Currently, the adherence to nutritional guidelines is critically low, with alarming rates of obesity worldwide and micronutrient deficiencies documented even in industrialized countries. As a consequence, nutritional screening and counselling represent a critical subject in early pregnancy, aiming to improve pregnancy outcome and population health. In this setting, the development of a simple and reproducible nutritional checklist is of utmost importance. The Simple Study is a longitudinal prospective multicenter study aiming to identify the associations between nutritional habits in the first trimester, early markers of placental function, and pregnancy outcome on a large population of singleton pregnancies in Italy. Ongoing healthy singleton pregnancies will be enrolled at the ultrasound scan of the first trimester combined screening test (11+0-13+6 gestational weeks). A nutritional score measuring the adherence to a healthy diet and nutritional deficiencies will be collected at recruitment. Fetal (crown-rump length, nuchal translucency, biparietal diameter, femur length) and utero-placental (placental volume, uterine arteries Doppler velocimetry) ultrasound data and biochemical placental markers (Pregnancy Associated Plasma Protein A (PAPP-A), free ß-Human Chorionic Gonadotropin (HCG)) will be collected. Second and third trimester ultrasound records and birth outcomes will be recorded from medical registers. The present study will set the stage for introducing a reproducible, time-saving and low-cost nutritional screening in pregnancy. The nutritional score will allow the implementation of specific corrective measures with potential large impact on placentation and pregnancy outcome.

In this contribution, the thermoelastic Lamb waves in the homogeneous, transversely isotropic, plate containing voids have been investigated in the context of classical and non-classical theories of thermoelasticity. To investigate the problem, the fundamental governing equations have been developed in a unified way. On the solutions of these governing equations, the thermal and mechanical stress-free boundary conditions, as well as constraints due to voids, have been imposed. The solutions of governing equations indicate that there lies a coupled system of wave motion called thermal waves (T-mode), void wave motion (V-mode), and elastic waves (E-mode). However, the shear horizontal component of elastic waves decouples from the system being unaffected by elasto-poro-thermal coupling. For the symmetric and anti-symmetric families of vibrations, the secular equation for the wave motion along with its special cases has been derived. To discover the wave characteristics, the secular equation has been solved using the numerical functional iteration method in MATLAB software, and the findings have been manifested by plotting the graphs. It has been concluded that the presence of voids affects the magnitudes of phase velocity, attenuation coefficient, and specific loss. This work may be helpful for geophysicists and engineers in the field of earthquake engineering. The developers of modern facilitating things such as acoustic touch screens, liquid viscosity sensors, etc. which are based on Lamb-type wave propagation may also get benefitted.

Termites, as main decomposers, are major contributors driving carbon cycle by litter decomposition. Termites were emphasized as one of high CO2 emission sources of spatial variation in soil respiration. The aim of this study was to compare CO2 emissions from the epigeal mounds of non-fungus growing termites in dry evergreen forest of Thailand. CO2 emission was directly measured on mounds and surrounding soils of five termite species (n = 5) with a portable infrared gas analyzer connected to PVC pipes during the wet season (October 2015) and the dry season (January 2016). The CO2 emissions were significantly different between termite species. Globitermes sulphureus had the highest nest CO2 emission (37.7 ± 14.7 µmol m-2 s-1 Mean ± SD), followed by Microcerotermes crassus, Termes comis, Termes propinquus and Dicuspiditermes makhamensis, respectively. CO2 emissions in termite mounds and their surrounding soil were significantly higher in wet season than dry season. Globitermes sulphureus and M. crassus mounds produced significantly more CO2 than surrounding soils but T. propinquus and D. makhamensis produced significantly less CO2 than surrounding soils. Therefore, G. sulphureus and M. crassus are major CO2 producers among non-fungus growing termites in a tropical forest.

Memantine is used for neurocognitive protection in patients undergoing cranial radiotherapy for central nervous system tumors and is assumed to be well-tolerated. We present a case of memantine-induced altered mental status requiring intensive care unit admission. An adolescent male with relapsed, progressive medulloblastoma presented with severe altered mental status shortly after the first fraction of palliative whole brain radiotherapy. After extensive evaluation, his profound confusion was attributed to memantine, which had been initiated one week prior. Clinicians should be aware of the risk of altered mental status with memantine, given the increased utilization and upcoming clinical trials in pediatric patients.

