Sand mining in the Mekong Delta: Extent and compounded impacts.

Sand mining has accelerated in recent years primarily due to population increase and rapid urbanization. To meet demand, the rate of sand extraction often exceeds the rate of natural replenishment with serious environmental consequences. In this review paper, the Vietnamese Mekong Delta (VMD), a global hotspot for sand mining with a prolonged history of intensive riverbed extraction, is used as a representative case study to highlight the extent and compounded impacts of this activity. The sand mining budget of the VMD ranged from 8.5 to 45.7 Mm3/yr. The large difference is due to the use of different methods to determine the sand mining budget as well as the difficulties associated with measuring the volume of sand extracted from the riverbed. Widespread illegal mining in the region further exacerbates the mismatch. The environmental consequences of riverbed sand mining include deeply incised riverbeds that result in riverbank and coastal erosion. Massive sediment removal has also led to river water level reductions, disrupted hydrological connectivity, and diminished floodplain inundation. In addition, the augmented backwater effect that results from riverbed lowering, amplifies the extent of saltwater intrusion in the dry season. While the physical and hydrological impacts of sand mining is well studied, studies on the ecological and socio-economic ramifications remain sparse. In addition, the ways in which upstream dams, irrigation infrastructure, excessive groundwater extraction, and sea-level rise (SLR) have amplified the effects of sand mining was also considered in this review. This paper concludes by advocating for the adoption of remote sensing-based approaches for effective mapping of sand mining activities and the need to mine sustainably to balance developmental needs with environmental conservation.

Soil salinization in agriculture: Mitigation and adaptation strategies combining nature-based solutions and bioengineering.

Soil salinization is among the most critical threats to agriculture and food security. Excess of salts adversely affects soil structure and fertility, plant growth, crop yield, and microorganisms. It is caused by natural processes, such as dry climates and low precipitations, high evaporation rate, poor waterlogging, and human factors, such as inappropriate irrigation practices, poor drainage systems, and excessive use of fertilizers. The growing extremization of climate with prolonged drought conditions is worsening the phenomenon. Nature-based solutions (NBS), combined with precision or conservation agriculture, represent a sustainable response, and offer benefits through revitalizing ecosystem services. This perspective explores NBS that can be adopted, along with their challenges and implementation limitations. We also argue that NBS could not be enough to combat hunger in the world's most vulnerable regions and fully achieve the Sustainable Development Goal - Zero Hunger (SDG2). We therefore discuss their possible combination with salt-tolerant crops based on bioengineering.

Apple Watch Sleep and Physiological Tracking Compared to Clinically Validated Actigraphy, Ballistocardiography and Polysomnography.

This paper investigates the performance of the latest Apple Watch (Series 8, released September 2022) in comparison with research grade devices. The Apple Watch was compared to wrist worn actigraphy, non-contact ballistocardiography (BCG) placed in the bed and evaluated with polysomnography (PSG) as a reference system. Sleep analysis and individual cardiorespiratory parameters were measured from the Apple Watch. The Apple Watch performed well for identifying sleep-wake states but had difficulty identifying the sleep stages compared to the reference PSG system. Physiological parameters obtained from the Apple Watch compared well with measurements of the other devices in the study.Clinical Relevance- Consumer devices are readily available and inexpensive compared to clinical devices. A consumer device that can provide accurate physiological data equivalent to a clinical device would let researchers and clinicians collect data without the intrusive nature of a clinical device.

Mapping the vulnerability of irrigation sand traps in a tropical volcanic basin, Indonesia.

