Duloxetine is indicated for the treatment of chemotherapy induced neuropathic pain in adults. It is also indicated for anxiety, depression and fibromyalgia in children. A rare side effect of syndrome of inappropriate antidiuretic hormone (SIADH) secretion has been reported in adults but not in pediatrics or pediatric oncology patients. We present a case of a 10-year-old child with acute lymphoblastic leukemia who developed SIADH after duloxetine was given for chemotherapy-induced neuropathic pain and co-morbid anxiety. The SIADH resolved after duloxetine was stopped. This case highlights a rare side effect of duloxetine and caution should be taken when prescribing duloxetine to children.

A document by Nobuhiro Takasugi. Click on the document to view its contents.

Introduction: Interventional cardiology procedures (ICPs) have become the mainstay treatments in cardiology diseases and increased rapidly. This study aims to assess the occupational health hazards (OHHs) related to the long-time wearing of lead personal protective equipment and reveal health protection needs in interventional cardiologists. Methods and Results: We invited interventional and non-interventional cardiologists in tertiary III hospitals in China to participate in an online cross-sectional survey on their health status, utilization of personal protective equipment (PPE), and personal health protection (PHP) needs. Propensity score methods were used for comparisons of OHHs between the matched interventional and non-interventional cardiologists. Totally, 642 interventional and 402 non-interventional cardiologists completed the survey. The interventional cardiologists had significantly higher incidence of body pain (56.6% vs. 24.2%, p<0.001), bone and joint disease (21.7% vs. 8.6%, p=0.001), cataract (3.5% vs. 0%, p=0.039), and anxiety (8.1% vs. 2.5%, p=0.029) than the matched non-interventional cardiologists. The risk of back pain was independently associated with female gender, performing percutaneous coronary intervention procedure or ≥2 types of ICP, and the personal annual volume of ICPs. Only 3.3% of interventional cardiologists were satisfied with PPE and 83.0% of them complained of physical toll caused by heavy PPE. 90.7% were willing to conduct ICP without radiation exposure. Conclusions: Body pain was the main OHH in interventional cardiologists likely due to wearing heavy lead PPE for long working hours. Besides training more interventional cardiologists, the adoption of emerging technologies without heavy lead PPE will be a promising way to reduce the OHH burden.

Introduction: We aimed to evaluate the influence of technological advances on ablation outcomes in patients with persistent atrial fibrillation (AF) (PeAF). Radiofrequency ablation for patients with AF has advanced, including contact force (CF)-sensing catheters and the ablation index (AI). Methods: Between 2009 and 2018, we analyzed 173 patients with PeAF who underwent catheter ablation. We categorized them into three groups: AF ablation without CF and AI information (no-CF group, n=63), with CF without AI (CF-only group, n=49), and with optimal AI-guided ablation (AI group, n=61). Early (within 3 months, ER) and late (from 3 months to 1 year, LR) AF recurrence after ablation were assessed. Procedure-related complications were also evaluated. Results: The baseline characteristics were similar among the 3 groups, excluding the baseline antiarrhythmic drug history. Additional substrate modification after pulmonary vein isolation was significantly low in frequency in the AI group (71.4%, no-CF; 69.4%, CF-only; 41.0%, AI, p=0.001). The AI group had a shorter mean procedure-related time than the other groups. Both ER and LR of PeAF showed a trend of reduction with technological advances. With a short experience (less than 1 year), the CF-only group showed more ER and LR than that shown by the AI group. However, with a long experience (more than 1 year), ER and LR occurred similarly in the two groups. Procedure-related complications improved with technological advances. Conclusion: As ablation technology advanced, favorable clinical outcomes with short procedural times were observed. However, prospective, large multicenter studies are needed to verify these results.