Objective: To describe the prevalence, profile and clinical outcomes of pregnant women with COVID-19 admitted to a tertiary facility in Gauteng, South Africa Design: Retrospective review Setting: An academic hospital in Johannesburg, South Africa Population: Two-hundred and four (204) pregnant women with COVID-19 admitted between 6 March and 30 August 2020 Methods: Patient data was captured on discharge or death from paper-based clinical files onto a digital database Main Outcome Measures: Rates of mortality and/or admission to ICU, symptomatic versus asymptomatic disease, maternal and fetal outcome and mode of delivery. Results: A final cohort of 204 pregnant women were included in the study. Thirty three (16.2%) women were critically ill, with 21 (10.3%) admitted to the ICU and 3 (1.5%) deaths related to COVID-19. Conclusions: COVID-19 related mortality in our cohort was higher than that seen internationally, likely due to differences in background maternal mortality rates and difficulty in accessing care.

Objective: To examine the association between exercise during pregnancy and preterm birth (PTB). Design: Retrospective cohort analysis. Setting: Jinan, China. Population: Singleton live births from December 2018 to December 2019. Methods: Questionnaires contained items about physical exercise (frequency, time, and primary exercise patterns) during pregnancy and each trimester. Adjusted odds ratios (OR) were estimated using logistic regression. Variable selection for the multivariate models was guided by the directed acyclic graph. The median effect was analyzed by the sequential test. Main Outcome Measures: PTB. Results: The prevalence of PTB in this study was 4.38% (285/6501). The adjusted OR (95% CI) for the risk of PTB related to exercise during pregnancy was 0.74 (0.58-0.95). During the 1st and 2nd trimesters, the ORs (95% CI) for 2.5 to 7 hours of exercise per week were 0.77 (0.59-0.99) and 0.74 (0.57-0.96). During the 3rd trimester, the ORs (95% CI) for 2.5 to 7 hours and more than 7 hours of exercise per week were 0.74 (0.56-0.96) and 0.65 (0.44-0.94). After stratifying the subjects, the association was only found among subjects without pregnancy complications. Pregnancy complications partially mediated (52.40%) the relationship between exercise during pregnancy and PTB. Conclusions: Exercise during pregnancy was a protective factor of PTB for women without pregnancy complications. 2.5 to 7 hours of exercise (like walking) per week may be appropriate in three trimesters of pregnancy, and the time could be extended in the 3rd trimester. Keywords: Preterm birth; Exercise; Pregnancy; Trimester; Mediation analysis

Due to the oral vaccination of foxes against rabies most of the territory of Poland was freed from rabies of non-flying mammals. In January 2021 rabies was diagnosed in fox in the central part of Mazowieckie Voivodship where rabies has not been detected since last 17 years. Subsequently, in the following months the rabies virus infection spread southward reaching the voivodship of Świętokrzyskie in November 2021. Emergency actions were implemented aiming at rapid rabies elimination.

Background: Thrombosis is an increasingly recognized complication of childhood malignancy and its treatment. The etiology of pediatric cancer-related thrombosis is multifactorial and not well understood at present. The aim of this study was to evaluate the prevalence of common prothrombotic genetic conditions in children with cancer, the frequency of thrombosis, and the role of inherited thrombophilia in the development of thrombosis in a pediatric oncology population. Methods: Forty-seven children (36 treated for hematological malignancies and 11 for solid tumors) with the median age of 8.8. years (range 0.4 – 19.3 years) were included in the study. Genetic polymorphisms of Factor V Leiden, prothrombin G20210A mutation, and methylenetetrahydrofolate reductase (MTHFR) C677T were determined by real-time polymerase chain reaction-based DNA analysis. Results: Four (8.5%) patients were heterozygous for Factor V Leiden, 3 (6.4%) were heterozygous for prothrombin G20210A mutation, and 3 (6.4%) were homozygous for MTHFR C677T mutation. All patients had inserted central venous lines. Four (8.5%) children had documented thrombosis, 3 of which were located in the upper venous system. Two of four patients with thrombosis had Factor V Leiden heterozygosity. Conclusions: Thrombosis is an important complication of childhood cancer. Our results suggest that congenital prothrombotic abnormalities could be implicated in increasing the risk of thrombosis and support a recommendation that children with cancer be evaluated for inherited thrombophilia.

