To explore the seasonal variability and associated health risks of dissolved trace elements (TEs), a total of 45 water samples (15 samples in each season) were collected from the Seti River Basin during pre-monsoon, monsoon, and post-monsoon seasons. A total of 15 TEs were analysed and the results revealed that Arsenic (As), Chromium (Cr), and Nickel (Ni) were primarily controlled by lithogenic sources, whereas, Cadmium (Cd), Cobalt (Co), Cesium (Cs), Cupper (Cu), Manganese (Mn), Lead (Pb), and Zinc (Zn) were derived from both anthropic and geogenic sources. Additionally, the concentration of Zn was markedly high, especially during the post-monsoon season nearby the landfill site, indicating the anthropic signatures. The hazard index and cancer index were found to be less then  1.00 and 10-6-10-4, respectively indicating minimum health impacts. The water quality index was less then  50 throughout the sampling periods, with better water quality during the monsoon. This study could help to formulate the necessary policies for the sustainability of the Himalayan River Basins.
  The aim was to determine long-term outcomes over a decade after first rib resection (FRR) in patients with neurogenic thoracic outlet syndrome (NTOS). A secondary aim was to investigate correlation of residual rib stump with long-term symptoms.
 
  This ambispective cohort included patients who underwent transaxillary FRRs for NTOS between 1998 and 2007. Short-term outcomes at 3-month clinical follow-up were retrospectively collected from medical records. Patients who agreed to participate in the study were invited to a long-term clinical follow-up in 2019. Disabilities of Arm, Shoulder, and Hand Score and Cervical Brachial Symptom Questionnaire were used. A chest X-ray limited to a clavicular projection was taken, and the length of the residual first rib was measured.
 
  Twenty patients mean age 41.8 [standard deviation (SD) 10.3 years] who underwent 27 FRRs participated in the study. The mean follow-up time was 14.9 (SD 3.6) years. Excellent or good recovery was noted after 16 (59.3% of operated arms) operations in the short-term follow-up and 22 (81.5%) operations in the long-term follow-up. No reoperations were necessary for residual symptoms. The mean Cervical Brachial Symptom Questionnaire score was 26.7 (SD 28.2) (maximum 120), and the Disabilities of Arm, Shoulder, and Hand Score was 21.1 (SD 18.4) (maximum 100) points. Twenty-six patients (96.3%) had a noticeable residual first rib stump. The mean length of the residual first rib was 28.9 (SD 9.5) mm. More than 30-mm rib stump did not indicate a worse long-term outcome.
 
  This study showed good long-term outcome without symptom recurrence after FRR for NTOS. In most patients, after surgery, quality of life and ability to work improved. Residual rib stump length was not associated with the treatment outcome.
 This study showed good long-term outcome without symptom recurrence after FRR for NTOS. In most patients, after surgery, quality of life and ability to work improved. Residual rib stump length was not associated with the treatment outcome.The global burden of neurologic disease is high and its impact manifests in health disparities observed in rural communities of limited resources like those surrounding San Lucas Tolimán, Guatemala. Telehealth may be one method to close these gaps by offering a virtual neurology curriculum. The goal of this project was to determine the pervasiveness of neurologic disease in San Lucas Tolimán and to increase interest and knowledge in neurology topics for local health promotors. A neurologic needs assessment was performed during the initial site visit. This information was subsequently used to create monthly health promotor neurology-based workshops and remote consultations delivered via a telehealth platform over the following year. The 29 health promotors were surveyed before and after the neurology course to measure self-reported knowledge of variable topics as well as their interest in neurology and how effective the remote lectures were. The needs assessment identified at least 68 different patients with neurologic diseases, the most common being headaches and seizures. The health promotors' knowledge of several neurologic diseases as well as their comfort level diagnosing a condition based on a description of neurologic symptoms significantly increased following the year-long neurology course. The lectures were convenient, easy to see and hear virtually, and increased the health promotors' interest in neurology. Telehealth is an acceptable and feasible method of delivering educational neurology topics relevant to rural communities.  https://www.selleckchem.com/products/pf-04620110.html  Future, longer-term studies are needed to determine if telehealth interventions such as these impact neurologic patient outcomes.
  The aim of this study was to evaluate the efficacy of adjuvant chemotherapy (ACT) for thymic squamous cell carcinoma after completely resection.
 
  Patients with thymic squamous cell carcinoma treated with complete resection between January 2009 and December 2016 were retrospectively identified. Kaplan-Meier analysis was used to summarize the time-to-event variables. Univariable and multivariable Cox proportional hazards regression analyses were performed.
 
  A total of 116 patients were analysed with 44 patients in the non-ACT group and 72 patients in the ACT group. No significant difference was found in the 5-year recurrence-free survival (RFS) rate (58.1% vs 51%, P = 0.33) or the 5-year overall survival (OS) rate (77.7% vs 67.1%, P = 0.26) between the ACT group and the non-ACT group. Masaoka stage was the only independent prognostic factor for both RFS and OS. Subgroup analysis showed significant improvement in 5-year RFS for Masaoka stage II patients (P = 0.035) and 5-year OS (P = 0.036) for Masaoka stage III patients when comparing ACT with non-ACT. No chemotherapy-related death occurred. The most frequent adverse effect higher than grade 3 was neutropenia.
 
  For completely resected thymic squamous cell carcinoma, ACT significantly improved the 5-year RFS in Masaoka stage II patients and the 5-year OS in Masaoka stage III patients.
 For completely resected thymic squamous cell carcinoma, ACT significantly improved the 5-year RFS in Masaoka stage II patients and the 5-year OS in Masaoka stage III patients.