Harnessing ZnCr2O4/g-C3N4 nanosheet heterojunction for enhanced photocatalytic degradation of rhodamine B and ciprofloxacin.

Utilizing semiconductors for photocatalytic processes in water bodies as an approach to environmental remediation has gained considerable attention. Theoretical band position calculations revealed a type-II step-scheme charge flow mechanism for ZnCr2O4/g-C3N4 (ZCr/gCN), emphasizing effective heterojunction formation due to synergies between the materials. A composite of agglomerated nanoparticle ZnCr2O4 (Zinc chromium oxide - ZCr)/g-C3N4 (graphitic carbon nitride - gCN) nanosheets was synthesized using the ultrasonication and leveraging the heterojunction to enhance degradation efficiency and active sites participation. The synthesized sample was characterized by XRD, XPS, FTIR, BET, HRSEM, EDX, HRTEM, EIS PL, and UV-visible spectroscopy. XRD analysis confirmed the successful formation of pure ZnCr2O4, g-C3N4 (gCN), and their composite without any secondary phases. Optical investigations demonstrated a red shift (444-470 nm) in UV-visible spectra as ZnCr2O4 content increased. Morphological assessment via HRSEM unveiled agglomerated nanoparticle and nanosheet structures. FTIR analysis indicated the presence of gCN with the tri-s-triazine breathing mode at 807 cm-1, and the identification of octahedral Zn-O (598.11 cm-1) and tetrahedral Cr-O (447.01 cm-1) metal bonds within the spinel structure of ZnCr2O4. A Surface area of 134.162 m2/g was noticed with a microporous structure of pore radius 1.484 nm. Notably, the 15% ZCr/gCN composite achieved a remarkable 93.94 % (Rhodamine B-RhB) and 74.36 % (Ciprofloxacin - CIP) within 100 and 120 min, surpassing the performance of pure gCN. Improved degradation was attributed to higher charge separation (photo-excited electrons and holes), reducing charge recombination, as supported by photoluminescence and photoelectrochemical analyses. The presence of active species like superoxide during degradation was confirmed through a scavenger test. The stability analysis confirms the sample's stable nature (without secondary phase formation) after degradation. This work underscores the potential of ZnCr2O4 based metal-free compounds intended for effective environmental remediation.

The effect of levosimendan on the right ventricular function in patients with right ventricular dysfunction undergoing mitral valve surgery.

Background: Right ventricular (RV) dysfunction is an important predictor of both immediate and long-term outcomes in valve surgeries. Levosimendan has proven beneficial in improving RV function. Aims: The objective was to study the effect of the addition of levosimendan to the conventional treatment on RV function in patients with RV dysfunction undergoing mitral valve (MV) surgeries. Setting and Design: Prospective randomized double-blinded controlled study at a tertiary care institution. Materials and Methods: Sixty adult patients aged 15-65 years, with preoperative transthoracic echocardiography (TTE) findings of RV dysfunction posted for elective MV surgery, were randomized into levosimendan (L) group and placebo (P) group. Patients in the L group were administered levosimendan at a rate of 0.1 mcg/kg/min after induction for 24 hrs, whereas patients in the P group were given multivitamin infusion at the same rate. Both the groups received standard inotropic therapy. The hemodynamic and echocardiographic parameters of RV function (RV size, Inferior vena cava (IVC) diameter, RV fractional area change (RVFAC) Tricuspid annular plane systolic excursion (TAPSE), and Systolic Pulmonary Artery Pressure (SPAP) were compared between the groups at 6 hrs, 24 hrs, and 7th day postoperatively. Results: All hemodynamic and echocardiographic parameters of RV function like RV size, IVC diameter, RVFAC, TAPSE, and SPAP improved from baseline to 24 hrs in both groups. Levosimendan caused a significant improvement in RV function compared to the P group at 24 hrs and 7th day postoperatively. Conclusions: The present study concludes that levosimendan is a promising option in patients with RV dysfunction undergoing MV surgeries.

Investigation of non-covalent interactions in Polypyrrole/Polyaniline/Carbon black ternary complex for enhanced thermoelectric properties via interfacial carrier scattering and π-π stacking.