Objective: to compare pregnancy risks between different congenital uterine anomalies utilizing other congenital anomalies as a control group in a large population database. Design, setting, and sample: A retrospective population-based cohort study from the Healthcare-Cost-Utilization Project-Nationwide-Inpatient-Sample(HCUP-NIS) included-3,846,342 births(2010-2014). Of them 6195 deliveries were to women with bicornuate uteri, 798 with arcuate uteri, 2255 with didelphys uteri, 802 with unicornuate uteri and 1404 with septate uteri. Main Outcome Measures and Results: After adjustent for confounders, women with bicornuate uteri were more likely to deliver vaginally(aOR 1.4, 95%CI: 1.1-1.9), P=0.01), less likely to deliver by cesarean(CD) and had lower risk of SGA(aOR 0.8, 95%CI: 0.7-0.9, P=0.03) when compared to the other anomalies (aOR 0.6, 95%CI: 0.5-0.6), P=0.0001). Pregnant women with arcuate uterus had lower risks of preterm delivery((aOR 0.6, 95%CI: 0.5-0.8), P=0.0001), less chance of operative vaginal delivery(aOR 0.5, 95%CI: 0.2-0.9), P=0.04), and higher risk for CD(aOR 1.6, 95%CI: 1.4-2, P=0.0001). Pregnant women with didelphys uteri had higher risk of PPROM(aOR 1.6, 95%CI: 1.3-1.9), P=0.0001), preterm delivery(aOR 1.5, 95%CI: 1.3-1.6), P=0.0001), CD(aOR 1.4, 95%CI: 1.2-1.5, P=0.0001) and wound complications (aOR 1.6, 95%CI: 1.1-2.4), P=0.02). Pregnant unicornuate uteri had increased risks of preterm delivery(aOR 1.4, 95%CI: 1.1-1.6), P=0.0001), CD(aOR 2, 95%CI: 1.6-2.5), P=0.0001) and of SGA(aOR 1.8, 95%CI: 1.4-2.3, P=0.0001). Pregnant septate uteri had higher risk of chorioamnionitis(aOR 1.5, 95%CI: 1.1-2.1), P=0.048) and CD(aOR 1.4, 95%CI: 1.2-1.6), P=0.0001). Conclusion: We demonstrated that there are different risks for certain adverse pregnancy and neonatal outcomes in diverse uterine anomalies as compared to the other anomalies

Explaining how cooperative individuals positively assort into a cohesive community is one of the greatest challenges for evolutionary biology. Here, we show that in antibiotic culture, many and even all of Escherichia coli bacteria cells will plastically mutate to be antibiotic resistant with the increase of antibiotic concentration and then altruistically protect antibiotic-sensitive individuals from the attack of antibiotics. A further experiment showed that antibiotic-sensitive E. coli strain could in turn help reduce the indole produced by the resistant strain;whistthis metabolic product is harmful to the growth of the antibiotic-resistant strain but benefits the antibiotic-sensitive strain by helping turn on the multi-drug exporter to discharge the antibiotic. A reciprocal cooperation can therefore evolve via a non-positive exchange between the metabolism byproduct indole of antibiotic-resistant cells and the indole-aborting service of antibiotic sensitive cells as unconscious help in nullifying indole side effect of antibiotic resistant strain.

Premature ovarian failure and Asherman syndrome are leading causes of infertility. This case is a woman who after cesarian scar pregnancy and uterine artery embolization developed premature ovarian failure and Asherman syndrome. she underwent hysteroscopic adhesiolysis. she became pregnant with low AMH levels and delivered the newborn without any complications.

High-throughput sequencing (HTS) provides an efficient and cost-effective way to generate large amounts of sequence data. However, marker-based methods and the resulting datasets come with a range of challenges and disputes, including incomplete reference databases, controversial sequence similarity thresholds for delineating taxa, and downstream compositional data analysis. Here, we use HTS data from a soil nematode biodiversity experiment to address the following questions: (1) how the choice of reference database affects HTS data analysis, (2) whether the same ecological patterns are detected with ASV (100% similarity) versus classical OTU (97% similarity), and (3) how different data normalization methods affect the recovery of beta diversity patterns and identification of differentially abundant taxa. At this time, the SILVA database performed better than PR2, assigning more reads to family level and providing higher phylogenetic resolution. ASV- and OTU-based alpha and beta diversity of nematodes correlated closely, indicating that OTU-based studies represent useful reference points. For downstream data analyses, our results indicate that rarefaction-based methods are more vulnerable to missed findings, while clr-transformation based methods may overestimate tested effects. ANCOM-BC retains all data and accounts for uneven sampling fractions for each sample, suggesting that this is currently the optimal method to analyze compositional data. Overall, our study highlights the importance of comparing and selecting taxonomic reference databases before data analyses, and provides solid evidence for the similarity and comparability between OTU- and ASV-based nematode studies. Further, the results highlight the potential weakness of rarefaction-based and clr-transformation based methods. We recommend future studies use ASV and that both the taxonomic reference databases and normalization strategies are carefully tested and selected before analyzing the data.

