Objective
Extra Nodal Extension (ENE) assessment in locally advanced head and neck cancers (LAHNCC) treated with concurrent chemo radiotherapy (CCRT) is challenging and hence the American Joint ...Committee on Cancer (AJCC) N staging. We hypothesized that radiology-based ENE (rENE) may directly impact outcomes in LAHNSCC treated with radical CCRT.
Materials and Methods
Open-label, investigator-initiated, randomized controlled trial (RCT) (2012–2018), which included LAHNSCC planned for CCRT. Patients were randomized 1:1 to radical radiotherapy (66–70 grays) with concurrent weekly cisplatin (30 mg/m
2
) cisplatin radiation arm (CRT) or same schedule of CRT with weekly nimotuzumab (200 mg) nimotuzumab plus CRT (NCRT). A total of 536 patients were accrued and 182 were excluded due to the non-availability of Digital Imaging and Communications in Medicine (DICOM) computed tomography (CT) data. A total of 354 patients were analyzed for rENE. Metastatic nodes were evaluated based on five criteria and further classified as rENE as positive/negative based on three-criteria capsule irregularity with fat stranding, fat invasion, and muscle/vessel invasion. We evaluated the association of rENE and disease-free survival (DFS), loco-regional recurrence-free survival (LRRFS), and overall survival (OS).
Results
A total of 244 (68.9%) patients had radiologically metastatic nodes (rN), out of which 140 (57.3%) had rENE. Distribution of rENE was balanced in the two study groups CRT or NCRT (p-value 0.412). The median follow-up period was 39 months (ranging from 35.5 to 42.8 months). Complete response (CR) was seen in 204 (57.6%); incomplete response (IR), i.e., partial response plus stable disease (PR + SD), in 126 (35.6%); and progressive disease (PD) in 24 (6.8%). rENE-positive group had poor survival compared to rENE-negative group 3-year OS (46.7% vs. 63.6%), poor DFS (48.8% vs. 87%), and LRRFS (39.9% vs. 60.4%). rENE positive had 1.71 times increased risk of IR than rENE negative. Overall stage, site, clinical metastatic node (cN), response, and rENE were the significant factors for predicting OS, DFS, and LRRFS on univariate analysis. After making adjustment on multivariate analysis, rENE was an independent prognostic factor for DFS and trending to be significant for OS.
Conclusion
Pre-treatment rENE is an independent prognostic marker for survival in patients with LAHNSCC treated radically with CCRT that can be used as a potential predictive marker for response to treatment and hence stratify patients into responders vs. non-responders. We propose the mahajan rENE grading system applicable on CT, magnetic resonance imaging, positron emission tomography–contrast-enhanced CT, and ultrasound.
The intake of microbial-contaminated food poses severe health issues due to the outbreaks of stern food-borne diseases. Therefore, there is a need for precise detection and identification of ...pathogenic microbes and toxins in food to prevent these concerns. Thus, understanding the concept of biosensing has enabled researchers to develop nanobiosensors with different nanomaterials and composites to improve the sensitivity as well as the specificity of pathogen detection. The application of nanomaterials has enabled researchers to use advanced technologies in biosensors for the transfer of signals to enhance their efficiency and sensitivity. Nanomaterials like carbon nanotubes, magnetic and gold, dendrimers, graphene nanomaterials and quantum dots are predominantly used for developing biosensors with improved specificity and sensitivity of detection due to their exclusive chemical, magnetic, mechanical, optical and physical properties. All nanoparticles and new composites used in biosensors need to be classified and categorized for their enhanced performance, quick detection, and unobtrusive and effective use in foodborne analysis. Hence, this review intends to summarize the different sensing methods used in foodborne pathogen detection, their design, working principle and advances in sensing systems.
Large scale integration of variable and uncertain Renewable Generation (RG) in power systems causes frequent load-generation imbalances. Systems require additional operational flexibility to ensure ...secure and reliable power system operations. Flexibility can be enhanced by increasing ramping availability from resources at generation and demand side. Flexible Ramp Products (FRPs) are implemented in mature power markets to ensure ramping availability from such sources. Accurate FRP design can effectively manage load-generation imbalances and ensure secure system operations. This has attracted quantum research attention in FRP related challenges. However, there is limited understanding of power system flexibility enhancement capability of FRPs, design components, modelling and implementation of FRPs in various electricity markets. A detailed study on this can support industry and academia to develop improved FRP designs. Also, this gives motivation to explore FRP availability from different sources. In this context, this paper provides a detailed review on FRPs, and problems and research challenges in existing FRP frameworks. Unique areas such as net load variability and uncertainty estimations in FRP modelling and FRP implementation in various power markets are extensively discussed. A case study is also conducted to demonstrate the advantages of implementing FRP. It concludes that FRP is a promising solution to manage frequent load-generation imbalances. However, there is a significant scope to improve existing FRP designs and their implementation. Also, FRP availability from different RG sources or RG mix needs to be adequately assessed to maximize the environmental advantages from them.
•A detailed review on power system flexibility enhancement using Flexible Ramp Products (FRPs).•Design components, modelling and implementation of FRPs in various electricity markets.•An in-depth discussion on problems and research challenges in existing FRP frameworks.•FRP is a promising solution to manage frequent load-generation imbalances.•FRPs from different Renewable Generation sources need to be adequately assessed.