Sand traps in irrigation networks are typically used in mitigating canal sedimentation. In irrigation networks located in basins of high sediment yield due to the presence of volcanoes, it is essential to assess the vulnerability of sand traps. Using sediment yield at irrigation scheme inlets, sand trap vulnerability can be evaluated. This study aims to understand the vulnerability of irrigation sand traps throughout the Progo-Opak-Serang (POS) Volcanic River Basin, Indonesia, via mapping the sediment yield distributions in the basin. We employed the Revised Universal Soil Loss Equation to estimate soil loss, where the results show that the average soil loss in the POS River Basin is 179.69 tons/ha/year that falls under the category of moderate erosion potential, while the average sediment yield for the whole basin is 51.04 tons/ha/year. Parts of the basin with high yields of more than 180 tons/ha/year were mostly found along the volcanic mountains such as Sindoro, Sumbing, Merapi, Merbabu, and Telomoyo, and the Menoreh Hills. The model demonstrated relatively high performance with R2, NSE, RMSE, and MAE of 0.89, 0.82, 0.14, and 0.11, respectively. Within the POS Basin, Badran, Kalibawang, and Blawong are the three most vulnerable irrigation sand traps, with sediment yield values of 252.83, 178.92, and 63.49 tons/ha/year, respectively; they are all located in sub-watershed outlets. The vulnerability assessment conducted in this study can be used for the decision support system to prioritize irrigation sand traps towards a more effective irrigation system development.

Uncovering the lack of awareness of sand mining impacts on riverbank erosion among Mekong Delta residents: insights from a comprehensive survey.

Global sand demand due to infrastructure construction has intensified sand mining activities in many rivers, with current rates of sand extraction exceeding natural replenishment. This has created many environmental problems, particularly concerning riverbank stability, which adversely affects the livelihoods of people in the Vietnamese Mekong Delta (VMD). However, sand mining's social impacts in the region remain inadequately understood. Here we assess locals' perception of sand mining activities in the VMD and its impacts on riverbank erosion. Residents living along the Bassac River, a hotspot of sand mining, were interviewed. Our results showed that while sand mining is perceived as destructive to the environment, few were aware of its role in worsening riverbank erosion. Only residents directly affected by riverbank collapse were aware of the implications of sand mining and its negative effect on bank stability, as they seem to have actively sought clarification. Our findings highlight the need for greater awareness and understanding among the locals regarding sand mining's impact on riverbank stability.

Adaptive capacity of high- and low dyke farmers to hydrological changes in the Vietnamese Mekong delta.

This research assesses the adaptive capacity of farmers in the Vietnamese Mekong Delta's floodplains (VMD) with respect to hydrological changes. Currently, climate change and socio-economic developments induce extreme- and diminishing floods, which in turn increase farmers' vulnerability. This research assesses farmers' adaptive capacity to hydrological changes using two prevalent farming systems: high dykes featuring triple-crop rice farming and low dykes where fields are left fallow during the flood season. We examine (1) farmers' perceptions on a changing flood regime and their current vulnerabilities and (2) farmers' adaptive capacity through five sustainability capitals. Methods include a literature review and qualitative interviews with farmers. Results show that extreme floods are becoming less frequent and damaging, depending on arrival time, depth, residence time, and flow velocity. In extreme floods, farmers' adaptive capacity is generally strong, and only low dyke farmers experience damage. As for diminishing floods, which is an emerging phenomenon, the overall adaptive capacity of farmers is remarkably weaker and varies between high- and low dyke farmers. Financial capital is lower for low dyke farmers due to their double-crop rice system, and natural capital is low for both farmer groups due to a decrease in soil- and water quality, affecting yields and increasing investment costs. Farmers also struggle with an unstable rice market due to strong fluctuating prices for seeds, fertilizers, and other inputs. We conclude that both high- and low dyke farmers have to cope with new challenges, including fluctuating flood patterns and the depletion of natural resources. Increasing farmers resilience should focus on exploring better crop varieties, adjusting crop calendars, and shifting to less water-intensive crops.

HRAS Mutations Define a Distinct Subgroup in Head and Neck Squamous Cell Carcinoma.