Medication incidents result in global economic burden and cause avoidable patient harm. Prescribing errors constitute 18.5% of all medication incidents. Aim: Establish incidence, types, potential harm and medicines involved in prescribing errors in Welsh University Hospital Health Board. Medication chart review by medical student undertaken to identify prescribing errors highlighted by pharmacists. Pilot study conducted to ensure student was adequately trained. Data collected on wards representing medicine, surgery, mental health and specialist services. All in-patient prescriptions included. Potential harm to patients categorised via consensus panel using WHO definitions. 366 prescribing errors identified in 2161 prescriptions (16.9%). Of 206 patient charts, 148 charts contained ≥1 prescribing errors (71.8%). Three most common errors were ‘No maximum 24-hour dose specified’ (n=59), ‘Wrong dose of drug’ (n=53) and ‘No indication’ (n=37). 110 medications implicated but ten medications constituted 43.2% of all errors (n=158). Morphine (n=38), enoxaparin (n=30) and paracetamol (n=22) were most erroneously prescribed medications. 244(66.7%) errors had potential for no patient harm, 56(15.3%) mild, 47(12.8%) moderate, 17(4.6%) severe, and 2(0.5%) had potential for death. Decision-making errors (34.5%, n=130) less common than prescription-writing errors (65.5%, n=236) but had greater harm potential; 70.0%(n=85) of all errors with harm potential were decision-making errors. Error rate (16.9%) comparable to previous research (7.5-14.7%). ‘Wrong dose of drug’ was a harmful error which may be ameliorated by electronic prescribing systems incorporating ‘clinical decision support’. Prevalence of ‘No indication’ errors makes strong case for indication-based prescribing. Future studies should employ this methodology to collect data post implementation of electronic prescribing.

