Groundwater quality assessment for drinking purpose using traditional and fuzzy-GIS-based water quality index in Gurugram District of Haryana, India.

Primarily groundwater is consumed for the drinking and irrigation purpose. However, due to increasing anthropogenic activities, its quality and quantity have substantially declined over time. The focus of this study is to evaluate the pre-monsoonal groundwater quality and its spatial variability for drinking purposes in the Gurugram, Haryana, India. Ground Water quality index (GWQI) developed on the basis of the Geographical Information System is effective in the assessment of groundwater quality and its spatial variability, but it is unable to account for uncertainties related to environmental problems. Thus, a Hybrid Fuzzy-GIS-based Water Quality Index (FGQI) has been proposed for the assessment of groundwater quality. The study conducted factor analysis to identify the prime factors responsible for groundwater contamination and collected pre-monsoonal groundwater samples through primary sampling. The groundwater quality was assessed based on eight hydro geochemical parameters (pH, TDS, Calcium, Chloride, Sulfate, Fluoride, Potassium, and Sodium). The spatial interpolation of each parameter was performed using appropriate techniques, selected based on a normality test. The guidelines of the World Health Organization and Bureau of Indian Standard were incorporated in the development of GWQI and FGQI, respectively. Correlation analysis was performed to determine the best fuzzy overlay technique for FGQI, and the Fuzzy GAMMA technique with gamma equal to 0.9 was selected. Finally, the GWQI and FGQI were classified into three classes: unsuitable, moderate suitable, and suitable using "natural break". A higher index indicates a higher water quality. The results show that the groundwater in the central part of Gurugram is suitable for drinking, while it is not suitable in the extreme north, south-east, and western regions. In conclusion, this study finds that FGQI effectively assesses the groundwater quality in the region better than GWQI.

Collimating the growth of twisted crystals of achiral compounds.

A great proportion of molecular crystals can be made to grow as twisted fibrils. Typically, this requires high crystallization driving forces that lead to spherulitic textures. Here, it is shown how micron size channels fabricated from poly(dimethylsiloxane) (PDMS) serve to collimate the circular polycrystalline growth fronts of optically banded spherulites of twisted crystals of three compounds, coumarin, 2,5-bis(3-dodecyl-2-thienyl)-thiazolo[5,4-d]thiazole, and tetrathiafulvalene. The relationships between helicoidal pitch, growth front coherence, and channel width are measured. As channels spill into open spaces, collimated crystals "diffract" via small angle branching. On the other hand, crystals grown together from separate channels whose bands are out of phase ultimately become a single in-phase bundle of fibrils by a cooperative mechanism yet unknown. The isolation of a single twist sense in individual channels is described. We forecast that such chiral molecular crystalline channels may function as chiral optical wave guides.

Allogeneic hematopoietic stem cell transplant in pediatric acute myeloid leukemia: Lessons learnt from a tertiary care center in India.

There is paucity of data on outcomes of MSD-HSCT in children with relapsed or high-risk AML from developing countries, which have unique challenges including adverse host factors and resource constraints. We retrospectively reviewed records of children (age ≤ 18 years) who underwent MSD-HSCT for AML at our center from 2009 to 2019 to evaluate clinical outcome and its predictors using Cox proportional hazards model. There were 46 children (36 boys and 10 girls) with mean age 10.7 ± 4.8 years. Indication for HSCT was relapsed AML in CR2 (n = 37), primary refractory (n = 3), or relapsed refractory disease (n = 3); high-risk (n = 1) or secondary (n = 2) AML in CR1. Five-year EFS and OS were 33.3 ± 7.2% and 36.3 ± 7.6%, respectively. On multivariate analysis, CR1 duration less than 12 months, presence of active disease at transplant, and use of bone marrow stem cell graft were associated with poorer EFS and OS. There was one (2.2%) TRM, while disease relapse occurred in 20/40 patients who underwent HSCT in remission. Though the 5-year EFS and OS were inferior to results reported from high-income countries, relapse (and not TRM) was the major cause of treatment failure. A well-sustained CR1, achievement of disease remission, and use of peripheral blood allograft seem imperative to a successful transplant. Targeted therapy along with HSCT may be the option for those with early relapse.