PURPOSE: In head and neck squamous cell carcinoma (HNSCC), HRAS mutation is a new actionable oncogene driver. We aimed to evaluate HRAS mutational variants, comutation profile, and survival outcomes of this molecularly defined population. METHODS: We leveraged four deidentified patient data sets with HRAS-mutant HNSCC, MD Anderson Cancer Center, Kura Oncology, Inc trial, Foundation Medicine, and American Association for Cancer Research GENIE v.12. Patient demographic information and clinical courses were extracted, when available, in addition to HRAS mutation type and co-occurring mutations. Survival outcomes were analyzed (Kaplan-Meier method). RESULTS: Two hundred forty-nine patients with HRAS-mutant HNSCC were identified from the four data sets. Median age ranged from 55 to 65 years, with a higher frequency in male patients (64%); the majority of HRAS-mutant HNSCC occurred in human papillomavirus-negative HNSCC. HRAS mutation patterns were similar across data sets; G12S was the most common (29%). Treatment responses to tipifarnib were not codon-specific. Compared with wild-type, significantly co-occurring mutations with HRAS were Casp8 (Fisher's exact test, P < .00013), TERT (P < .0085), and NOTCH1 (P < .00013). Analysis of clinical courses from the MD Anderson Cancer Center and Kura Oncology, Inc data sets demonstrated poor clinical outcomes with a high rate of recurrence following primary definitive treatment (50%-67% relapse < 6 months) and short disease-free survival (4.0 months; 95% CI, 1.0 to 36.0) and overall survival (OS; 15.0 months; 95% CI, 6.0 to 52.0). Use of tipifarnib in this data set demonstrated improved OS (25.5 months; 95% CI, 18.0 to 48.0). CONCLUSION: Oncogenic mutations in HRAS occur in 3%-4% of HNSCC, with G12S being the most frequent. Without targeted therapy, patients with HRAS-mutant HNSCC had poor clinic outcomes; observable trend toward improvement in OS has been noted in cohorts receiving treatments such as tipifarnib. The comutation pattern of HRAS-mutant in HNSCC is distinct, which may provide insight to future therapeutic combination strategies.

The Great 2011 Thailand flood disaster revisited: Could it have been mitigated by different dam operations based on better weather forecasts?

This paper revisits the 2011 Great Flood in central Thailand to answer one of the hotly debated questions at the time "Could the operation decisions of the flood control structures substantially mitigate the flood impacts in the downstream areas?". Using a numerical modeling approach, we develop a hypothesis such that the two upstream dam reservoirs: Bhumibol and Sirikit had more accurately forecasted the typhoon-triggered abnormal rainfall volumes and released more water earlier to save the storage capacity via 17 different scenarios or alternative operation schemes. We subsequently quantify the potential improvements, or reduced flood impacts in the downstream catchments, solely by changing the operation schemes of these two dam reservoirs, with all other conditions remaining unchanged. We observed that changing the operation schemes could have reduced only the flood depth while offering very limited improvements in terms of inundated areas for the lower Chao Phraya River Basin. Among 17 scenarios simulated, the inundated areas could have been reduced at most by 3.68%. This result justifies the limited role of these mega structures in the upstream during the disaster on one hand, while pointing to the necessity of handling local rainfall differently on the other. The paper expands the discussion into how the government of Thailand has drawn the lessons from the 2011 flood to better prepare themselves against the lurking flood risk in 2021, also triggered by tropical cyclones. The highlighted initiatives, both technical and institutional, could have provided important references for the large river catchment managers in Southeast Asia and with implications of our method beyond the present application region.

Dorsal Root Ganglion Stimulation for the Management of Phantom Limb Pain: A Scoping Review.