The thermoelectric (TE) performance of conducting polymers can be improved by the incorporation of carbon nanomaterials. In this work, the impact of carbon black (CB) on polypyrrole (PPy) and polypyrrole/polyaniline (PPy/PANI) binary composite have been investigated. Herein, PPy/PANI binary composite was initially prepared through chemical oxidative polymerization and then solution mixed with CB to form PPy/PANI/CB ternary nanocomposite. The structural and morphological analyses confirmed the formation of composites, and the strong interaction present between polymer matrix and CB. This was further confirmed by theoretical study, which showed strong noncovalent interaction and high complex stability between the materials. The thermoelectric results showed that both the electrical conductivity (σ) and Seebeck coefficient (S) has been increased with the increase in CB content (from 10 wt% to 30 wt%) and temperature (303 K to 373 K), while the thermal conductivity (κ) increase was low. The ternary nanocomposite involving 30 wt% of CB was found to be the most promising material which showed an enhanced power factor (PF) of 0.0251 µW/mK2 and high figure of merit (ZT) of 4.37x10-5 at 370 K. The enhancement in ZT for PPy/PANI/CB ternary composite is 2 times, 316 times, 17.3 times, 3.97 times, 11.7 times, and 6.8 times greater than other samples. The enhancement in power factor and ZT was due to energy filtering effect and strong non-covalent interactions between the homopolymers and CB.

Randomized control study of nebulized colistin as an adjunctive therapy in ventilator-associated pneumonia in pediatric postoperative cardiac surgical population.

Background: Ventilator-associated pneumonia (VAP) with multidrug-resistant (MDR) gram negative organisms is a common problem in intensive care unit (ICU). Aerosolized antibiotics enhance the efficacy of systemic antibiotics when added as adjuvants. Aim: The primary objective of the study was to compare the clinical and bacteriological outcome of patients with VAP who were administered intravenous (IV) antibiotics alone with those patients who were treated with adjunctive nebulized colistin (NC) along with IV antibiotics. The secondary objective was to study the occurrence of any adverse events during colistin nebulization. Settings and Design: The study was a prospective, randomized, double-blinded controlled study conducted at a tertiary-care teaching institution. Materials and Methods: Ninety-eight children from surgical ICU aged less than 12 years who were diagnosed with VAP due to gram negative bacteria following cardiac surgery were chosen and divided randomly into two groups. The experimental group (NC group) was treated with systemic antibiotics along with NC, whereas the control group (NS group) was administered systemic antibiotics with nebulized normal saline (NS). Clinical and bacteriological outcomes were noted. Statistical analysis was done using SPSS Version 20.0 software. The patient characteristics were compared using independent Student's t test and Chi-square test. Results: There was a statistically significant reduction in the duration of mechanical ventilation, postoperative ICU and hospital stay (P < 0.05) in the NC group compared with the NS group. Conclusion: Aerosolized colistin may be considered as an adjunct to systemic IV antibiotics in pediatric patients with VAP due to gram negative bacteria susceptible to colistin.

Calcifying Epithelial Odontogenic Cyst of Maxilla: Report of A Case and Review and Discussion on the Terminology and Classification.

A cyst is defined as a pathological cavity which may or may not have an epithelial lining and which has a fluid, semi-fluid, or gaseous contents and is not formed by accumulation of pus. The calcifying epithelial odontogenic cyst (CEOC) was first reported by Gorlin et al. in 1962. At that time, it was classified as a cyst related to the odontogenic apparatus. It was later renamed as calcifying cystic odontogenic tumor (CCOT) in the World Health Organization classification devised in 2005 due to its histological complexity, morphological diversity, and aggressive proliferation. CCOT was later recognized by numerous names including Gorlin cyst, calcifying ghost cell odontogenic cyst, and/or dentinogenic ghost cell tumor. It has a peak incidence during the second and third decades of life and does not demonstrate any gender predilection. Radiographically, CEOC may appear as a unilocular or multilocular radiolucent lesion with either well-circumscribed or poorly-defined margins and may also be observed in association with unerupted teeth. Calcification is an important radiographic feature for the interpretation of CEOC/CCOT. The typical histopathological features of CEOC include a fibrous wall and lining of odontogenic epithelium with either columnar or cuboidal basal cells resembling ameloblasts. The treatment of choice for CEOC is conservative surgical enucleation, however, recurrence is also not found to be uncommon. Herein, we are reporting a case of the same in a 21-year-old female which was a great dilemma during the diagnostic work-up.