Diphtheria is a respiratory disease caused by the bacterium Corynebacterium diphtheriae. Although the development of a toxin-based vaccine in the 1930s has allowed a high level of control over the ...disease, cases have increased in recent years. Here, we describe the genomic variation of 502 C. diphtheriae isolates across 16 countries and territories over 122 years. We generate a core gene phylogeny and determine the presence of antimicrobial resistance genes and variation within the tox gene of 291 tox
isolates. Numerous, highly diverse clusters of C. diphtheriae are observed across the phylogeny, each containing isolates from multiple countries, regions and time of isolation. The number of antimicrobial resistance genes, as well as the breadth of antibiotic resistance, is substantially greater in the last decade than ever before. We identified and analysed 18 tox gene variants, with mutations estimated to be of medium to high structural impact.
The cultivation of sugarcane is very labour intensive especially during planting and at harvesting time. Timely supply of harvested cane to the sugar mills significantly affects the sugar recovery of ...mills. Delayed harvests cause greater yield loss and quality as well. Now mechanical harvesters are introduced as promising machinery for the timely and efficient management of harvesting process. So, a study was conducted to quantify top cane, trash and contribution of extraneous matter in mechanical and manual harvested cane at different sugar mills viz., Saraswati Sugar Mills (Yamuna Nagar), Piccadily Agro Industries Ltd. Bhadson (Karnal) and Karnal Coop. Sugar Mills (Karnal) with total six locations during April, 2019. The results have shown that the extraneous matters (on mean basis) was found higher in mechanical harvested cane for trash (1.7%), green top (5.7%) along with cut portion (8.1%). In case of manual harvested, trash and green top was 1.0 and 2.9%, respectively without any cut portion (setts). The presence of higher extraneous matter consequently reduced juice quality in mechanical harvested as compared to manual harvest cane and mechanical harvested (cane portion). There was 0.33 unit decrease in the sugar recovery (5%) in mechanical harvested mixed cane produce including cane portion, green top and trash as compared to mechanical harvested cane portion only. Similarly, there was 0.71 unit decrease in the sugar recovery in the mechanical harvested mix produce as compared to manual harvested cane.
Remediating hexavalent chromium Cr(VI) from contaminated water systems is a significant concern due to its harmful effects on human health, aquatic life, and plants. To tackle this issue, scientists ...have created a chitosan cross-linked hydrous ceria incorporated cupric oxide bio-polymeric composite (CHCCO) by combining chitosan biopolymer with corresponding metal ions using glutaraldehyde as a cross-linker. The composite was characterized using advanced analytical instruments such as FTIR, p-XRD, SEM, XPS, etc. The synthesized composite (CHCCO) was then tested for its efficiency in removing Cr(VI) from synthetic Cr(VI) aqueous samples. The parameters examined included pH, material dose, contact time, concentration, temperature, and co-existing ions. The experimental data showed that the kinetics and equilibrium data fit well with the pseudo-second-order and the Freundlich isotherm models, respectively. Thermodynamic analysis demonstrated that the investigated surface adsorption process is spontaneous and endothermic. Except for the SO42− ion, no other species imparts adverse influence significantly on the reaction. The CHCCO bio-composite surfaces were refreshed using a dilute NaOH (1.0 M) solution and effectively recycled five times for Cr(VI) adsorption, indicating no significant surface activity deterioration. This study highlights the high effectiveness of CHCCO bio-polymeric composites in Cr(VI) remediation and the potential for this technology as an easy-to-use technique for environmental restoration.
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•Chitosan bio-polymer used as a platform for Ceria Incorporated Hydrous Copper Oxide•The bio-polymeric metal composite efficiently removes Cr(VI) from polluted water•This bio-polymeric metal composite can be recycled five times.•Maximum adsorption capacity of the biopolymeric composite was 297.62 mg.g-1•Plausible mechanism for the abatement of Cr(VI) was illustrated
Diphtheria is caused by a toxigenic bacterium Corynebacterium diphtheria which is being an emerging pathogen in India. Since diphtheria morbidity and mortality continues to be high in the country, ...the present study aimed to study the molecular epidemiology of C. diphtheriae strains from India. A total of 441 diphtheria suspected specimens collected as part of the surveillance programme between 2015 and 2020 were studied. All the isolates were confirmed as C. diphtheriae with standard biochemical tests, ELEK's test, and real-time PCR. Antimicrobial susceptibility testing for the subset of isolates showed intermediate susceptibility to penicillin and complete susceptible to erythromycin and cefotaxime. Isolates were characterized using multi locus sequence typing method. MLST analysis for the 216 C. diphtheriae isolates revealed major diversity among the sequence types. A total of 34 STs were assigned with majority of the isolates belonged to ST466 (30%). The second most common ST identified was ST405 that was present in 14% of the isolates. The international clone ST50 was also seen. The identified STs were grouped into 8 different clonal complexes (CC). The majority belongs to CC5 followed by CC466, CC574 and CC209, however a single non-toxigenic strain belongs to CC42. This epidemiological analysis revealed the emergence of novel STs and the clones with better dissemination properties. This study has also provided information on the circulating strains of C. diphtheriae among the different regions of India. The molecular data generated through surveillance system can be utilized for further actions in concern.
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