BACKGROUND: Amputees commonly feel an intermittent tingling, piercing, or burning sensation in the region of the missing portion of the amputated limb, a phenomenon known as phantom limb pain. Current treatment modalities include medications, mirror therapy, transcutaneous electrical nerve stimulation, and more recently neuromodulation through spinal cord stimulation and dorsal root ganglion (DRG) stimulation. OBJECTIVES: The aim of this review is to examine the existing literature to identify and analyze evidence for the use of DRG stimulation as a pain relief modality for phantom limb pain. STUDY DESIGN: Scoping Review. METHODS: A literature search was conducted using relevant search terms. PubMed, Web of Science, Cochrane, and CINAHL databases were used, and reference lists of selected articles were searched for additional relevant literature. RESULTS: Most studies analyzed had low to moderate bias in all categories assessed. There are case reports and case series indicating that DRG stimulation could be an effective treatment method for phantom limb pain. Fifteen of 25 patients across 5 studies achieved satisfactory levels of pain relief and significant improvements were reported by all patients evaluated for quality of life. Patient selection and proper targeting of stimulation are important factors in limiting large variability in results while determining effectiveness of this pain relief modality. LIMITATIONS: The studies included in this scoping review are limited by the number of cases and by the length of follow-up. Also, there are no randomized control trials or observational studies with large sample sizes that allow for adequate power. Many of these studies do not have a standardized methodology of quantifying pain relief from DRG stimulation. CONCLUSIONS: The cumulative evidence at present suggests DRG stimulation may be a potentially effective treatment for phantom limb pain, however, a powered prospective randomized controlled trial is needed to assess the long-term benefits of this treatment modality. Given the increasing population of military veterans who are living with limb amputations, finding a modality for adequate long-term pain control is crucial.

Rapid identification of Staphylococcus aureus based on a fluorescence imaging/detection platform that combines loop mediated isothermal amplification assay and the smartphone-based system.

Food associated diseases pose significant public health threat in the United States. Health risks associated with food-borne pathogens drive the need for constant monitoring of food products. An efficient method that can diagnose food-borne pathogens rapidly will be invaluable and in high demand. In this study, we showed the feasibility of a novel rapid detection platform based on fluorescence imaging/detection that combines a user-friendly, portable loop mediated isothermal amplification (LAMP) reaction device and a smartphone-based detection system. The proposed platform was used to detect Staphylococcus aureus which is one of the most important food-borne pathogen especially dairy products. The complete protocol is quicker; the reaction is performed under isothermal conditions and completed in 1 h or less. Experimental results show that LAMP assays were ten-fold more sensitive than PCR-based detection. The proposed smartphone detection system was able to detect and quantify LAMP assay samples containing three different concentrations of S. aureus from 109 CFU/mL down to 103 CFU/mL. The present proof-of-concept study demonstrated that this platform offers a portable, easy to use method for measuring target pathogens with LAMP amplification.

Inhibition of gastric acid secretion with omeprazole affects fish specific dynamic action and growth rate: Implications for the development of phenotypic stomach loss.

An acid-secreting stomach provides many selective advantages to fish and other vertebrates; however, phenotypic stomach loss has occurred independently multiple times and is linked to loss of expression of both the gastric proton pump and the protease pepsin. Reasons underpinning stomach loss remain uncertain. Understanding the importance of gastric acid-secretion to the metabolic costs of digestion and growth will provide information about the metabolic expense of acid-production and performance. In this study, omeprazole, a well characterized gastric proton pump inhibitor, was used to simulate the agastric phenotype by significantly inhibiting gastric acidification in Nile tilapia. The effects on post-prandial metabolic rate and growth were assessed using intermittent flow respirometry and growth trials, respectively. Omeprazole reduced the duration (34.4%) and magnitude (34.5%) of the specific dynamic action and specific growth rate (21.3%) suggesting a decrease in digestion and assimilation of the meal. Gastric pH was measured in control and omeprazole treated fish to confirm that gastric acid secretion was inhibited for up to 12 h post-treatment (p < 0.05). Gastric evacuation measurements confirm a more rapid emptying of the stomach in omeprazole treated fish. These findings reinforce the importance of stomach acidification in digestion and growth and present a novel way of determining costs of gastric digestion.

