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Objective To assess long-term trends in disparities for prenatal diagnosis of Down syndrome in relation to policy changes. Design Population-based observational study. Setting Paris. Population Residents of Paris who gave birth or had a termination of pregnancy in Paris during 1983–2003 (approximately 23 000 births per year). Methods Using population-based data from the Paris Registry of Congenital Malformations on 1934 cases of Down syndrome, we assessed differences in prenatal diagnosis proportions by maternal profession and geographical origin for the years 1983–2003. Analyses included locally weighted scatter plot smoother curves and binomial regression. Main outcome measure Trends in proportion of Down syndrome cases diagnosed prior to birth for different maternal occupation groups and women of different geographical origins. Results The proportion of prenatally diagnosed cases increased substantially, reaching to about 85–90% of cases in 2003 for most socio-economic groups. This increase was accompanied by a significant decrease in disparities in prenatal diagnosis. Nonetheless, the proportion of prenatally diagnosed cases remained 12% lower for women without a profession compared with those in the highest occupational category (maternal age-adjusted risk difference −12.0%, 95% CI −17.1 to −6.9). Conclusions Together with the implementation of policies aimed at providing access to prenatal screening for all women, socio-economic differences in prenatal diagnosis of Down syndrome decreased over time. These trends need to be monitored, particularly in light of technical advances and alternative strategies for prenatal testing. However, while monitoring the proportion of cases with prenatal diagnosis is important, the ideal evaluation of prenatal testing programmes should also include measures of informed choice. [ABSTRACT FROM AUTHOR]

Background: Continuous-wave transscleral cyclophotocoagulation (CW-TSCP) is usually reserved for advanced/refractory glaucoma. Micropulse transscleral laser therapy (MPTLT) utilises short energy pulses separated by 'off'-periods. MPTLT is postulated to have fewer complications, but its relative efficacy is not known. The National Institute for Health and Care Excellence (NICE) has deemed the evidence supporting MPTLT use of inadequate quality, limiting its use to research. This study aims to evaluate MPTLT efficacy and safety compared to CW-TSCP., Methods: This 24-month follow-up retrospective audit included 85 CW-TSCP and 173 MPTLT eyes at a London tertiary referral centre. Primary outcome was success rate at the last follow-up; defined as at least 20% intraocular pressure (IOP) reduction with the same/fewer medications, and IOP between 6 and 18 mmHg. Secondary outcomes were acetazolamide use and success rates per glaucoma type. Safety outcomes were reported as complication rates., Results: By 24-months, mean IOP reduced from 34.6[±1.4]mmHg to 19.0[ ± 3.0]mmHg post-CW-TSCP (p < 0.0001); and from 26.1[±0.8]mmHg to 19.1[±2.2]mmHg post-MPTLT (p < 0.0001). Average IOP decreased by 45.1% post-CW-TSCP, and 26.8% post-MPTLT. Both interventions reduced medication requirements (p ≤ 0.05). More CW-TSCP patients discontinued acetazolamide (p = 0.047). Overall success rate was 26.6% for CW-TSCP and 30.6% for MPTLT (p = 0.83). Only primary closed-angle glaucoma saw a significantly higher success rate following CW-TSCP (p = 0.014). CW-TSCP complication rate was significantly higher than MPTLT (p = 0.0048)., Conclusion: Both treatments significantly reduced IOP and medication load. CW-TSCP had a greater absolute/proportionate IOP-lowering effect, but it carried a significantly greater risk of sight-threatening complications. Further prospective studies are required to evaluate MPTLT compared to CW-TSCP., (© 2024. The Author(s).)