Different allergic phenotypes exhibit unique patterns of gut microbiota from early life Anchalee Senavonge 1, Massalin Nakphaichit2,3, Wanwipa Vongsangnak 4,5, Sittiruk Roytrakul 6, Preecha Patumcharoenpol7, Amornthep Kingkaw 7, Chantha Wongoutong 8, Wanlapa Weerapakorn 1, Natapol Pornputtapong 9,10, Orawan La-ongkham11, Pannipa Kittipongpattana 1, Sunee Nitisinprasert 4,5, Pantipa Chatchatee1*, Narissara Suratannon 1*1 Pediatric Allergy & Clinical Immunology Research Unit, Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand2 Department of Zoology, Faculty of Science, Kasetsart University, Bangkok, Thailand3 Omics Center for Agriculture, Bioresources, Food, and Health, Kasetsart University (OmiKU), Bangkok, Thailand4 Department of Biotechnology, Faculty of Agro-Industry, Kasetsart University, Bangkok, Thailand5 Specialized Research Unit: Probiotics and Prebiotics for Health, Faculty of Agro-Industry, Kasetsart University, Bangkok, Thailand6 Functional Proteomics Technology Laboratory, Functional Ingredients and Food Innovation Research Group, National Center for Genetic Engineering and Biotechnology, National Science and Technology Development Agency, Pathum Thani, Thailand7 Interdisciplinary Graduate Program in Bioscience, Faculty of Science, Kasetsart University, Bangkok, Thailand8 Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand9 Department of Biochemistry and Microbiology, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand10 Center of Excellence in Systems Biology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand11 Department of Applied Microbiology, Institute of Food Research and Product Development, Kasetsart University, Bangkok, Thailand* Corresponding author:Narissara Suratannon, MDPediatric Allergy & Clinical Immunology Research Unit, Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand1873, Praram 4 Road, Pathumwan, Bangkok, 10330, ThailandTel: +662 256 4951E-mail: narissara.su@chula.md, orchid number: 0000-0003-1182-3611Pantipa Chatchatee, MDPediatric Allergy & Clinical Immunology Research Unit, Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand1873, Praram 4 Road, Pathumwan, Bangkok, 10330, ThailandTel: +662 256 4971E-mail: pantipa.c@chula.md* Pantipa Chatchatee and Narissara Suratannon are considered joint corresponding authors.Keywords: proteomics, gastrointestinal microbiome, cohort studies, dermatitis, atopic, food hypersensitivityFunding sources: This study was supported by National Science and Technology Development Agency (NSTDA) (Grant No. P-17-50648), Ratchadapisek Research Funds (Grant No. CU-GR(S)_61_38_30_03), Chulalongkorn University, Bangkok, Thailand.Conflicts of interest: All authors have no relevant financial relationships to disclose.Authors’ contributions: AS contributed on writing the first draft of manuscript, data collection and data analysis; WV and PP performed bioinformatic analysis and wrote the manuscript, MN performed 16S sequencing, real-time PCR and wrote the manuscript, AK and SR performed proteomic analysis and wrote the manuscript. CW performed the statistical analysis and wrote the manuscript. WW, NP, OL, PK and SN provided valuable advice, reviewed and edited the manuscript. PC and NS wrote the manuscript and taking care overall of this work. All authors read and approved the final manuscript.Ethics approval: The study was approved by the Ethics Committee of King Chulalongkorn Memorial Hospital in Bangkok, Thailand (IRB No. 358/58).Abbreviations: AD: atopic dermatitis, FA: food allergyAcknowledgments: The authors would like to thank pediatric allergists and research team from Pediatric Allergy & Clinical Immunology Research Unit, Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand and Center of Excellence Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand especially Professor Yong Poovorawan, Dr. Nasamon Wanlapakorn for enrollment, follow-up the subjects and collected stool samples in this cohort. We would also like to thank the Department of Zoology, International SciKU Branding (ISB), Faculty of Science, Kasetsart University, Omics Center for Agriculture, Bioresources, Food, and Health, Kasetsart University (OmiKU) and SciKU Biodata Server for resources and computing facilities. We also would like to thank Prof. Jarungchit Ngamphaiboon from Chulalongkorn University for valuable comments and suggestions.Word count 594 words; 1 figure, 1 tableData Deposition: Sequence data generated and analyzed during this study are available on the NIH Sequence Read Archive (SRA) under Bioproject ID PRJNA716451. Raw MS/MS spectra data are available in ProteomeXchange: JPST001282 and PXD027692.To the editor,Allergic diseases are known to be associated with gut dysbiosis. However, whether gut microbial colonization and functions are different among distinct allergic phenotypes has not been elucidated. This study aimed to identify differences in gut microbiota between healthy subjects, subjects with only atopic dermatitis (AD), or food allergy (FA), or those with both AD and FA (AD+FA), using 16s rRNA sequencing and shotgun metaproteomic approach. Study populations were derived from a longitudinal birth cohort in Bangkok, Thailand, conducted during 2015 and 2019. Fecal samples of 26 allergic subjects and 26 matched controls were collected at age 9-12 months. Demographic data were shown in Table S1.Compared to controls, gut microbiome of allergic subjects showed a trend of decreased bacterial diversity and richness. This trend was most pronounced in FA (Figure 1A). The diversity of AD and AD+FA were not different compared to controls. No significant clustering was found among samples within groups (Figure S1). Regarding microbiome composition (Figure 1B), subjects with AD and AD+FA were significantly colonized with Erysipelotrichaceae . FA and AD+FA groups had low abundance of Bifidobacteriaceae but high abundance ofBacteroidaceae . Enterobacteriaceae was prominently found in FA. Microbiome profiling using real-time PCR confirmed the findings of 16S rRNA gene sequencing (Figure S2).Using metaproteome analysis, 37,579 microbial protein expressions from 12 bacterial families were identified in all subjects (Figure 1C), in which 1,179 differentially expressed proteins (DEPs) were observed between four study groups. Interestingly, all DEPs were higher in allergic subjects than controls (Figure S4). Subjects with AD+FA showed the highest distinctive DEPs, followed by FA and AD (Figure 1D). This reflected that the microbial functions of the AD+FA group were more deviate from healthy subjects than those with only AD or FA. Notably, DEPs of AD+FA and FA groups were similar, while a large difference between AD+FA and AD was observed. This implied that bacterial metabolic activities in the AD+FA group were more similar to FA than the AD group.By manual curation, 37 proteins from 4 bacterial families found from 16S bacterial sequencing were selected and functionally assigned (Table 1). In AD+FA group, proteins involving thiamine, riboflavin and menaquinone synthesis were found from three genera of Enterobacteriaceae . Proteins involving in carbohydrate metabolism were found inBifidobacterium pseudocatenulatum, Enterobacter huaxiensis, Enterobacter cloacae, Escherichia coli and Faecalitalea cylindroides , reflecting high activities of these gut microbiome. In AD group, a protein involving menaquinone synthesis demethylmenaquinone methyltransferase (DMM) from Bacteroides sp. ,and 6-phospho-beta-glucosidase from Erysipelotrichaceae were identified. Finally, proteins involving in pyruvate kinase pathway from Bifidobacterium longum subsp.longum were identified in FA group.From previous studies, Erysipelotrichaceae was reported in inflammatory bowel diseases 1, colorectal cancer2 and type 2 diabetes 3. Our cohort was the first to describe Erysipelotrichaceae related to AD4 and AD+FA phenotypes. Menaquinone (vitamin K2) synthesis pathway was highlighted in AD and AD+FA groups. Previous studies showed that menaquinone was solely produced by gut microbiome and had immunosuppressive effects on peripheral blood of AD subjects5. We hypothesize that menaquinone-producing pathway of gut microbiota is activated to counteract allergic inflammation of human host. This compensatory mechanism might also be the case forBifidobacterium longum, a good bacteria found in FA.Additionally, we confirmed the findings of Bifidobacterium pseudocatenulum in children with AD 6. Finally,Enterobacter cloacae and Faecalitalea cylindroides , which were reported in obesity 7 and Crohn disease8, were first reported in allergic diseases in our cohort.In conclusion, subjects with different allergic phenotypes showed distinct gut microbial patterns and functions. Subjects with both allergic phenotypes (AD+FA) displayed the mixtures pattern but were dominated by the FA pattern.