Spatial-social evaluations of ecosystem services of adaptive aquaculture models using SAR and multivariate analyses: a case in the Vietnamese Mekong Delta.

The presented study is conducted to investigate the efficiency of two important aquaculture models of the Vietnamese Mekong Delta (VMD)'s Soc Trang province via quantifying and mapping the supporting ecosystem services (ES). The study targets the two most prevalent rearing practices, intensive and semi-intensive, covering four rural districts: My Xuyen, Tran De, Cu Lao Dung, and Vinh Chau. A mixed-method approach was applied, combining remote sensing, grass-root social survey, and multivariate statistical analyses. First, image analysis using Sentinel-1A time-series data was conducted to detect the aquaculture areas across the study area based on temporal changes of VV backscatter of different land use/land cover (LULC) types, in which aquaculture receives relatively low backscatter values compared to other LULC categories except river and deeper water surfaces. Our analysis yields an overall accuracy of 91% with a kappa coefficient of 0.82. Second, using semi-structured questionnaires, a total of 140 shrimp farming households across the four focused districts were interviewed for their rearing experience. Thereupon, the collected responses were analyzed using two multivariate analyses, including principal component analysis (PCA) and hierarchical cluster analysis (HCA). In general, the intensive model could have generated more economic values of ecosystem services than the artisanal/semi-intensive model. Our analyses also took note of the potential barriers hindering the semi-intensive farmers from achieving higher economic income. These include (i) geographical factors, i.e., locations; (ii) social factors, i.e., experience, farming calendar, education; (iii) financial factors, i.e., investments; and (iv) technical factors, i.e., farm areas, productivity, rearing concentration. Since semi-intensive food is more appropriate for small-scale farming households, it is recommendable that addressing these factors can enhance the efficiency of this model as a profitable livelihood option.

Decoding Brain Signals to Classify Gait Direction Anticipation.

The use of brain-computer interface (BCI) technology has emerged as a promising rehabilitation approach for patients with motor function and motor-related disorders. BCIs provide an augmentative communication platform for controlling advanced assistive robots such as a lower-limb exoskeleton. Brain recordings collected by an electroencephalography (EEG) system have been employed in the BCI platform to command the exoskeleton. To date, the literature on this topic is limited to the prediction of gait intention and gait variations from EEG signals. This study, however, aims to predict the anticipated gait direction using a stream of EEG signals collected from the brain cortex. Three healthy participants (age range: 29-31, 2 female) were recruited. While wearing the EEG device, the participants were instructed to initiate gait movement toward the direction of the arrow triggers (pointing forward, backward, left, or right) being shown on a screen with a blank white background. Collected EEG data was then epoched around the trigger timepoints. These epochs were then converted to the time-frequency domain using event- related synchronization (ERS) and event-related desynchronization (ERD) methods. Finally, the classification pipeline was constructed using logistic regression (LR), support vector machine (SVM), and convolutional neural network (CNN). A ten-fold cross-validation scheme was used to evaluate the classification performance. The results revealed that the CNN classifier outperforms the other two classifiers with an accuracy of 0.75. Clinical Relevance - The outcome of this study has the potential to be ultimately used for interactive navigation of the lower-limb exoskeletons during robotic rehabilitation therapy and enhance neurodegeneration and neuroplasticity in a wide range of individuals with lower-limb motor function disabilities.

Overprescription of opioid analgesia is common following ambulatory Otolaryngology-Head and Neck surgery procedures: A multicenter study.