High-dose chemotherapy followed by autologous stem cell transplant for multiple myeloma: Predictors of long-term outcome.

Background & objectives: Survival of patients with multiple myeloma (MM) has improved in the past two decades following use of novel agents and autologous stem cell transplantation. To determine predictors of long-term outcome, data of MM patients who underwent autologous stem cell transplantation (ASCT) at a tertiary care centre in north India were retrospectively analyzed. Methods: Between 1995 and 2016, 349 MM patients underwent ASCT. Patients' median age was 52 yr, ranging from 29 to 68 yr, 68.2 per cent were males. Thirty three per cent patients had international staging system (ISS) Stage III and 68.5 per cent had received novel agents-based induction. High-dose melphalan (200 mg/m2) was used for conditioning; patients with renal insufficiency (estimated glomerular filtration rate <40 ml/min) received melphalan 140-150 mg/m2. Results: Post-transplant, 317 of 349 (90.8%) patients responded; complete [complete response (CR)] -213 (61%)], very good partial response (VGPR) -62 (17.8%) and PR in 42 (12%)]. Induction with novel agents, pre-transplant chemosensitive disease, transplant in first remission and serum albumin (≥3.5 g/dl) were predictors of significant response. At a median follow up of 73 months, median overall survival (OS) was 90 months [95% confidence interval (CI) 70.8-109.2], and progression-free survival (PFS) was 41 months (95% CI 33.0-49.0). On multivariate analysis, achievement of CR post-transplant, transplant in first remission, ISS Stages I and II (vs. III), absence of extramedullary disease and serum albumin ≥3.5 g/dl were predictors of prolonged OS. For PFS, achievement of post-transplant CR and transplant in first remission were predictors of superior outcome. Interpretation & conclusions: Treatment with novel agents, achievement of complete remission post-transplant, ISS Stages I and II, absence of extramedullary disease and transplant in first remission were predictors of long-term survival for patients with MM.

A dual growth mode unique for organic crystals relies on mesoscopic liquid precursors.

Organic solvents host the synthesis of high-value crystals used as pharmaceuticals and optical devices, among other applications. A knowledge gap persists on how replacing the hydrogen bonds and polar attraction that dominate aqueous environments with the weaker van der Waals forces affects the growth mechanism, including its defining feature, whether crystals grow classically or nonclassically. Here we demonstrate a rare dual growth mode of etioporphyrin I crystals, enabled by liquid precursors that associate with crystal surfaces to generate stacks of layers, which then grow laterally by incorporating solute molecules. Our findings reveal the precursors as mesoscopic solute-rich clusters, a unique phase favored by weak bonds such as those between organic solutes. The lateral spreading of the precursor-initiated stacks of layers crucially relies on abundant solute supply directly from the solution, bypassing diffusion along the crystal surface; the direct incorporation pathway may, again, be unique to organic solvents. Clusters that evolve to amorphous particles do not seamlessly integrate into crystal lattices. Crystals growing fast and mostly nonclassically at high supersaturations are not excessively strained. Our findings demonstrate that the weak interactions typical of organic systems promote nonclassical growth modes by supporting liquid precursors and enabling the spreading of multilayer stacks.

Polymer-Assisted Polymorph Transition in Melt-Processed Molecular Semiconductor Crystals.

A previously unreported polymorph of 5,11-bis(triisopropylsilylethynyl)anthradithiophene (TIPS ADT), Form II, crystallizes from melt-processed TIPS ADT films blended with 16 ± 1 wt % medium density polyethylene (PE). TIPS ADT/PE blends that initially are crystallized from the melt produce twisted TIPS ADT crystals of a metastable polymorph (Form IV, space group P1̅) with a brickwork packing motif distinct from the slipstack packing by solution-processed TIPS ADT crystals (Form I, space group P21/c) at room temperature. When these films were cooled to room temperature and subsequently annealed at 100 °C, near a PE melting temperature of 110 °C, Form II crystals nucleated and grew while consuming Form IV. The growth rate and orientations of Form II crystals were predetermined by the twisting pitch and growth direction of the original banded spherulites in the melt-processed films of the blends. Notably, the Form IV → II transition was not observed during thermal annealing of neat TIPS ADT films without PE. The presence of the mobile PE phase during thermal annealing of TIPS ADT/PE blend films increases the diffusion rate of TIPS ADT molecules, and the rate of nucleation of Form II. Form IV crystals are more conductive but less emissive compared to Form II crystals.