Background: We just right were carrying out a multicenter cohort study about ICH when COVID-19 broke out in Wuhan，and we wondered whether COVID-19 pandemic was associated with the manifestations and outcomes of intracerebral hemorrhage (ICH). Methods: Acute ICH patients before (1/12/2018-30/11/2019) and during COVID-19(1/12/2019-30/11/2020) pandemic at 31 centers in China, were entered into the analysis. Demographic information, clinical manifestations and outcomes were collected and compared between the two groups. Results: From December 1, 2018 to November 30, 2020, a total of 3460 patients with ICH were enrolled and eventually analyzed. Results showed that patients with ICH were more likely to be older, have higher systolic blood pressure (BP) (P<0.001), diastolic-BP (P=0.002), higher admission NIHSS score (P=0.039) and higher fasting blood glucose (P=0.003) during COVID-19 pandemic compared with before. After adjusting age, gender, COVID-19 pandemic was associated with 3-month poor outcome (OR adjusted = 1.206, 95%CI: 1.043-1.395) and 3-month mortality (OR adjusted = 1.711, 95%CI: 1.428-2.050) after ICH onset. Conclusions: COVID-19 pandemic deteriorated the manifestations and outcomes of ICH.

Influenza virus developed resistance to the currently class of drugs, which eventually becoming more virulent and cause more mortality and hospitalization. Our study aims to search new candidate drugs from the plant source. We investigated the cytotoxicity of R. stricta euouaes extract and its antiviral activity against influenza virus (A/Puerto Rico/8/34 (H1N1)) using MTT assay. The mode of action of the plant extract was tested using time of addition assay. in silico study was performed including molecular docking, ADME assay and toxicity risk assessment to investigate the best compound to be developed into anti-influenza virus drug. The cytotoxicity concentration 50% of the extract was (CC50: 184.6µg/ml) and the Inhibitory concentration was (CI50: 19.71 µg\ml and SI 9.37. The time of addition assay revealed that, R. stricta extract exerted its activity in the late step of the influenza virus replication cycle. The in silico study demonstrated that some compounds can be subjected to in vitro study. Therefore, isolation and purification of the candidate compounds and testing their antiviral activity are recommended.

The placenta is a large organ that develops during pregnancy that attaches to the wall of your uterus, and the baby’s umbilical cord arises from it. The umbilical cord connects the placenta to the baby. Blood from the mother passes through the placenta, filtering oxygen, glucose and other nutrients to your baby via the umbilical cord. The placenta also filters out substances that could be harmful to the baby and removes carbon dioxide and waste products from the baby’s blood. KEY WORDS: Placenta, pregnancy, blood, umbilical cord.