Worldwide, harmful emissions from coal power plants cause many illnesses contribute to premature deaths burden. Despite its high impact on human health and being a major source of toxic pollutants, coal has been considered a component of global energy for decades. Hence, this work was envisaged to understand the rising environmental and multiple health issues from coal power plants. Studies on the adverse impacts of coal power plants on the environment, including soil, surface water, groundwater and air, were critically evaluated. The health risk from exposure to different pollutants and toxic metals released from the power plant was also demonstrated. The study also highlighted the government initiatives and policies regarding coal power operation and generation. Lastly, the study focused on guiding coal power plant owners and policymakers in identifying the essential cues for the risk assessment and management. The current study found an association between environmental and human health risks due to power generation, which needs intervention from the scientific and medical fields to jointly address public concerns. It is also suggested that future research should concentrate on exposure assessment techniques by integrating source-identification and geographic information systems to assess the health effects of different contaminants from power plants and to mitigate their adverse impact., 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.)

The seasonal quality of groundwater and its appropriateness for drinking and irrigation were assessed using a multiple indexing approach in this study. Physicochemical and ionic parameters were examined in groundwater samples near the industrial zone of Rupnagar, Punjab. To assess groundwater quality, water quality index (WQI) and pollution index were used. The Durov's, piper, wilcox and stiff diagrams were plotted to understand the hydro-chemistry. Similarly, the irrigation indices, i.e., salinity hazard, sodium adsorption ratio, soluble sodium percentage (Na%), magnesium adsorption ratio, residual sodium carbonate, permeability index and Kelley's ratio were applied to ascertain the water quality for agricultural purposes. As a result, total hardness, calcium (Ca 2+ ), magnesium (Mg 2+ ) and fluoride (F - ) were found above the standard permissible limits. WQI analysis showed 12% samples of pre-monsoon (PRE-M) and 28% samples of post-monsoon (POS-M) were of poor quality, which may pose health risks. Hydrochemistry revealed the predominance of Ca 2+ , Na + , Mg 2+ and HCO 3 - ions in the groundwater attributed to natural and anthropogenic sources. Piper diagram revealed Ca 2+ -Mg 2+ -Cl - , Na + -Cl - , Ca 2+ -Na + - HCO 3 - , Ca 2+ - HCO 3 - and Ca 2+ -Cl, Ca 2+ -HCO 3 - water types exist in the study area. USSL diagram showed that the samples from both seasons come under the low salinity hazard. In addition, total dissolved solids and electrical conductivity showed a strong positive association, indicating the saline nature of groundwater. Furthermore, hierarchical clustering classified groundwater into three groups (I, II and III), revealing that groundwater quality varies due to natural and anthropogenic effects. Based on the findings, the groundwater was found marginally suitable for drinking and irrigation purposes. It is therefore recommended that the groundwater is examined on a regular basis in order to maintain its quality., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Autologous costal cartilage for rhinoplasty is an excellent graft material providing both volume and quality of cartilage required for nasal reconstruction. Commonly, the 5th, 6th, 7th, and 8th rib costal cartilages have been harvested but other ribs such as the 10th rib are often overlooked and yet offer an excellent graft option for columellar, alar rim, nasal tip, and dorsal augmentation grafts. The use of the 10th rib costal cartilage in patients with complex secondary cleft nasal deformity has scant reference in the literature. We demonstrate our simple and quick 10th rib cartilage harvesting technique and elicit its use in secondary rhinoplasty and cleft lip nasal deformities. The advantages of harvesting the 10th rib cartilage and our long-term results demonstrating ease of harvest, stability, and predicable outcomes are with several clinical cases. The senior author has used the 10th rib graft successfully in a variety of challenging secondary cleft rhinoplasty procedures with excellent and consistent outcomes. We advocate the use of the 10th rib graft in such procedures as it is easy to harvest, is a dynamic cartilage graft, and offers predictable results with low levels of complications., Competing Interests: None declared., (Thieme. All rights reserved.)