Aiming to test the lactic acid fermentation ability to reduce the pathogenic microbial content in a waste activated sludge, fermentation reactors were tested in real conditions of sludge (4.3 x 104 MPN/g fecal coliform). Therefore, pH and titratable acidity (% lactic acid) were monitored during the fermentation process and statistically evaluated on day 5. According to these results and to evaluate the remaining concentration of pathogenic microbial content after treatment, the lactic acid fermentation reactors were microbiological and physic-chemically characterized. Additionally, at 3 % of lactic acid microbial consortium and 18 % of molasses, optimum conditions such as pH 3.57, 2.2 % lactic acid (titratable acidity) and fetid odour-free were achieved. Furthermore, the final product has < 3 MPN/g of fecal coliform, achieving 99.9 % efficiency at day 5 of the treatment and is maintained all the experimental time control (30 days). Finally, the presence of lactic acid bacteria and antimicrobials presence was not inhibited by heavy metals content present in sludge in a real condition, supporting the hygienization process. Key words: waste activated sludge, hygienization, sanitization, lactic acid fermentation, sludge treatment.

ABSTRACT Otomycosis is increasing in prevalence and can account for up to 20% of ENT outpatient consultations in warm and humid regions. Objectives: The aim of this review was to investigate the treatment strategies and antifungal agents used in various institutions and to highlight current trends. Design: PubMed, Cochrane Library and Google Scholar electronic databases were searched for freely-accessible articles spanning January 2001 and December 2020. Results: 59 full-text English-language articles were retrieved. Aspergillus spp. were the commonest species isolated followed by Candida spp. Clotrimazole-resistant Aspergillus spp. were encountered more frequently among immunosuppressed patients. Topical medications included drops, creams, ointments, powders, lotions and sprays. Systemic treatment was given orally or intravenously. Antifungal agents used were azoles, polyenes, echinocandin, allylamine, thiocarbamate, hydroxyquinoline and griseofulvin. Antiseptics employed included Betadine, Gentian Violet, N-chlorotaurine, Castellani’s Paint, Cresylate drops and Tincture Merthiolate. Steroids (beclomethasone, betamethasone, dexamethasone and hydrocortisone) were generally used in combination therapy. Acidifying agents administered were 3% boric acid, 2% acetic acid and 2% salicylic acid. Lignocaine and tetracaine formed part of some formulations. Conclusions: Topical applications are the mainstay of treatment of otomycosis, but occasionally oral or intravenous agents are required. Aural toilet and specific antiseptics have an important role. Clotrimazole remains an essential antifungal against a variety of fungi, but other antifungals may be needed against resistant species and in immunocompromised patients.

Wular Lake, one of the largest wetlands in Asia with 11,277 ha in Kashmir valley, is a biodiversity-rich Ramsar site supporting about 32,000 rural families involved in harvesting fish, water chestnut, lotus stem and fodder. With 2914 active fishers, Wular contributes 54% of Kashmir’s fish catch. Large scale land-use changes and global warming have led to siltation, shrinkage of lake area and alterations in water flow regime threatening lake ecology and livelihoods. This study uses a novel census-based multi-criteria Socio-Economic Vulnerability Index (SEVI) covering 23 fishing and 115 non-fishing adjacent villages. Except for Kunas, all fishing villages exhibited ‘low’ (0.21 to 0.40) vulnerability levels. Interestingly, no significant differences in vulnerability was found between fishing (23) and non-fishing (115) villages though, the former showed relatively higher social sensitivity. A graphical decision matrix based on sensitivity and adaptive capacity scores provides a snapshot of vulnerability status of each village. Using SEVI values, drivers - key indicators responsible for high sensitivity & low adaptive capacity - were identified and village specific development interventions suggested using Kunas as the model village for illustration. Improving education levels, strengthening community and rural infrastructure, and expanding livelihood options were key short-term strategies for improving resilience in Kashmir’s Wular region.