Excellent electrochemical properties, Li ion dynamics and room temperature work function of Li2MnO3cathode thin films.

We report on excellent electrochemical properties, Li ion diffusion coefficient and work function of Li2MnO3thin films fabricated by RF sputtering technique. The x-ray diffraction study confirms the formation of Li2MnO3thin film in layered structure. The x-ray photoelectron spectroscopy study confirms the existence of Li and Mn ions and their appropriate oxidation states in Li2MnO3thin film. Work function of the Li2MnO3thin film has been measured using scanning Kelvin probe microscopy and is found to be 5.51 eV. Electrochemical studies show that the Li2MnO3thin film exhibits oxidation and reduction peaks at 2.98 V and 2.81 V respectively with the discharging capacity of 10µAh cm-2in the first cycle and 9µAh cm-2in the 100th cycle at aCrate of 25µA cm-2. Electrochemical stability of Li2MnO3thin film is probed by measuring the charge discharge profile with high sweep rate of 500 mV s-1. Li ion diffusion coefficient value is seen to 1.6 × 10-14cm2s-1and 2.56 × 10-14cm2s-1before and after the cycling respectively. Electrochemical studies indicate that Li2MnO3thin films can be utilized as a promising cathode layer in all-solid thin film battery fabrication.

A Method to Differentiate Fatiguing Conditions in Surface Electromyography Signals using Instantaneous Spectral Centroid.

The nonstationarity measure of surface Electromyography (sEMG) signals provide an index for muscle fatigue conditions. In this paper, a new framework has been proposed for the analysis of sEMG signal using Instantaneous Spectral Centroid (ISC). The novelty of the proposed work is use of topological signal processing method to quantify the nonstationarity of sEMG signal. For this, the signals are recorded from the biceps brachii muscles of 25 healthy subjects in isometric contraction. The analytical signals corresponding to nonfatigue and fatigue segments are computed using Hilbert Transform. Further, topological features such as center of gravity (CoG), triangular area function (TAF) and ISC are calculated from the geometrical representation of a transformed signal. The result indicates the increase of TAF in fatigue condition and the significant right shift of CoG in x-axis for 80% of subjects. Importantly, the ISC estimate is decreased by 17% upon fatiguing for 84% of subjects. The obtained results show statistical significance with p < 0.05. It is observed that the shape parameters are varied in accordance with the changes observed in global characteristics of sEMG signals during muscle fatigue. The preliminary results show that the topological features are able to quantify the nonstationarity in sEMG signal. Therefore, the proposed method can be used as a fatigue index for diagnosing various neuromuscular disorders.Clinical Relevance-This method can be used to establish metrics of muscle fatigue for the benefit of physicians especially in the field of fitness, sports, pre and post-surgery surveillance and rehabilitation.

Synthesis and biological evaluation of Schizandrin derivatives as tubulin polymerization inhibitors.

A series of oxime ester-derivatives were prepared by utilizing the schizandrin (1), a major compound isolated from Schisandra grandiflora, which is deployed in different traditional system of medicine. The in vitro antiproliferative activities of the synthesized compounds were assessed against a selected panel of human cancer cell lines (A549, RKO P3, DU145 and Hela) and normal cell (HEK293). Several of these derivatives were found more potent in comparison to parent compound, schizandrin (1). Particularly, 4a and 4b demonstrated potent activity against DU-145 and RKOP3 cell lines with IC50 values of 3.42 µM and 3.35 µM respectively. To characterize the molecular mechanisms involved in antitumoral activity, these two compounds, 4a and 4b were selected for further studies. Cell cycle analysis revealed that both the compounds were able to induce apoptosis and cell cycle arrest at G0/G1 phase. To know the extent of apoptosis in DU145 and RKOP3 cell lines, Annexin V-FITC were performed. Moreover, the tubulin polymerization assay indicated that 4a and 4b exhibits potent inhibitory effect on the tubulin assembly. Molecular docking studies and competitive binding assay also indicated that 4a and 4b effectively bind at the colchicine binding site of the tubulin.

Effect of α-Fe2O3 Phase on the Magnetic Interactions in Nickel Ferrite (NiFe2O4) Nanoparticles.