Leveling up Organic Semiconductors with Crystal Twisting.

The performance of crystalline organic semiconductors depends on the solid-state structure, especially the orientation of the conjugated components with respect to device platforms. Often, crystals can be engineered by modifying chromophore substituents through synthesis. Meanwhile, dissymetry is necessary for high-tech applications like chiral sensing, optical telecommunications, and data storage. The synthesis of dissymmetric molecules is a labor-intensive exercise that might be undermined because common processing methods offer little control over orientation. Crystal twisting has emerged as a generalizable method for processing organic semiconductors and offers unique advantages, such as patterning of physical and chemical properties and chirality that arises from mesoscale twisting. The precession of crystal orientations can enrich performance because achiral molecules in achiral space groups suddenly become candidates for the aforementioned technologies that require dissymetry.

Energy Consumption Modeling of 3D-Printed Carbon-Fiber-Reinforced Polymer Parts.

Three-dimensionally printed carbon-fiber-reinforced polymer (3DP-CFRP) has become an important contributor to commercialized additive manufacturing. Due to carbon fiber infills, the 3DP-CFRP parts can enjoy highly intricate geometry, enhanced part robustness, heat resistance, and mechanical properties. With the rapid growth of 3DP-CFRP parts in the aerospace, automobile, and consumer product sectors, evaluating and reducing their environmental impacts has become an urgent yet unexplored issue. To develop a quantitative measure of the environmental performance of 3DP-CFRP parts, this paper investigates the energy consumption behavior of a dual-nozzle fused deposition modeling (FDM) additive manufacturing process which includes melting and deposition of the CFRP filament. An energy consumption model for the melting stage is first defined using the heating model for non-crystalline polymers. Then, the energy consumption model for the deposition stage is established through the design of experiments approach and regression by investigating six influential parameters comprising the layer height, infill density, number of shells, travel speed of gantry, and speed of extruders 1 and 2. Finally, the energy consumption models are combined and experimentally tested with two different CFRP parts. The results show that the developed energy consumption model demonstrated over 94% accuracy in predicting the energy consumption behavior of 3DP-CFRP parts. The developed model could potentially be used to find a more sustainable CFRP design and process planning solution.

Autonomous self-repair in piezoelectric molecular crystals.

Living tissue uses stress-accumulated electrical charge to close wounds. Self-repairing synthetic materials, which are typically soft and amorphous, usually require external stimuli, prolonged physical contact, and long healing times. We overcome many of these limitations in piezoelectric bipyrazole organic crystals, which recombine following mechanical fracture without any external direction, autonomously self-healing in milliseconds with crystallographic precision. Kelvin probe force microscopy, birefringence experiments, and atomic-resolution structural studies reveal that these noncentrosymmetric crystals, with a combination of hydrogen bonds and dispersive interactions, develop large stress-induced opposite electrical charges on fracture surfaces, prompting an electrostatically driven precise recombination of the pieces via diffusionless self-healing.

Prognostic Significance of IL-6 in Hodgkin Lymphoma.

Elevated serum interleukin-6 (IL-6) in Hodgkin lymphoma (HL) is reported to correlate with B symptoms, response rate and survival in adult patients. The authors studied prognostic significance of IL-6 expression by immunohistochemistry on Hodgkin-Reed Sternberg cells and background reactive cells in a retrospective cohort of pediatric HL patients treated with doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) from January 2009 through December 2013. Of 142 patients, tissue blocks were retrieved in 110 patients. On logistic regression analysis, IL-6 expression on background cells alone was among the factors associated with inferior response rate (OR-9.9, 95%CI-1.2, 78.3; p = 0.03). On multivariate analysis, IL-6 expression on background cells alone had significant impact on 5 y freedom from treatment failure (FFTF) (HR-7.7, 95% CI-1.2, 48.6; p = 0.03). IL-6 expression by immunohistochemistry in the background cells is an independent poor predictor of response and FFTF in pediatric HL. Further prospective studies in children are needed to confirm the current findings and whether IL-6 expression can be used to stratify treatment.