Background. Recently three large-scale epidemiological registry-based Scandinavian studies examined the association between use of hormonal contraception and the risk of developing depression or use of antidepressants. They reached surprisingly divergent results. Objectives: The aim of this study was to explain why these three recent studies from Denmark and Sweden could achieve quite different results, interpretations, and conclusions. Search strategi and selection. The three existing large scale Scandinavian studies examining associations between exposure to different types of hormonal contraception and risk of depression or use of antidepressants were examined according to chosen design, exclusion criteria, and included confounders. Methodological choices were considered, and the validity of these methodological choices tested. Main results. First, the assumption that differences between studies are due to residual confounding is proven unlikely, already because confounder control beyond age, year and education rarely change estimates materially. More likely basic differences in chosen study groups, exclusions from the study groups, exposure definitions, chosen reference populations, and interpretation of the results seem to explain the differences between the studies. Conclusion. The detailed review of the three Scandinavian studies reveals methodological choices as the main explanation for their different findings. Residual confounding was found unlikely to explain the divergent results, while ideological circumstances might have a main responsibility for the different chosen methods and for the interpretation of the results. Funding. None.

Objective: To evaluate if moderate-severe endometriosis impairs uterine arteries pulsatility index (UtA-PI) during pregnancy when compared to unaffected controls. Design: Observational prospective cohort study. Setting: University-affiliated obstetrics and fetal medicine Department in Italy. Population: Pregnant women with stage III-IV endometriosis according to revised American Fertility Society (r-AFS) classification, matched in a 1:2 ratio according with body mass index and parity with unaffected controls. Methods: UtA-PIs were assessed at 11–14, 19–22 and 26–34 weeks of gestation following major reference guidelines. A General Linear Model (GLM) was implemented to evaluate the association between endometriosis and UtA-PI Z-scores. Main Outcome Measure: UtA-PI Z-scores, calculated from published reference equations of previously validated normal range. Results: Significantly higher third trimester UtA-PI Z-scores were observed in patients with r-AFS stage III-IV endometriosis when compared to controls (p=0.024). In the GLM, endometriosis (p=0.026) and maternal age (p=0.007) were associated with increased third trimester UtA-PI Z-scores, whereas conception by in-vitro fertilization with frozen-thawed embryo transfer significantly decreased UtA-PI measures (p=0.011). No differences were observed in first or in second trimester UtA-PI Z-scores of cases vs. controls. Conclusions: Stage III-IV endometriosis according to r-AFS classification is associated with a clinically measurable impaired placental perfusion as shown by increased UtA-PI Z-scores in the third, but not in the first or second trimesters. Closer follow-up may be recommended in pregnant patients affected by moderate-severe endometriosis in order to attempt prediction and prevention of adverse pregnancy/perinatal outcomes due to a defective late placental perfusion. Funding: N/A.

Due to the intensive use of land and global warming, the response of species within the plant community to environmental changes and the developmental trend of the community have attracted global attention. Affected by human disturbance and rising sea levels, mangrove forests are undergoing a significant reduction in plant density. Due to unfavorable factors such as increased salinity and prolonged flooding time accompanying rising sea levels, it is difficult to predict how the growth and physiological processes of different mangrove individuals will respond to these factors and what impact these responses will bring to the development of mangrove plant communities. In this study, we simulated rising sea levels by controlling light intensity, seawater salinity, and flooding time, and studied the physiological and ecological response mechanisms of six representative mangrove species on Hainan Island, China, to rising sea levels with the goal to predict the development of mangrove plant communities in this region. The results showed that tree species distributed at high tidal levels were more susceptible to rising sea levels than those growing at medium and low tidal levels. Due to the rise in sea level, increasing flooding time, and high salinity stress, mangroves would naturally migrate inland. However, due to human disturbance that resulted in shoreline hardening, the mangrove retreat space is inadequate as their distribution area gradually becomes smaller and disappears. If measures are not taken to restore the natural environment of the offshore coast and allow mangroves to advance and retreat freely, global warming and rising sea levels will affect in particular the mangrove species growing at high tidal levels, such as Excoecaria agallocha, Lumnitzera littorea, Lumnitzera racemosa, Bruguiera sexangula, and Ceriops tagal.