Coal-powered thermal plants are the primary source of energy production around the globe. More than half (56.89%) of the Indian power plants use coal for power production. Coal burning in power plants results in coal combustion residuals, which contain coal fly ash (CFA) that is recognized as principle by-product. CFA is difficult to characterize due to its broad compositional variation. Hence, the present article summarizes the various physical, chemical, mineralogical, and petrological characterizations of CFA to its use in different applications. Indian coal thermal power plants are found to release two types of CFA: F (fine) and C (coarse). CFA particles are identified as unburned carbon particles with a large fraction of silica oxides, alumina oxides, and iron oxides with a small fraction of calcium oxide (CaO). Morphologically, CFA particles are spherical, with large carbon molecules and a smooth texture surface. In terms of mineralogy; quartz, mullite, magnetite, and hematite are the dominant mineral phases of CFA and tend to be non-plastic, with permeability levels ranging from 8 × 10 -6 to 1.87 × 10 -4 cms -1 . Petrographically, CFA is enriched in inertinite and liptinites as well as collotelinite, collodetrinite, and vitrodetrinite particles. Moreover, CFA is found to be composed of various organic and inorganic particles. By virtue of multiple characterizations, it has been utilized in several applications for decades, which is still quite limited. Therefore, current study aim to provide helpful insights into the potential use of CFA-derived products in different ways to increase sustainability., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

This case-control study aims to compare the efficacy, safety, and postoperative burden of MicroShunt versus trabeculectomy. The first consecutive cohort of MicroShunt procedures (n = 101) was matched to recent historical trabeculectomy procedures (n = 101) at two London hospital trusts. Primary endpoints included changes in intraocular pressure (IOP) and glaucoma medications. Secondary outcome measures included changes in retinal nerve fibre layer (RNFL) thickness, rates of complications, further theatre interventions, and the number of postoperative visits. From the baseline to Month-18, the median [interquartile range] IOP decreased from 22 [17-29] mmHg (on 4 [3-4] medications) to 15 [10-17] mmHg (on 0 [0-2] medications) and from 20 [16-28] mmHg (on 4 [3-4] medications) to 11 [10-13] mmHg (on 0 [0-0] medications) in the MicroShunt and trabeculectomy groups, respectively. IOP from Month-3 was significantly higher in the MicroShunt group ( p = 0.006), with an increased number of medications from Month-12 ( p = 0.024). There were greater RNFL thicknesses from Month-6 in the MicroShunt group ( p = 0.005). The rates of complications were similar ( p = 0.060) but with fewer interventions ( p = 0.031) and postoperative visits ( p = 0.001) in the MicroShunt group. Therefore, MicroShunt has inferior efficacy to trabeculectomy in lowering IOP and medications but provides a better safety profile and postoperative burden and may delay RNFL loss.

Background: Tackling the spread of COVID-19 remains a crucial part of ending the pandemic. Its highly contagious nature and constant evolution coupled with a relative lack of immunity make the virus difficult to control. For this, various strategies have been proposed and adopted including limiting contact, social isolation, vaccination, contact tracing, etc. However, given the heterogeneity in the enforcement of these strategies and constant fluctuations in the strictness levels of these strategies, it becomes challenging to assess the true impact of these strategies in controlling the spread of COVID-19., Methods: In the present study, we evaluated various transmission control measures that were imposed in 10 global urban cities and provinces in 2021- Bangkok, Gauteng, Ho Chi Minh City, Jakarta, London, Manila City, New Delhi, New York City, Singapore, and Tokyo., Findings: Based on our analysis, we herein propose the population-level Swiss cheese model for the failures and pitfalls in various strategies that each of these cities and provinces had. Furthermore, whilst all the evaluated cities and provinces took a different personalized approach to managing the pandemic, what remained common was dynamic enforcement and monitoring of breaches of each barrier of protection. The measures taken to reinforce the barriers were adjusted continuously based on the evolving epidemiological situation., Interpretation: How an individual city or province handled the pandemic profoundly affected and determined how the entire country handled the pandemic since the chain of transmission needs to be broken at the very grassroot level to achieve nationwide control., Funding: The present study did not receive any external funding., Competing Interests: The authors declare no conflicts of interests with regards to the present study. Authors did not receive any external funding for the study., (© 2022 The Author(s).)