Clinical Predictors and Prognostic Model for Pediatric Lymphoblastic Lymphoma Treated With Uniform BFM90 Protocol: A Single-Center Experience of 65 Patients From Asia.

BACKGROUND: There is a lack of clinical predictors for prognosticating lymphoblastic lymphoma (LBL). In view of this lacuna, we evaluated outcomes and prognostic factors for LBL treated with a uniform protocol at our center. PATIENTS AND METHODS: This study included consecutive patients of pediatric LBL aged ≤18 years from January 2003 to January 2017. Patients were staged using the St Jude staging system. All patients were treated with acute lymphoblastic leukemia like BFM90 protocol. The Kaplan-Meier method was used for survival analysis. A statistical model was made using stepwise regression and forward selection of the factors predicting event-free survival (EFS) and overall survival (OS). RESULTS: Sixty-five patients were evaluated with a median age of 12 years (range, 1-18 years) and male:female ratio of 2.25:1. Fifty-four patients presented with mediastinal disease. Median follow-up was 54.57 months (range, 0.6-140.5 months). EFS at 10 years was 62 ± 6% (95% confidence interval [CI], 0.49-0.73) and OS 71 ± 5% (95% CI, 0.57-0.81). In multivariate analysis, symptom duration ≤30 days, white blood cell (WBC) count >12000/µL and serum albumin ≤3.5 g/dL predicted inferior EFS and OS. A prognostic model with these 3 factors suggested that those without any of these risk factors had an OS of 92 ± 5% whereas those with 2 or 3 factors had an OS of 37 ± 14%. CONCLUSION: Our outcomes are 15% to 20% lower than in the published literature. Low albumin level, high WBC count at baseline, and symptom duration <30 days emerged as adverse predictors for EFS and OS. These clinical predictors and prognostic model for pediatric LBL should be validated in prospective cohorts.

Chemotherapy in Nonmetastatic Osteosarcoma: Recent Advances and Implications for Developing Countries.

PURPOSE: Osteosarcoma (OS) is a relatively chemosensitive primary bone tumor, with the peak age of onset occurring in late childhood and early adolescence. The treatment paradigm of nonmetastatic OS has typically been multimodality therapy, including neoadjuvant and adjuvant chemotherapy with definitive surgery. Over the years, various permutations and combinations of chemotherapeutic agents have been used. However, the majority of recent trials have still used high-dose methotrexate as the backbone, with cisplatin and doxorubicin (MAP). In the last decade, various strategies targeted to improving outcomes in OS have included the addition of a fourth drug to the three-drug MAP regimen, changing therapy according to histopathologic response and the addition of immunotherapies. Through this review, we sought to underscore a few pertinent issues related to chemotherapy in nonmetastatic OS, with special reference to challenges confronted in Indian settings. METHODS: We reviewed the literature, focusing on studies comparing high-dose methotrexate and non-high-dose methotrexate-containing regimens. In addition, this review focuses on non-methotrexate-containing triple-drug therapy. RESULTS: Although a high-dose methotrexate regimen has become standard of care in developed countries, there are few data to suggest that it is superior to a non-high-dose methotrexate regimen. CONCLUSION: Developing countries with lack of infrastructure and logistics for high-dose methotrexate might resort to non-high-dose methotrexate-containing regimens with a simultaneous focus on early detection, decreasing abandonment, multidisciplinary clinics, improved surgery, and meticulous pathologic evaluations.

Diffuse large B-cell lymphoma: An institutional analysis.