Objective: To evaluate the clinical, demographic and laboratory characteristics of the patients followed up with the diagnosis of acute respiratory distress syndrome (ARDS) in our pediatric intensive care unit (PICU) and to determine the factors that have an effect on the outcomes. Methods: The files of 40 patients with ARDS who were followed up on mechanical ventilators (MV) in PICU of XXXX University between 2013 and 2018 were retrospectively scanned. Results: Eighteen of the patients were female and 22 were male. The mean age was 45.25±56.63 months. 27 (67.5%) of the patients were classified as pulmonary and 13 (32.5%) as extrapulmonary ARDS. Sixteen (40%) patients were followed in pressure-controlled mode only, 2 (5%) patients in volume-controlled mode only, and 22 (55%) patients in alternately modes. The median value of the length of stay (LOS) in PICU was 17.5 days. The median duration of the stay on MV was 276.5 hours. 17 (42.5%) patients died. The median PIM, PIM-II, PRISM and PELOD scores values of the surviving patients were significantly lower than died patients. Median AST (p=0.003) and LDH (p= 0.008) values were found to be significantly higher in patients who died, while median pH values (p=0.049) were found to be lower. The median LOS in PICU and duration of MV were significantly shorter in patients who died. Also, the median PIM, PIM-II, PRISM and PELOD values of pulmonary ARDS patients were significantly lower than those of extrapulmonary ARDS patients. Conclusion: Despite advances in follow-up and management, mortality due to ARDS is still high. MV duration, LOS in PICU, some MV parameters, mortality scores and laboratory tests associated with mortality. Alternately MV applications may reduce mortality rates.

In the face of the rapid emergence and spread of new variants of the type 2 coronavirus causing acute respiratory syndrome, it is necessary to seek new pharmacological treatments for the disease, especially for patients infected by the new and more aggressive variants of the virus. In the present work, we selected ~18,000 compounds with similar structure to GRL0617 (Tanimoto index greater than 80 %) from the PubChem database with ~109 million compounds. Molecular docking was used to assess the affinity of the selected compounds, in which GRL0617 was included as an internal control. Then, based on the ligand efficacy index obtained as molecular docking, 500 compounds with higher affinity than GRL0617 for papain-like protease were considered. Finally, based on ADME parameters within the acceptable range for a drug, the seven best compounds were selected. Next, 200 ns molecular dynamics simulation studies, ∆G calculations using generalized Born and surface continuous solvation molecular dynamics, and quantum mechanical calculations were performed with the selected candidates. Using this In Silico protocol, seven papain-like protease inhibitors are proposed: three compounds with binding free energy like GRL0617 (D28, D04 and D59), three compounds with higher binding free energy than GRL0617 (D60, D99 and D06) and one compound (D24) that binds to a region of the enzyme that could block inhibition by the host immune system. The compounds proposed in this study could be used for invitro testing or smart drug design, accelerating the development of an effective treatment for this disease.

This paper deals with study of the nonlinear singular elliptic equations in a bounded domain $\Omega\subset\mathbb{R}^N$, $(N\geq2)$ with Lipschitz boundary $\partial\Omega$, $$ Au=\frac{f}{u^{\gamma(\cdot)}}+\mu, $$ Where $A:=-\mathrm{div}\left(\widehat{a}(\cdot,Du)\right)$ is a Leray-Lions type operator which maps continuously $W^{1,p(\cdot)}_0(\Omega)$ into its dual $W^{-1,p’(\cdot)}(\Omega)$, whose simplest model is the $p(\cdot)$-laplacian type operator ( i.e. $\widehat{a}(\cdot,\xi)=|\xi|^{p(\cdot)-2}\xi$ ), such taht $f$ is a nonnegative function belonging to the Lebesgue space with variable exponents $L^{m(\cdot)}(\Omega)$, with $m(\cdot)$ being small ( or $L^{1}(\Omega)$ ) and $\mu$ is a nonnegative bounded Radon measure, while $m:\overline{\Omega}\to (1,+\infty)$, $\gamma:\overline{\Omega}\to (0,1)$ are continuous functions satisfying certain conditions depend on $p(\cdot)$. We prove the existence, uniqueness and regularity of nonnegative weak solutions or this class of problems with $p(\cdot)$-growth conditions. More precisely, we will discuss that the nonlinear singular term has some regularizing effects on the solutions of our problem which depends on the summability of $f$, $m(\cdot)$ and the value of $\gamma(\cdot)$. The functional framework involves Sobolev spaces with variable exponents as well as Lebesgue spaces with variable exponents. Our results can be seen as a generalization of some results given in the constant exponents case.