The hoverfly, Eupeodes corollae (Diptera: Syrphidae), is an economically important insect that provides dual ecosystem services including aphid control and pollination. Here we present a 595-Mb chromosome-level reference genome of E. corollae with contig N50 length of 1,794 kb. With Hi-C scaffolding, about 570.8 Mb (96.0%) of the assembled contigs were anchored into 4 chromosomes, and 51.47% repeat sequences and 23,374 gene models were predicted in the genome. Comparative genomics reveals significant expansion of digestive enzyme gene families in E. corollae compared to other dipteran species. Furthermore, there was also significant expansion of cytochrome CYP6 subfamily genes in E. corollae, with tandem arrangements on the genome. Several digestive enzymes with high expression levels at the larval stage might be related to aphid digestion. The high quality of the E. corollae genome assembly will help us understand its pest control mechanisms and pollination behaviors and provide a reference for other natural enemies of pests and promoting the use of beneficial insects.

Interspecific somatic hybridization has been performed in potato breeding experiments to increase plant resistance against biotic and abiotic stress conditions. We analyzed the mitochondrial and plastid genomes and 45S nuclear ribosomal DNA (45S rDNA) for the cultivated potato (S. tuberosum, St), wild potato (S. commersonii, Sc), and their somatic hybrid (StSc). Complex genome components and structure, such as the hybrid form of 45S rDNA in StSc, unique plastome in Sc, and recombinant mitogenome were identified. However, the mitogenome exhibited dynamic multipartite structures in both species as well as in the somatic hybrid. In St, the mitogenome is 756,058 bp and is composed of five subgenomes ranging from 297,014 to 49,171 bp in St. In Sc, it is 552,103 bp long and is composed of two sub-genomes of 338,427 and 213,676 bp length. StSc has 447,645 bp long mitogenome with two subgenomes of length 398,439 and 49,206 bp. The mitogenome structure exhibited dynamic recombination mediated by tandem repeats; however, it contained highly conserved genes in the three species. Among the 35 protein-coding genes of the StSc mitogenome, 21 were identical for all the three species, and 12 and 2 were unique in Sc and St, respectively. The recombinant mitogenome might be derived from homologous recombination between both species during somatic hybrid development.

Chinese dwarf cherry (Cerasus humilis), which is well known as “calcium fruit” for its high calcium content, is widely utilized in North China for its ecological and economical value. Understanding the evolutionary history and genetic basis underlying the calcium accumulation in this fruit is a fundamental goal in comparative genomics. In this study, we obtained a chromosome-scale C. humilis genome for the cultivar “zhisha” using PacBio and Proximo Hi-C technologies. The final assembled genome lengths were 235.41 Mb with an N50 contig length of 3.23 Mb. The genome contained 26,800 protein-coding genes, while 41.33% of the genome length consisted of TEs. Phylogenetic analysis revealed that C. humilis displayed a close relationship with Prunus and phylogenetically diverged from its common ancestor ~23.2 million years ago (MYA). Functional enrichment of expanded gene families in C. humilis genome highlighted genes involved in signal transduction, antiporter activity, polygalacturonase activity, auxin efflux transmembrane transporter activity, and auxin efflux, which is related to calcium transport and distribution. Phylogenetic analysis coupled with tissue-specific expression patterns indicated that PSGs identified in this study, such as WAK2 and CBL10, may also be responsible for the high Ca2+ accumulation ability in C. humilis. These results glean tremendous insight into the fundamental genetic basis of the high calcium content in C. humilis fruit. In addition, the reference C. humilis genome we present in this study will be valuable resources for breeding of this fruit species and molecular evolution analysis with related species.

This work studies the existence and the uniqueness of the solution to a kind of high-order nonlinear fractional differential equations involving Rieman-Liouville fractional derivative. The boundary condition is of integral type which entangles both starting and ending points of the domain. First, the unique exact solution is extracted in terms of Green's function for the linear fractional differential equation and then Banach contraction mapping theorem is applied to prove the main result in the case of general nonlinear source term. Furthermore, our main result is demonstrated by an illustrative example to show its legitimacy and applicability.