INTRODUCTION: Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin's lymphoma. We conducted a retrospective study to analyze the clinicopathological characteristics, cell of origin, response to therapy, and the outcome of patients with DLBCL. MATERIALS AND METHODS: This was a retrospective study which included all patients with DLBCL registered at our center, between May 1, 2013, and July 31, 2015. The data regarding demography, clinical presentation, histopathology, stage, prognostic index, treatment, and treatment-related outcome were collected from prospectively maintained clinical case records of the patients. RESULTS: In the study, we included 267 patients. The median age is 49 (20-81) years with male: female ratio of 2:1. B symptoms were seen in 124 (45%) of patients. Early Stages (I and II) were seen in 130 (52%) patients, while advanced Stages (III and 1V) were seen in 119 (48%) patients. Bulky disease (>7.5 cm) was seen in 30% of cases, and bone marrow was involved in 12%. Extranodal involvement is present in 35% of cases. Cell of origin data was available in 160 (60%) of cases, of which 88 (55%) were germinal center and 72 (45%) were activated B cell in origin. The distribution according to the international prognostic index (IPI) was as follows: low risk 40%, intermediate risk 45%, and high risk in 15%. Rituximab was used in 45% of cases. The overall response rate was 84% with a complete response (CR) rate of 70.5%. The CR rates were better with RCHOP compared with CHOP (77% vs. 61.5%, P = 0.001) and good-risk IPI (83.3% vs. 65.2%, P < 0.001) compared with intermediate- and high-risk IPI. Median follow-up period was 24 months, and 2-year event-free survival (EFS) was 70%. The presence of B symptoms, high IPI, failure to attain CR, poor PS, and nonrituximab-based chemotherapy were significantly associated with lower EFS. CONCLUSIONS: This is the first study from India, which investigated the impact of chemotherapy with or without rituximab in context of cell of origin. Adding rituximab to CHOP showed better response rate and EFS irrespective of cell of origin.

Clinicopathological profile of breast cancer: An institutional experience.

INTRODUCTION: This study was undertaken to evaluate the clinicopathological characteristics of patients with breast cancer at our institute, a tertiary-care cancer center in northern India. MATERIALS AND METHODS: This retrospective study included all patients with breast cancer registered at our institute from January 1st, 2014 to December 31st, 2016. We retrieved data (demographic, baseline clinical characteristics, pathology, and treatment details) from prospectively maintained clinical case records. Patients with incomplete case records or missing baseline information were excluded. RESULTS: We included 550 patients with breast cancer. The median age was 48 years (23-85). The median clinical tumor size was 5.0 cm. The TNM (AJCC-7th edition) stage distribution was stage I, 22 (4%); stage II, 182 (33%); stage III, 247 (44.9%); and stage IV, 99 (18%). Locally advanced breast cancer constituted 40% of the cases. Bone (48 [48.5%]) was the most common site for metastasis followed by lung. Infiltrating ductal carcinoma (528 [96%]) was the most common histologic subtype. Majority of patients, 325 (59%), were positive for estrogen receptor/progesterone receptor whereas 160 (29%) patients were HER2/neu positive. Triple negative breast cancer (TNBC) constituted 28% (154) of patients. In the nonmetastatic subgroup, 343 (76%) patients underwent modified radical mastectomy. Neoadjuvant chemotherapy (NACT) was given in 120 (26.6%) patients, of these 23 (19%) achieved pathological complete remission. Sequential anthracyline and taxane were used as NACT/adjuvant chemotherapy in most cases. Of the eligible patients, 48 (30%) received anti-HER2/neu therapy. CONCLUSION: This is one of the largest comprehensive data from a single center in India. Majority of our patients are younger in age and have advanced disease. TNBC and HER2/neu positive breast cancer are more common in our population.

Anthropometric Assessment of the Normal Adult Human Ear.

PURPOSE: Knowledge of anthropometric measurements of the external ear is important as variations exist based on gender, age and ethnicity. This study has derived anthropometric data pertaining to the external ear in the Maharashtrian population. MATERIALS AND METHODS: Nine variables of the external ear were measured in 505 Maharashtrian adults (aged 18-64 years) using photoanthropometric methods. RESULTS: Descriptive data and the left-right symmetry for the study population were obtained. CONCLUSION: These data have applications in screening for or monitoring diseases, otoplastic surgery, forensics, industrial design, apparel design and ergonomics.

