In case of nails samples, 92% of the samples were having high arsenic concentration more than the permissible limit (>0.5mg/Kg). The health survey study uncovered the exceptionally chronic weakness status of the village populace as individuals were experiencing the issues like asthma, anaemia, hepatomegaly, diabetes, cardiac problem, skin fungal infections, breathlessness, mental disability, etc. Few cancer cases of renal, skin, breast and cervix were also found among the population of this village. The percentage of cancer cases in this village was 0.94% that is low but it would be an aggravated situation in the near future if people will continue drinking arsenic contaminated water. Therefore, a mitigation intervention was done in March 2020 by installing an arsenic filter plant. The health situation in the present scenario is hope to restore in the village in the coming years. However, motivation and awareness among the village population is still required.

In this chapter, we are addressing complex problems regarding the operation of storage reservoirs in Iraq and relationships taking place between reservoir operators and agricultural water users during the water resources allocation process. These problems are addressed using various mathematical tools like simulation, multiple criteria optimization, and finally games theory. At first hydrologic characteristics of the river flow in both Euphrates and Tigris rivers were analyzed. Then, the properties of the traditional reservoir operation policy have been analyzed followed by the optimization analysis of the modified operation policy. In the following section of the chapter, the fundamental concepts of the game theory are presented along with the game theoretic analysis of the decision-making process taking place between reservoir operators and agricultural water users. Finally, conclusions drawn from the research conducted are presented.

Several studies support the role of autophagy in maintenance of genome integrity and cancer suppression. However, it remains unclear how autophagy deficiency contributes to mutagenic or epigenetic alterations during the early stages of carcinogenesis. In this study, we show that compromised autophagy led to deregulated activity of Fanconi anemia tumor suppressor pathway, which plays a major role in the suppression of genomic alterations caused by replication stress. We found that expression of FA protein FANCF is significantly reduced in autophagy-deficient cells in a manner that epigenetic alteration drives the defect. Comprehensive genome-wide analysis revealed that autophagy deficiency causes copy number variations at common fragile sites and multiple other loci encoding tumor suppressors, leading to their deregulation. Our results suggest that autophagy deficiency drives genetic and epigenetic catastrophe escalated by the defect in FA-pathway, disrupts proper control of other tumor suppressors and promotes tumorigenesis at the early stage.

Objectives This study aimed to investigate whether the combination of transcranial direct current stimulation (tDCS) and gait training with FES affected walking speed and trunk accelerometry-based gait characteristics in patients with subacute stroke, compared with FES or tDCS gait training only. Materials and Methods Stroke patients (n = 34; female 15; mean age, 72.5 ± 11.2 years; mean days poststroke, 38.7) with resultant paresis in the lower extremity (mean Fugl-Meyer score, 25.5) were enrolled. Patients were randomly assigned to one of three groups: combined anodal tDCS and gait training with FES (tDCS+FES, n = 11), anodal tDCS with gait training (tDCS, n = 11), or combined sham tDCS and gait training with FES (FES, n = 12). Participants received the intervention for 20 minutes and a 40-minute conventional rehabilitative intervention daily for a week. Patients’ walking ability was evaluated using walking speed, harmonic ratio (HR), autocorrelation coefficient (AC), and root mean square (RMS) along each axis using a wearable trunk accelerometer. Results The tDCS+FES group had a significantly greater change in AC in the anteroposterior axis and mediolateral axis than the FES and tDCS groups and FES group, respectively. There were no significant effects on walking speed or other parameters (HR and RMS) among the groups. Conclusions The combination of anodal tDCS and gait training with FES improved the post-stroke patients’ gait regularity than FES gait training intervention only. Thus, combined tDCS and FES gait training, as a novel intervention, could be an important therapeutic tool in improving walking performance.

Background The design process of a removable partial denture (RPD) consists of rests, major connectors, minor connectors, denture base, and retainer. The abutment tooth contour determines the location of the retention portion of the clasp at the retention areas. The load capacity of the clasp depends on various factors such as type, the position of a clasp, tooth position, clasp length, and pullout location. As a general rule, the amount of retention required to dislodge the RPD from the supporting structure should always be the minimum necessary to resist reasonable dislodging forces. Excessive force from the clasps may cause many problems. Although there are many reports on the retentive force of cast clasps using large devices, it has not been possible to measure it using simple devices until now. Method The purpose of the present study is to develop a small-sized retentive force measurement device that can easily measure the retentive force of a clasp used for an RPD. It is to examine inter-rater and intra-rater reliability. A small-sized retentive force measurement device that can be easily measured in the laboratory has been developed. Using commercially available hard plaster cast, a skilled dental technician has made 10 types of cast clasps used in clinical practice using conventional techniques. Three assessors measured the retentive force of 10 types of cast clasps. To confirm the reliability, the intra-class correlation coefficients ICC (1,1) and ICC (1,3) of the 3 assessors were calculated, and the reliability within the assessor was examined. The inter-class correlation coefficients ICC (3,1) and ICC (3,3) were calculated, and the reliability of the assessors was examined. Result The intra-class correlation coefficients of 3 assessors are as follows: assessor 1 has ICC (1,1) = 0.971, ICC (1,3) = 0.990, assessor 2 has ICC (1,1) = 0.967, ICC (1,3) = 0.989, assessor 3 has ICC (1,1) = 0.962, ICC (1,3) = 0.987. The inter-class correlation coefficients of 3 assessors are as follows: ICC (3,1) = 0.993, ICC (3,3) = 0.998. From the evaluation standard of the intraclass correlation coefficients of reliability value by ICC, it was evaluated as almost perfect and high reproducibility was confirmed. Conclusion The developed small-sized retentive force measurement device has reproducibility within and between the assessors.

Previous literature has shown that standing stability relies on the vestibular system; however, the neural correlates underlying standing stability remains unclear. This study aimed to investigate the neural correlates of standing stability using functional magnetic resonance imaging (fMRI) following galvanic vestibular stimulation (GVS).Forty-five healthy right-handed healthy volunteers were included. Postural stability was measured using the modified Clinical Test of Sensory Interaction and Balance (mCTSIB), which measures swaying speed and area on hard and soft surfaces when the volunteer's eyes are open and closed. Functional activation as determined by the blood oxygenation level-dependent (BOLD) response, was measured during GVS using fMRI. We investigated the association between BOLD responses during GVS and postural stability.Relative to rest, participants showed significantly higher BOLD signal during GVS in the parietal operculum, central operculum, and the opercular part of the inferior frontal gyrus. Moreover, functional activation in the central operculum was negatively correlated with standing stability, indexed using swaying speed when volunteers stood on a foam surface with their eyes closed.Our findings suggest that the neural correlates of standing stability involve greater functional activation in the central operculum.