Evaluating the feasibility of water sharing as a drought risk management tool for irrigated agriculture

Droughts can exert significant pressure on regional water resources resulting in abstraction constraints for irrigated agriculture with consequences for productivity and revenue. While water trading can support more efficient water allocation, high transactional costs and delays in approvals often restrict its wider uptake among users. Collaborative water sharing is an alternative approach to formal water trading that has received much less regulatory and industry attention. This study assessed how the potential benefits of water sharing to reduce water resources risks in agriculture are affected by both drought severity and the spatial scale of water-sharing agreements. The research focused on an intensively farmed lowland catchment in Eastern England, a known hot-spot for irrigation intensity and recurrent abstraction pressures. The benefits of water sharing were modelled at four spatial scales: (i) individual licence (with no water sharing), (ii) tributary water sharing among small farmer groups (iii) sub-catchment and (iv) catchment scale. The benefits of water sharing were evaluated based on the modelled reductions in the probability of an irrigation deficit occurring (reducing drought risks) and reduced licensed ‘headroom’ (spare capacity redeployed for more equitable allocation). The potential benefits of water sharing were found to increase with scale, but its impact was limited at high levels of drought severity due to regulatory drought management controls. The broader implications for water sharing to mitigate drought impacts, the barriers to wider uptake and the environmental consequences are discusse

Elucidating drivers of oral epithelial dysplasia formation and malignant transformation to cancer using RNAseq

Oral squamous cell carcinoma (OSCC) is a prevalent cancer with poor prognosis. Most OSCC progresses via a non-malignant stage called dysplasia. Effective treatment of dysplasia prior to potential malignant transformation is an unmet clinical need. To identify markers of early disease, we performed RNA sequencing of 19 matched HPV negative patient trios: normal oral mucosa, dysplasia and associated OSCC. We performed differential gene expression, principal component and correlated gene network analysis using these data. We found differences in the immune cell signatures present at different disease stages and were able to distinguish early events in pathogenesis, such as upregulation of many HOX genes, from later events, such as down-regulation of adherens junctions. We herein highlight novel coding and non-coding candidates for involvement in oral dysplasia development and malignant transformation, and speculate on how our findings may guide further translational research into the treatment of oral dysplasia

Prognostic factors in oral cancer surgery - results from a UK tertiary centre

Introduction Oral cancer surgery is complicated by the diverse nature of clinical and histopathological presentations that occur. Current National guidance recognises the significant role that surgical margin status plays in the overall survival of patients. Many other histopathological factors influence patient survival, the importance of which varies between the literature. Materials and methods In this prospective longitudinal study, all patients diagnosed with squamous cell carcinoma who had primary surgical treatment under general anaesthesia were included. Surgery was performed by one surgical team within this tertiary referral centre. Patients were followed up for a maximum of 7 years following their surgery. Results A total of 250 patients were included from 2015 to 2022. Patients were 61.44 years old (SD 13.23) at diagnosis, and 56.4% were male (n = 141). Pathology was mainly pT1 (39.1%) and the most common sites were the border of tongue (31.2%) and floor of mouth (18.8%). 43.4% of patients had clear surgical margins, with overall survival being significantly associated with margin status (p = 0.0079). Extra-capsular spread was significantly associated with higher risk of death from metastatic head and neck cancer (p = 0.014), whereas presence of high-grade dysplasia at surgical margins and depth of invasion of tumour were not. Conclusion This study has reinforced the importance of surgical margin clearance and as such the development of intra-operative techniques to ensure this is imperative. The significance of extra-capsular spread in survival has also been demonstrated. Discussion regarding the current deficiency in accurate pre-operative diagnostic methods for extra capsular spread is covered

An enhanced version of the D-Risk decision support webtool for multi-scale management of water abstraction and drought risks in irrigated agriculture