Adult Burkitt lymphoma: An institutional experience with a uniform chemotherapy protocol.

BACKGROUND: Burkitt lymphoma (BL) is treated with short, intensive, noncross resistant multidrug chemotherapy regimens. The management of this aggressive lymphoma is a challenge in our resource-limited setting, and the published data from India is scarce. AIM: This retrospective study aims to evaluate the clinical features and treatment outcomes in adult patients with BL treated with uniform chemotherapy, cyclophosphamide, vincristine, doxorubicin, methotrexate, ifosfamide, etoposide, cytarabine (CODOX-M/IVAC) protocol (± Rituximab). MATERIALS AND METHODS: The hospital records between 2011 and 2017 were reviewed to identify adult patients (age ≥18 years) who were treated with CODOX-M/IVAC protocol (± Rituximab). The demographic and clinical details, treatment, outcomes, and toxicity were recorded from the patient's prospectively maintained case records. RESULTS: Eighteen patients were included in this study. The median age was 38 years with male:female ratio 3.5:1. The majority of patients were high risk (14/18). All patients had extranodal site of involvement. The treatment completion rate was 83.3%. The overall response rate = 77.8% including complete response rate = 66.7%. Five patients (27%) had progressive disease on therapy. The estimated 2-year overall survival and event-free survival were 73% and 68.4%, respectively. The most common toxicity was myelosuppression (grade v3/4 neutropenia = 88.8%, grade 3/4 thrombocytopenia = 77.7%, and grade 3/4 anemia = 66.6%), febrile neutropenia was seen in 66.6% cases. Most common nonhematological toxicity was mucositis (grd3/4 = 33.3%). No toxic death was seen. CONCLUSION: This one of the first retrospective analyses of treatment outcomes from India suggests that our patients are demographically and clinically similar to the western counterpart. The treatment completion rate is high despite significant toxicity. BL has a good outcome if treated adequately.

Newer medical therapies for metastatic soft tissue sarcoma.

INTRODUCTION: Metastatic/advanced soft tissue sarcoma has a poor prognosis conventionally, treatment options have been limited. In recent years, this area has been a rich ground for research with many new drugs being approved and several more in the pipeline. With multiple new treatment options available, it is vital to keep up pace with this rapidly changing field. Areas covered: Recent data regarding use of novel agents in advanced soft tissue sarcoma is reviewed with a focus on clinical applicability. The goal is to guide the clinician into choosing appropriate lines of therapy for the individual patient in light of recent availability of multiple new treatment options. Expert commentary: Patients with advanced soft tissue sarcoma can expect to receive several lines of therapy in the modern era. Tumor histology should ideally guide the choice of therapy. The new FDA approved second line drugs viz, trabectedin, pazopanib and eribulin should be considered first after failure of doxorubicin-based chemotherapy. Additional options have become available, such as antiangiogenic agents, mTOR inhibitors, and several new molecules targeting specific oncogenic pathways. All these agents have a role in treating soft tissue sarcoma, and careful individualization of therapy can help achieve optimal outcomes in these challenging patients.

An Extremely Rare Case of Accessory Auricle, Polyotia and its Surgical Correction.

Certain malformations may occur during the embryonic development of the ear. Accessory auricle has a wide range from a small elevation of skin to a large size to resemble an additional auricle, where the latter is called polyotia. This condition is defined as an accessory auricle that is large enough to closely resemble an additional pinna rather than a skin remnant and cartilage. Polyotia, also known as mirror ear or accessory ear, is a type of ear anomaly in the tragus area, but this term refers to substantial anomalies which resemble an accessory ear, unlike a pre-auricular tag. Here, we present a case of an accessory auricle in a young female adult. The occurrence was unilateral; the subject did not have any audiological disorder. A simple surgical procedure is also mentioned for excision of accessory without any complications. We compared our findings with different cases of accessory auricle in the literature. The clinical importance and genetic association are also discussed.