Coal thermal power plants are the dominant factor in producing various hazardous elements in surrounding surface soil, resulting in a significant human health hazard. In the current study, the seasonal (pre- and post-monsoon) concentration of As, Cd, Co, Cr, Cu, Fe, Li, Mg, Mn, Ni, Pb, and Zn in surface soil around coal power production unit was analyzed using inductively coupled plasma-mass spectrometry (ICP-MS). The possible health risks throughout multiple exposure routes, i.e., ingestion, dermal, and inhalation were estimated for adult and children. Furthermore, geo-accumulation index (Igeo), enrichment factor (EF), pollution factor (CF), ecological risk index, and pollution load index (PLI) were applied to interpret the environmental pollution in the study area. The geospatial distribution pattern was computed to understand the trace and hazardous element distribution in the surface soil. As a result, the concentration of Fe (mg/kg) in pre-monsoon (15,620) and post-monsoon (27,180), Ni (mg/kg) in pre-monsoon (19.8), and post-monsoon (81.7) was found above the standard limits of soil prescribed by the WHO and FAO. Enrichment factor was observed between 0.95-6948 (pre-monsoon) and 0.53-116.09 (post-monsoon). The ecological risk index was found moderate to considerable for As and Cd metals during both seasons. In addition, the average PLI value was observed high for both seasons indicating the contamination of the study area with heavy metals. Moreover, Igeo values for Fe, Mg, and As were found relatively high. Conversely, health risks to the human population were found within the USEPA acceptable limits., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Purpose: This study evaluates the 6-month safety and efficacy of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in cases of uncontrolled glaucoma/ocular hypertension using a reduced energy protocol., Methods: Retrospective analysis of patients undergoing MP-TSCPC from January-April 2018 was carried out. Patients received up to 90 s of laser with settings of 2000 mW/Cm2 and a duty cycle of 31.3%., Results: A total of 29 patients were included, with a mean age of 64.7 ± 15.1 years. The most common diagnosis was primary open angle glaucoma (41.4%) with a mean Logmar visual acuity of 1.5 ± 1.2. All subjects had either undergone intraocular surgery (58.6% filtration surgery) or continuous wave diode laser prior to micropulse treatment. Mean pre-laser IOP was 26.2 ± 11.1 mmHg. There was a significant reduction (p < 0.05) in IOP at 1 month to 15.8 ± 5.4 mmHg (39.7% reduction), at 3 months to 15.04 ± 5.25 mmHg (42.6% reduction) and at 6 months to 18.19 ± 7.47 mmHg (30.6% reduction). There was also a corresponding reduction (p < 0.05) in the number of topical agents required to control pressure from a baseline of 3.31 ± 0.97, to 2.72 ± 0.88 at 1 month, 2.76 ± 0.91 at 3 months and 2.90 ± 1.08 at 6 months. Requirements for oral acetazolamide reduced from 41.3% (1/29) at baseline to 3.4% (1/29) at 6 months. Success rates were 75.9% at 1 month, 79.3% at 3 months and 58.6% at 6 months. There was no drop in the visual acuity, no change in central retinal thickness and no cases of intraocular inflammation., Conclusions: MP-TSCPC at a decreased duration is effective at reducing intraocular pressure in ethnically diverse glaucoma patients refractory to previous glaucoma laser or surgeries at 6 months follow-up, with no significant complications. Further work is needed to confirm efficacy in the long term and to determine optimal settings.

Secondary nasal deformity in bilateral cleft lip is one of the great surgical challenges. The problems are an under projected tip, an infra-tip lobule merging with the pro-labium and a short columella. Upper lip vermillion border deformity is a further significant problem. We demonstrate our novel approach to management by classifying patients into 3 groups depending on the status of important features such as the anatomy of the prolabial skin island, length of columella and upper lip width and fullness. We demonstrate that cleft patients with nasal deformity and poor upper lip aesthetics can be managed with a single operation., (Crown Copyright © 2019. Published by Elsevier B.V. All rights reserved.)