Objective To compare the conversion rate of non-cephalic to cephalic presentation in external cephalic version (ECV) with and without nitrous oxide Design Retrospective cohort study Setting Single, tertiary care institution between January 2016 an June 2017 Population Women with singleton, term gestation ECVs identified via International Classification of Diseases Clinical Modification diagnosis code with breech or malpresentation. Pregnancies with preterm, multi-fetal gestation, abnormal placentation, and rupture of membranes were excluded Methods Logistic regression was performed to test whether nitrous oxide was associated with successful conversion to cephalic presentation. Main Outcomes The primary outcome was successful rate of conversion to cephalic presentation. The secondary outcome was the rate of vaginal delivery. Results During the study period, 167 women underwent ECV: 77 with nitrous oxide and 90 without nitrous oxide. Of the 77 women who used nitrous oxide, 25 (32.5%) were successful and 17 of these women delivered vaginally (68%). Of the women who underwent ECV without nitrous oxide, 29 (32.2%) successfully converted and 21 of these delivered vaginally (72%). After controlling for confounders, the use of nitrous oxide had no clinically or statistically significant difference on ECV success rates (OR 1.08, 95% CI 0.52-2.23). Conclusion Nitrous oxide does not seem to affect conversion rate to cephalic presentation in ECV. Further studies are needed to determine the impact of nitrous oxide on women’s decision to undergo ECV and on patient satisfaction and tolerability. Funding The authors received no financial support for the research, authorship, or publication of this data.

Rationale, aims and objectives: The coronavirus infection 2019 (COVID-19) pandemic has affected the emergency department (ED) management. Its viral transmission necessitates the use of isolation rooms and personal protective equipment for treating suspected patients, such as those with fever. This delays the time until the first encounter with the patients, thereby increasing the length of stay (LOS) in the ED. We aimed to compare delays in the ED LOS and clinical processes between the COVID-19 period and pre-COVID-19 period. Moreover, we intended to evaluate if the aforementioned delay affected patient outcomes. Methods: We conducted a single-center, retrospective study in Korea. Patients with fever were compared between the “COVID-19 period” from March 2020 to August 2020 and the “pre-COVID-19 period” from March 2019 to September 2019. We compared the overall ED LOS and individual time variable, including initial diagnostic tests (laboratory tests, radiography), specific diagnostic test (computed tomography), and treatment processes (antibiotics). A logistic regression analysis was conducted to identify the association between hospital admission and patient data. Results: We enrolled 931 and 749 patients during pre- and COVID-19 periods, respectively. Patients with fever remained in the ED for a longer duration during the COVID-19 period (pre-COVID-19:207.7±102.7 min vs. during COVID-19: 223.5±119.4 min, p=0.004). The total time for performing laboratory tests and radiography displayed significant differences between the two periods, particularly from the time of patient arrival in the ED to the time of issuing the order. The time until antibiotic administration was delayed in the COVID-19 period (pre-COVID-19:195.8±103.3 min vs. during COVID-19: 216.9±108.4 min, p=0.003). The logistic regression analysis for hospital admission identified ED LOS as an independent factor in both periods. Conclusion: The delay until encountering patients with fever resulted in longer ED LOS during the COVID-19 period; however, it possibly did not increase the hospital admission rates.

Although phylogenetic distance between native and exotic species has a close link with their interactions, it is still unclear how environmental stresses and species interactions influence the effect of phylogenetic distance on biological invasion. Here we assessed the effect of invader-native phylogenetic distance on the growth of the invader (Symphyotrichum subulatum) under three levels of drought (no, moderate or intensive drought). We found the effect of communities with closely related natives on the invader shifted from negative (supporting Darwin’s naturalization hypothesis) to positive (supporting the pre-adaptation hypothesis.) with increasing drought intensity, which could be largely explained by the shift of species interactions from competition to facilitation by mutualism with arbuscular mycorrhizal fungi. Therefore, our results provide a new angle to resolve Darwin’s naturalization conundrum from the change of species interactions along a stress gradient, and provide important clues for invasion management in the changing environments.

In 1953 Dr Shih-I Pai accurately correlated the experimental velocity profile data of Nikuradse (Re = 25,000) for turbulent flow in a pipe. The resultant general equation, and conclusions therefrom, are derived.

This paper is devoted to the study of existence, uniqueness, continuous dependence, general decay of solutions of an initial boundary value problem for a viscoelastic wave equation with strong damping and nonlinear memory term. At first, we state and prove a theorem involving local existence and uniqueness of a weak solution. Next, we establish a sufficient condition to get an estimate of the continuous dependence of the solution with respect to the kernel function and the nonlinear terms. Finally, under suitable conditions to obtain the global solution, we prove the general decay property with positive initial energy for this global solution.