Since SARS-CoV-2 emerged in China, it has spread rapidly around the world. Effective vaccines and therapeutics for SARS-CoV-2−induced disease (coronavirus disease 2019; COVID19) are urgently needed. In order to assess the immune response to immunization with SARS-CoV-2 and the ability of the immune serum to neutralize the virus infection, we immunized a llama ( Lama glama) with the inactivated SARS-CoV-2 virus, and tested serum samples with an ELISA assay specific to the SARS-CoV-2, and viral neutralization by plaque-reduction neutralization test (PRNT). An increase in seroreactivity was observed for the immunized llama from week 4 onward, revealing seroconversion induced by the immunization, with the highest antibody titers on the 8 th boost. On the reactive serum sample, we performed Western Blot analysis that confirmed the positive ELISA findings, and antibodies from immune serum recognized various viral proteins. The gold standard PRNT showed a visible viral neutralization corresponding with ELISA results. Thus, our findings suggest this llama hyperimmune serum as a possible source of therapeutically antibodies against the SARS-CoV-2 virus infections to evaluate in further studies.

Objective: To evaluate obstetrical providers’ behaviours and maternal outcomes of women transferred with postpartum haemorrhage before and after introduction of a simulation-based training programme and standardised protocol Design: A retrospective cohort study Setting: All institutes operating deliveries in Satsuma Peninsula, Kagoshima Prefecture, Japan Population and Sample: Patients transferred with postpartum haemorrhage to Kagoshima City Hospital or Kagoshima University Hospital were included. Data collected before (period 1: 2015–2017) and after (period 2: 2018–2020) programme initiation were compared. There were 72 and 131 patients during periods 1 and 2. Methods: Data from medical records were used to compare providers’ behaviours and outcomes between the two periods. Main outcome measures: Effectiveness of the simulation-based training and standardised protocol in postpartum haemorrhage, change in providers’ behaviours, and maternal outcomes, including massive blood transfusion Results: Changes in providers’ behaviours were observed after the programme. The rate of shock index recording increased from 9.7% to 36.6% (p<0.001), and the rate of using intravenous lines ≥20 gauge increased from 91.7% to 100% (p=0.0017). The mean shock index on arrival significantly decreased from 0.85 to 0.77 (p<0.05). The massive transfusion (red blood cells ≥ 10 units) rate significantly decreased from 43.1% to 26.0% (p<0.05). Clinical factors related to massive transfusion were programme attendance, blood loss, and coagulopathy. Programme attendance reduced the risk of massive transfusion, while blood loss ≥2,200 g increased the risk. Conclusions: Introducing the simulation-based training programme and using a standardised protocol changed the providers’ behaviours and decreased the massive transfusion rate for postpartum haemorrhage.

Objective: To describe the alterations of the composition of vaginal microbiota in pregnant women with COVID-19. Design: Prospective observational single-centre study Setting: Tertiary referral hospital Participants: Pregnant women with COVID-19 Methods: The vaginal swabs were collected during the active phase of infection and consecutively, within a month after recovering from infection. In three patients, longitudinal samples before, in the course, and after infection were also obtained. The microbiome alterations were examined by 16S rRNA gene sequencing. Main outcome measures: Vaginal microbiota profiles in pregnant women with COVID-19 Results: Nineteen pregnant women with COVID-19 and 28 healthy controls who were matched according to the maternal age and gestational week were recruited. Shannon index and inverse Simpson index for cross-sectional cohort indicate that alpha diversity is significantly higher in women with COVID-19 (P=0.007 and P=0.006, respectively). There was a significantly decrease in Firmicutes (P=0.007) and Lactobacillus (P=0.019) with an increase in Bacteroidetes (P=0.024) in women with COVID-19 when compared to those of healthy controls. The higher amounts of Ureaplasma were found in women with the moderate/severe disease, compared to those of the asymptomatic/mild disease (P=0.001). Lactobacillus gasseri disappeared in women with the moderate/severe disease. Prevotella timonensis was identified only in the COVID-19 group. In longitudinal analysis, Actinobacteria was elevated, Firmicutes and Bacteroides depleted during the active phase. Conclusion: The study revealed that vaginal dysbiosis with a low abundance of Lactobacillus and an increase in Bacteroidetes is associated with COVID-19.