It is increasingly recognised that phenotypic plasticity, apparently driven by epigenetic mechanisms, plays a key role in tumour behaviour and markedly influences the important processes of therapeutic survival and metastasis. An important source of plasticity in malignancy is epithelial-to-mesenchymal transition (EMT), a common epigenetically controlled event that results in transition of malignant cells between different phenotypic states that confer motility and enhance survival. In this review, we discuss the importance of phenotypic plasticity and its contribution to cellular heterogeneity in oral squamous cell carcinoma with emphasis on aspects of drug resistance and EMT., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

For the determination of lenalidomide using carbamazepine as an internal standard, an ultra-fast stability indicating LC-MS/MS method was developed, validated and optimized to support clinical advancement. The samples were prepared by solid-phase extraction. The calibration range was 2-1000 ng mL(-1), for which a quadratic regression (1/x(2)) was best fitted. The method was validated and a 3(2) factorial was employed using Box-Behnken experimental design for the validation of robustness. These designs have three factors such as mobile phase composition (X(1)), flow rate (X(2)) and pH (X(3)) while peak area (Y(1)) and retention time (Y(2)) were taken as response. This showed that little changes in mobile phase and flow rate affect the response while pH has no affect. Lenalidomide and carbamazepine were stable in human plasma after five freeze thaw cycles, at room temperature for 23.7 h, bench top stability for 6.4 h. This method competes with all the regulatory requirements for selectivity, sensitivity, precision, accuracy, and stability for the determination of lenalidomide in human plasma, as well as being highly sensitive and effective for the pharmacokinetic and bioequivalence study of lenalidomide.

Purpose: For the determination of desloratadine (DES) and 3-OH desloratadine (3-OHD) in human plasma using deutrated desloratadine (DESD5) as internal standard (IS), a novel stability indicating liquid chromatography-tandem mass spectrometric method was developed and validated to support the clinical advancement., Materials and Methods: The solid-phase extraction method used for sample preparation and calibration range was 100-11,000 pg/ml, for which a quadratic regression (1/x(2)) was best fitted. The blank plasma was screened and observed free from any endogenous interference., Results: The accuracy (% nominal) at low limit of quantification LLOQ level for DES and 3-OHD was 100.4% and 99.9% whereas precision (%CV) was 4.6 and 5.1%. They (DES and 3-OHD) were stable in human plasma after five freeze-thaw cycles, at room temperature for 23.8 hour, bench top stability for 6.4 hour., Conclusion: This method fulfills all the regulatory requirements for selectivity, sensitivity, precision, accuracy, stability, goodness of fit, and ruggedness of the method for the determination of DES and 3-OHD in human plasma.

Publications are important for all surgeons, including those practising oral and maxillofacial surgery (OMFS). The results of relevant research are usually presented at the annual scientific meetings of the British Association of Oral and Maxillofacial Surgeons (BAOMS). The aim of this study was to find out how many abstracts that were accepted for presentation at the BAOMS go on to be published. Lists of abstracts accepted at BAOMS meetings 2002-2006 were obtained, and a thorough search was made for each article using the web-based search engine PubMed. Related publications were recorded. A total of 623 abstracts were accepted, of which only 147 (24%) resulted in peer-reviewed publication. Compared with clinical studies, scientific research was in the minority, but was more likely to appear in print and in journals with higher impact factors. Units with senior academic input had better records of publication. Currently only a small fraction of studies deemed worthy of presentation at the BAOMS become publications. This conversion from presentation to print is facilitated by strong academic support. Exposing trainees in OMFS training posts to basic research training might improve their ability to publish., (Copyright © 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)