Background: The rise in the use of prescription opioids for postoperative analgesia within surgery has mirrored an increased trend of opioid-related morbidity within Canada and the United States. This study prospectively studied daily pain levels and medication requirements postoperatively in patients undergoing elective Otolaryngology-Head and Neck surgery procedures. Methods: Patients were asked to prospectively document their pain level and medication use daily for 7 days postoperatively. A final survey was used to quantify unused medication left at home and clarify each patient's disposal plan. We included patients undergoing elective outpatient or short stay surgeries from three tertiary care centers in Toronto, Ontario from September 2016 to September 2017. Previous opioids users or patients suffering from chronic pain were excluded. Results: A final cohort of 56 eligible adult patients were included in the study. The most common procedures were thyroidectomy (n = 19), endoscopic sinus surgery (n = 10), tympanoplasty/ossiculoplasty (n = 7), and cochlear implant (n = 5). Most patients received a prescription for acetaminophen/codeine (n = 29, 51.8%) or acetaminophen/oxycodone (n = 22, 39.3%) and used on average 29% of their initial prescription. Patients most commonly opted to keep their unused narcotics at home (n = 23, 41%). A total of 710 tablets of narcotics were overprescribed in our study population, 351 of which were kept in patients' home for future use. Conclusion: There is a clear tendency to overestimate postoperative pain resulting in significant overprescription of opioids among Otolaryngologists.

Increased chlorophyll-a concentration in Barra Bonita reservoir during extreme drought periods.

Climate projections models indicate that longer periods of droughts are expected within the next 100 years in various parts of South America. To understand the effects of longer periods of droughts on aquatic environments, we investigated the response of chlorophyll-a (Chl-a) concentration to recent severe drought events in the Barra Bonita Hydroelectric Reservoir (BBHR) in São Paulo State, Brazil. We used satellite imagery to estimate the Chl-a concentration from 2014 to 2020 using the Slope Index (NRMSE of 18.92% and bias of -0.20 mg m-3). Ancillary data such as precipitation, water level and air temperature from the same period were also used. Drought events were identified using the standardized precipitation index (SPI). In addition, we computed the probability of future drought events. Two periods showed extremely dry conditions: 1) January-February (2014) and 2) April-May (2020). Both periods were characterized by a recurrence probability of 1in every 50 years. The highest correlation was observed between Chl-a concentration and SPI (-0.97) in 2014, while Chl-a had had the highest correlation with water level (-0.59) in 2020. These results provide new insights into the influence of extreme drought events on the Chl-a concentration in the BBHR and their relationship with other climate variables and reservoir water levels. Drought events imply less rainfall, higher temperatures, and atmospheric dryness, and these factors affect evaporation and the water levels in the reservoir.

Monsoonal variations of lead (Pb) in coastal waters around Singapore.

Anthropogenic lead (Pb) has been the overwhelming Pb source to the global ocean, primarily contributed from Pb gasoline and industrial emissions. However, since Pb gasoline has been phased out globally, questions about whether there was a decrease in seawater Pb concentration, or if there are other sources taking over remains unclear in Southeast Asia. Here, combining Pb concentrations in seawater from Singapore Strait in 2010-2017; trap sediment in 2018-2019; and the previously published coral reconstruction covering 1975-2010; we found that the seawater Pb concentration in Singapore Strait over past decades followed the regional gasoline emissions, and no additional major source had contributed the Pb in the seawater since ~2010. The present-day Pb in Singapore Straits' water mainly follows the monsoonal current reversals, with variable degrees of scavenging that peak in inter-monsoon season. Minor Pb sources still contribute to some local-scale variabilities, despite a decadal-scale decreasing trend of Pb in seawater.

Increased burned area in the Pantanal over the past two decades.