We report on the effect of α-Fe2O3 phase in the magnetic properties and magnetic interactions in nickel ferrite (NiFe2O4-NFO) nanoparticles synthesized by co-precipitation method. Structural analysis confirms the formation of the cubic inverse spinel phase without any impurities for the NFO sample annealed in air at 650 °C. When the annealing temperature is increased to 750 °C and 850 °C, α-Fe2O3 impurity phase is formed along with the parent NFO phase. Raman spectra recorded at room temperature (RT) confirm the presence of pure NFO phase for the sample annealed at 650 °C, and presence of α-Fe2O3 phase is observed in the samples annealed at 750 °C and 850 °C. Saturation magnetization values at RT for the NFO samples annealed at 650 °C, 750 °C and 850 °C are 34 emu/g, 19 emu/g and 28 emu/g respectively. Zero Field Cooled (ZFC) and Field Cooled (FC) measurement reveals the super-paramagnetic behavior along with competing magnetic interactions in all the samples. For the NFO sample annealed at 750 °C and 850 °C, a drop in ZFC magnetization and a small kink in FC magnetization observed around 245 K indicate the presence of a Morin transition (TM) from the α-Fe2O3 phase. Anisotropy constants were calculated for all the samples using the law of approach to saturation (LAS) method. The magnetocrystalline anisotropy energy distribution function for the NFO samples annealed at 750 °C and 850 °C exhibit broad peak due to the random distribution of spins associated with different particle size.

Inhaled levosimendan versus intravenous levosimendan in patients with pulmonary hypertension undergoing mitral valve replacement.

CONTEXT: Inhaled levosimendan may act as selective pulmonary vasodilator and avoid systemic side effects of intravenous levosimendan, which include decrease in systemic vascular resistance (SVR) and systemic hypotension, but with same beneficial effect on pulmonary artery pressure (PAP) and right ventricular (RV) function. AIM: The aim of this study was to compare the effect of inhaled levosimendan with intravenous levosimendan in patients with pulmonary hypertension undergoing mitral valve replacement. SETTINGS AND DESIGN: The present prospective randomized comparative study was conducted in a tertiary care hospital. SUBJECTS AND METHODS: Fifty patients were randomized into two groups (n = 25). Group A: Levosimendan infusion was started immediately after coming-off of cardiopulmonary bypass and continued for 24 h at 0.1 mcg/kg/min. Group B: Total dose of levosimendan which would be given through intravenous route over 24 h was calculated and then divided into four equal parts and administered through inhalational route 6th hourly over 24 h. Hemodynamic profile (pulse rate, mean arterial pressure, pulmonary artery systolic pressure [PASP], SVR) and RV function were assessed immediately after shifting, at 1, 8, 24, and 36 h after shifting to recovery. STATISTICAL ANALYSIS USED: Intragroup analysis was done using paired student t-test, and unpaired student t-test was used for analysis between two groups. RESULTS: PASP and RV-fractional area change (RV-FAC) were comparable in the two groups at different time intervals. There was a significant reduction in PASP and significant improvement in RV-FAC with both intravenous and inhalational levosimendan. SVR was significantly decreased with intravenous levosimendan, but no significant decrease in SVR was observed with inhalational levosimendan. CONCLUSIONS: Inhaled levosimendan is a selective pulmonary vasodilator. It causes decrease in PAP and improvement in RV function, without having a significant effect on SVR.

Local degradation pathways in lithium-rich manganese-nickel-cobalt-oxide epitaxial thin films.

The electrochemical performance and microstructure of positive electrodes are intimately linked. As such, developing batteries resistance to capacity and voltage fade requires understanding these underlying structure-properties relationships and their evolution with operation. Epitaxial films of a Li-rich manganese-nickel- cobalt oxide cathode material were deposited on (100) and (111) orientated SrRuO3/SrTiO3 substrates. Cyclic voltammetry and impedance spectroscopy tracked the response of these positive electrode materials, while the microstructure of the pristine and cycled films was characterized using transmission electron microscopy. Energy-dispersive X-ray spectroscopy identifies compositional fluctuations in as-deposited films. Phase transformations and dissolution were observed after electrochemical testing. There is a correlation between both local composition and substrate orientation (i.e., surface faceting) and what degradation pathways are active. Regions with comparatively higher concentrations of Ni and Co were more resistant to dissolution and unfavorable phase transformations than those with relatively more Mn. As such, a global composition metric may not be an accurate predictor of degradation and performance. Rather possessing the synthetic ability to engineer the chemical profile as well as characterizing it, pose a challenge and opportunity.