Due to it having the lowest priority for water allocation during drought events and the consequent agronomic and economic impacts of abstraction restrictions, UK irrigated agriculture has been identified as a key business sector ‘at risk’. An enhanced version of the D-Risk webtool has been developed to help agricultural stakeholders and catchment water managers to evaluate the joint multi-scale risks of abstraction restrictions (voluntary and mandatory) and having insufficient irrigation volumes during drought events. The webtool uses annual maximum potential soil moisture deficit as the agroclimate index to calculate monthly and annual volumetric irrigation demand for the selected crop mix, soil available water capacity and location. Simulated river flows are used to identify days not under abstraction restrictions. Annual probability distributions of irrigation deficit and licence utilisation (headroom) are derived from a monthly time-step water balance model that calculates whether the farm irrigation demand in each month can be met, taking account of river flow-based abstraction restrictions, daily and annual volumetric licensed abstraction limits, the licenced abstraction period(s) and any on-farm reservoir storage. The enhanced D-Risk tool provides a more holistic understanding of drought risk on irrigated agriculture from individual farm to catchment scales and supports improved collaborative decision-making regarding future water sharing, water trading and on-farm reservoir investment to reduce business vulnerability to drought and regulatory change

Standardisation of labial salivary gland histopathology in clinical trials in primary Sjögren's syndrome

Labial salivary gland (LSG) biopsy is used in the classification of primary Sjögren's syndrome (PSS) and in patient stratification in clinical trials. It may also function as a biomarker. The acquisition of tissue and histological interpretation is variable and needs to be standardised for use in clinical trials. A modified European League Against Rheumatism consensus guideline development strategy was used. The steering committee of the ad hoc working group identified key outstanding points of variability in LSG acquisition and analysis. A 2-day workshop was held to develop consensus where possible and identify points where further discussion/data was needed. These points were reviewed by a subgroup of experts on PSS histopathology and then circulated via an online survey to 50 stakeholder experts consisting of rheumatologists, histopathologists and oral medicine specialists, to assess level of agreement (0–10 scale) and comments. Criteria for agreement were a mean score ≥6/10 and 75% of respondents scoring ≥6/10. Thirty-nine (78%) experts responded and 16 points met criteria for agreement. These points are focused on tissue requirements, identification of the characteristic focal lymphocytic sialadenitis, calculation of the focus score, identification of germinal centres, assessment of the area of leucocyte infiltration, reporting standards and use of prestudy samples for clinical trials. We provide standardised consensus guidance for the use of labial salivary gland histopathology in the classification of PSS and in clinical trials and identify areas where further research is required to achieve evidence-based consensus

Primary malignant gingival melanoma : case report and educational reminder

Oral melanomas are extremely rare tumours accounting for approximately 1.6% of all head and neck malignancies. They usually have a silent clinical presentation but are distinctly more aggressive than all other types of melanoma. Poor patient awareness coupled with a lack of education amongst health care professionals in recognising premalignant pigmented lesions can result in delayed patient presentation and referral to specialist services for diagnosis and treatment. We present the case of a patient who was referred to the Oral Medicine Department at Leeds Dental Institute with a hyper‐pigmented lesion affecting the maxillary gingivae. Histopathology findings confirmed a diagnosis of primary malignant gingival melanoma (Breslow stage 1). The patient sadly died less than 6 months later. This case highlights the importance of early detection, timely referral and the need for greater public awareness in order to improve prognosis of such highly invasive lesions

Recurrent oral metastatic lesion of renal cell carcinoma - A case report

Metastatic lesions to the oral cavity are extremely rare, accounting for approximately 1% of all malignant oral tumours [1]. Although an uncommon tumour, Renal Cell Carcinoma (RCC) is the most common type of renal tumour presenting in adults, originating from the lining of the proximal convoluted tubule. It is responsible for approximately 90%–95% of all cases in kidney cancer [1].It is known to metastasise 20% to 25% most frequently to the brain and liver. Renal Cell Carcinoma can also metastasise to the oral cavity, although rarely (around 1%).</p

Margins and survival in oral cancer

In the surgical management of oral squamous cell carcinoma (SCC) we aim to resect the tumour with clear margins in all planes. The aim of this study was to identify and compare overall survival in a group of 591 patients who had resections, and to relate this to the clearance of margins at the tumour bed. We used life tables to calculate survival at one, two, three, five, and 10 years after diagnosis by margin (clear = 5 mm or more; close = 2–5 mm; and involved = less than 2 mm). Kaplan–Meier curves were produced for the margins alone, which were defined as clear in 480 patients (81%), close in 63 (11%), and involved in 48 (8%). Five-year survival was 81%, 75%, and 54% for clear, close, and involved margins, respectively, which highlights the importance of clear margins for survival. There is a significant prognostic implication associated with close, and particularly with involved, margins