Wildfires are behaving differently now compared to other time in history in relation to frequency, intensity and affected ecosystems. In Brazil, unprecedented fires are being experienced in the last decade. Thus, to prevent and minimize similar disasters, we must better understand the natural and human drivers of such extreme events. The Brazilian Pantanal is the largest contiguous wetland in the world and a complex environmental system. In 2020, Pantanal experienced catastrophic wildfires due to the synergy between climate, inadequate fire management strategies and weak environmental regulations. In this study, we analyzed recent patterns and changes in fire behavior across the Pantanal based on land use and cover (LULC) classes. The inter-annual variability of the fire and land cover changes between 2000 and 2021 was assessed using BA from MCD64A1 V.6 product and LULC data from Landsat satellite. Our work reveals that fires in the Pantanal over the last two decades tended to occur more frequently in grassland than in others land cover types, but the 2020 fires have preferentially burned forest regions. Large fire patches are more frequent in forest and grasslands; in contrast, croplands exhibit small patches. The results highlight that a broad scale analysis does not reflect distinct localized patterns, thus stratified and refined studies are required. Our work contributes as a first step to disentangling the role of anthropogenic-related drivers, namely LULC changes, in shaping the fire regime in the Pantanal biome. This is crucial not only to predict future fire activity but also to guide appropriated fire management in the region.

Deep well injection for the waste brine disposal solution of potash mining in Northeastern Thailand.

Under the pressure of the existing world population growth trends, the dercreasing pastoral fields and the increasing duration and incidences of drought and heat stress, the potash fertilizers demand dramaticly increase to enhance the world food production. Asia currently consumes 40% of the world's potash market, yet 70% of world potash exports come from mines in Canada and Europe. Weak collective efforts to produce potassium fertilizers economically pose the risk of global shortages of potash goods and threatening global food security. While the Khorat Plateau in Northeastern Thailand is noted to contain active and promising regional potash deposits, developing a proper potash industry in the region has largely been unsuccessful due to major constraints such as the challenge of establishing a brine disposal solution. This study demonstrates the performance of deep well injection (DWI) as an environmentally friendly alternative to secure waste brine production from the potash mine. The groundwater numerical model demonstrates the movement and penetration of the concentrate during and after deep well injection. The boundary condition was utilized from the regional hydrogeology data. The waste brine injection is based on the waste products of the mine factory. Our simulation shows that the DWI can isolate waste brine with freshwater by injecting it into the deep formation based on the geologic structure and properties analysis. With high porosity and low specific yield, the Khok Kruat formation within Khrat Basin shows a high potential injection rate of 200,000 m3/day, which is 200 times higher than current water brine production rates. Moreover, the salinity can easily dissolve into the target domain with specific formation properties. Hence, the DWI not only boosts the potash industry's image in the long term but also enable sustainable potash mining development in the region. Finally, we recommend that government agencies with regulatory oversight over the DWI must promote further research associated with site characterization, well construction and injection technologies, and monitoring tools in the long term.

Paraganglioma masquerading as a primary liver lesion: A rare entity discovered during surgery.

A 54-year-old woman with controlled hypertension presented with abdominal pain and weight loss. Imaging revealed a 6.6 cm liver lesion. During resection, she became severely hypertensive and diagnosis was paraganglioma. Hepatic paragangliomas are exceedingly rare but must be considered in the differential of abdominal mass even without typical clinical symptoms.

The worst 2020 saline water intrusion disaster of the past century in the Mekong Delta: Impacts, causes, and management implications.

Vietnam Mekong Delta (VMD), the country's most important food basket, is constantly threatened by drought-infused salinity intrusion (SI). The SI disaster of 2020 is recognized as the worst in recent decades, hence inspiring this perspective article. The authors' viewpoints on the disaster's impacts and causes are presented. The arguments presented are mainly drawn from (i) up-to-date publications that report on the recent SI intensification in the VMD and (ii) the power spectral analysis results using water level data. We verified the intensifying SI in the VMD both in its frequency and magnitude and remarked on four of the key SI drivers: (i) upstream hydropower dams, (ii) land subsidence, (iii) the relative sea-level rise, and (iv) riverbed sand mining. Also, a non-exhaustive yet list of recommendable management implications to mitigate the negative effects of the SI is contributed. The mitigation measures must be realized at multiple scales, ranging from pursuing transboundary water diplomacy efforts to managing internal pressures via developing early warnings, restricting illegal sand mining activities, alleviating pressures on groundwater resources, and diversifying agriculture.