Domain Formation in Lithium-Rich Manganese-Nickel-Cobalt-Oxide Epitaxial Thin Films and Implications for Interpretation of Electrochemical Behavior.

Due to the directional dependence of physical properties, it is advantageous to grow and then study materials in specific orientations. Films of battery materials grown in epitaxy offers the possibility to gain new insight into the role of physical structure on electrochemical behaviors. Here we demonstrate the growth, testing, and characterization of monoclinic-phase (space group C2/m) Li-Mn-Ni-Co-O epitaxial films. The monoclinic phase is a layered structure and as such lithium diffusion is favored along specific crystallographic directions. Films were grown by pulsed laser deposition onto SrRuO3/SrTiO3 substrates with (001) and (111) orientations. Cyclic voltammetry measured the response of these positive electrode materials, while the film structure was characterized using scanning transmission electron microscopy. A combination of imaging and diffraction identifies the presence of orientational variants. Variants disrupt the orientation anisotropy expected of these layered materials when grown in epitaxy, thereby masking differences in electrochemical behavior as a function of substrate orientation. Learning to control the domain structure now presents itself as a challenge to realize the potential of low symmetry battery materials grown in epitaxy on high symmetry substrates.

Study of Basic Coagulation Parameters among HIV Patients in Correlation to CD4 Counts and ART Status.

INTRODUCTION: HIV infection is known to cause coagulation abnormalities by various mechanism, especially during its late course. AIM: The objective of this study was to analyse platelet count, prothrombin time and activated partial thromboplastin time among HIV infected patients and to analyse these parameters with respect to their CD4 count and ART status. MATERIALS AND METHODS: A case control study was conducted with 120 HIV infected patients and 40 normal individuals. The blood samples were collected after obtaining consent from the subjects. The blood samples were processed for platelet count, prothrombin time and activated partial thromboplastin time and CD4 count. The results were tabulated and analysed with statistical package. RESULTS: The platelet count was significantly decreased in HIV infected patients compared to controls. Though HIV patients with CD4 count less than 200cells/mm(3) showed a decreased platelet count compared to those with CD4 count greater than 200cells/mm(3), it was not statistically significant. Prothrombin Time (PT) and Activated Partial Thromboplastin Time (aPTT) was significantly prolonged in HIV patients, but only aPTT showed significant inverse correlation with CD4 count. None of the parameters showed statistical significance on comparing HIV patients on ART with those not on ART. CONCLUSION: Basic coagulation tests like platelet count, PT and especially aPTT can be used as prospective screening test to assess severity in HIV patients in resource limited settings where CD4 count is not available.

Takotsubo cardiomyopathy precipitated by negative pressure pulmonary oedema following total thyroidectomy.

'Takotsubo cardiomyopathy (TCM)' or 'stress cardiomyopathy' is a reversible cardiomyopathy that is precipitated by intense emotional or physical stress. This syndrome is characterised by symptoms mimicking acute coronary syndrome with transient systolic dysfunction associated with regional wall motion abnormalities, which extend beyond a single coronary vascular bed in the absence of obstructive coronary vascular disease. The presentation of TCM and myocardial infarction is similar with sudden onset of chest pain, breathlessness as well as abnormalities in both the electrocardiogram and cardiac enzymes. It is difficult to differentiate between the two until cardiac catheterisation establishes the diagnosis. We report a case of TCM in a post-menopausal female, precipitated by negative pressure pulmonary oedema following total thyroidectomy in whom timely cardiac catheterisation established the diagnosis and influenced the management. Heightened awareness of this unique cardiomyopathy is essential to have a high index of suspicion in at-risk population for the prompt diagnosis of stress-related cardiomyopathy syndromes occurring in the perioperative period.

Microscopy Study of Structural Evolution in Epitaxial LiCoO2 Positive Electrode Films during Electrochemical Cycling.

The evolution of interface between the epitaxial thin film LiCoO2 (LCO) electrode and liquid electrolyte and inside the LCO film during electrochemical cycling has been analyzed by high resolution scanning transmission electron microscopy. Relaxation of sharp translational domain boundaries with mismatched layers of CoO2 octahedra occurs during cycling and results in formation of continuous CoO2 layers across the boundaries. The original trigonal layered structure of LiCoO2 tends to change into a spinel structure at the electrode/electrolyte interface after significant extraction of Li from LCO. This change is more pronounced at 4.2 V peak of CV, indicating lower stability of the layered LCO structure near its surface after Li is extracted above 60%. The transformed structure is identified to be close to Co3O4, with Co both on tetrahedral and octahedral sites, rather than to LiCo2O4 as it was suggested in earlier publications. Electron energy-loss spectroscopy measurements also show that Co ions oxidation state is reduced to mixed valence state Co(2+)/Co(3+) during the structure changes to spinel rather than oxidized.

Epitaxial LiCoO2 films as a model system for fundamental electrochemical studies of positive electrodes.

Epitaxial LiCoO2 (LCO) thin films of different orientations were fabricated by pulsed laser deposition (PLD) in order to model single-crystal behavior during electrochemical reaction. This paper demonstrates that deposition of conductive SrRuO3 between a SrTiO3 (STO) substrate and an LCO film allows (1) epitaxial growth of LCO with orientation determined by STO and (2) electrochemical measurements, such as cyclic voltammetry and impedance spectroscopy. Scanning transmission electron microscopy (S/TEM and SEM) has demonstrated an orientation relationship between LCO and STO of three orientations, (111), (110) and (100), and identified a LCO/electrolyte surface as consisting of two crystallographic facets of LCO, (001) and {104}. The difference in the orientation of LCO accounts for the difference in the exposed area of {104} planes to the electrolyte, where lithium ions have easy access to fast diffusion planes. The resistance for lithium ion transfer measured by electrochemical impedance spectroscopy had inverse correlation with exposed area of {104} plane measured by TEM. Chemical diffusivity of lithium ions in LCO was measured by fitting electrochemical impedance spectroscopy data to a modified Randles equivalent circuit and allowed us to determine its dependence on film orientation.

Oculosporidial polyp infected secondarily by Enterobius vermicularis.

Oculosporidiosis caused by Rhinosporidium seeberi is a common infectious disease of south India. Here we are reporting a rare case of oculosporidial polyp containing another parasite Enterobius vermicularis as a co infection. This is the first report of its kind in literature. A nine year old school going girl from a rural area presented with a reddish polypoidal lesion from conjunctiva along with complaints of severe itching over it. On examination, the polyp measured 5 mm × 5 mm in size, reddish, granular with a tendency to bleed on touch. Her vision was normal. All the basic investigations were within normal limits. A differential diagnosis of conjunctival papilloma, foreign body granuloma and oculosporidiosis were considered clinically. The polyp was removed completely using electro cautery with healthy margins around the lesion. To our surprise histopathological examination of the swelling revealed the presence of two different parasites in the conjunctival polyp. Sections showed sporangia of Rhinosporidium seeberi, fragments of Enterobius vermicularis and its eggs. She was then treated with anti helminthic drugs. Two months of follow up till now showed no recurrence of the lesion.

Myofibroblastoma of female breast masquerading as schirrous malignancy - a rare case report with review of literature.

Myofibroblastoma is a rare benign mesenchymal tumour of the breast commonly reported in males. It is a spindle cell neoplasm exhibiting myofibroblastic differentiation with characteristic immunohistochemical staining. Herein, we present a case of myofibroblastoma in a premenopausal female which was mimicking like malignancy clinically. Lump was growing rapidly in size measuring 8 cm x 6 cm and stony hard in consistency. Mammogram showed a large homogeneous hyperdense lump suggestive of fibroadenoma, Hamartoma and fibromatosis. FNAC and trucut biopsy of mass could not be done due to stony hard consistency. Hence excision biopsy was done. Histopathological examination revealed the tumour as myofibroblastoma. Immunohistochemical staining for markers of myofibroblasts like CD-34 and Vimentin showed strong positivity. A negative expression for cytokeratin was noted. This case is presented for its rarity, unusual clinical presentation and stony hard consistency.

Virilizing cystic juvenile granulosa cell tumour of the ovary: a case report.

We report a rare case of virilizing cystic juvenile granulosa cell tumour of the ovary diagnosed by histopathological examination in a 17-year-old female presented with mass abdomen for two months, growing of the hairs on the face and abdomen and deepening of voice for one year.