In this paper, some estimations in general form of sum of left and right sided conformable fractional integrals for convex functions are studied. Also some similar fractional inequalities for functions whose derivatives in absolute value are convex, have been obtained

To investigate the prevalence of tocilizumab off-label prescribing in outpatient department of a tertiary hospital and evaluate the rationality of these off-label prescriptions by looking through scientific evidences. Setting Peking Union Medical College Hospital in Beijing in China. Method Retrieving one year tocilizumab related prescriptions from hospital electronic information system. The standard of evaluating the on-label or off-label prescription according to whether the indication approved by China. Logistic regression was applied to explore predictive variables. All of the literature source acquired from Up-To-Date, Micromedex database, PubMed, Embase, and clinical guidelines. Main outcome measure The percentage of off-label use, influence factors identified by logistic regression, the rationality of off-label use. Conclusion according to our analysis, the majority of off-label indications of tocilizumab in our hospital have evidence support. But some indications were supported by low grade scientific evidence, more studies are required to confirm the clinical values. For the indication that has no evidence support, we suggest the administration should strength supervision.

Background: Since December 2019, 2019 novel corona virus (2019-nCov) disease (COVID-19) has extended to most parts of China with more than 80 thousand cases. From Feb 1 st to Mar 31 st of 2020, all children were asked to stay indoors in China. Then how it affected allergic asthma (AA) sensitized to house dust mites (HDM) in children was interestingly to clarify. Objective: To investigate the changes of clinical characteristics of children with AA sensitized to HDM during COVID-19 pandemic. Method: The data including asthma symptom scores(SS), visual analog scores (VAS), asthma quality of life questionnaire (AQLQ) and medicine scores (MS) as well as respiratory infections, cares, staying up late and diets, collected from children with AA sensitized to HDM from Feb 1 st to Mar 31 st of 2019 and 2020 retrospectively, were analyzed. Results: There were 85 children with AA sensitized to HDM included in this research. Compared with SS, VAS, AQLQ and MS of the patients from Feb 1 st to Mar 31 st of 2019, SS, VAS, AQLQ and MS of the patients improved significantly (p<0.05) during COVID-19 pandemic. No respiratory infections occurred among them and they got better cares, had better diets and stayed up late less during COVID-19 pandemic. Conclusion: During COVID-19 pandemic, children with AA sensitized to HDM got better health for staying indoors, which might be associated with no respiratory infections, better cares, better diets and less staying up late.

Background Drug-induced severe cutaneous adverse reactions (SCARs) are presumed T-cell-mediated hypersensitivities associated with significant morbidity and mortality. Traditional in-vivo testing methods, such as patch or intradermal testing, are limited by a lack of standardisation and poor sensitivity. Modern approaches to testing include measurement of IFN-γ release from patient peripheral blood mononuclear cells (PBMC) stimulated with the suspected causative drug. Objective We sought to improve ex-vivo diagnostics for drug-induced SCAR by comparing enzyme-linked immunospot (ELISpot) sensitivities and flow cytometry-based intracellular cytokine staining (ICS) and cellular composition of separate samples (PBMC or blister fluid cells (BFC)) from the same donor. Methods IFN-γ release ELISpot and flow cytometry analyses were performed on donor-matched PBMC and BFC samples from four SCAR patients with distinct drug-allergies. Results Immune responses to suspected drugs were detected in both PBMC and BFC samples of two donors (Case 1 in response to ceftriaxone and Case 4 to oxypurinol), with BFC eliciting stronger responses. For two other donors, only BFC samples showed a response to meloxicam(Case 2) or sulfamethoxazole and its 4-Nitro metabolite (Case 3). Consistently, flow cytometry revealed a greater proportion of IFN-γ-secreting cells in the BFC compared to PBMC. BFC cells from Case 3 were also enriched for memory/activation/tissue-recruitment markers over PBMC. Conclusion Analysis of BFC samples for drug-allergy diagnostics offers a higher sensitivity for detecting positive responses compared to PBMC. This is consistent with recruitment (and enrichment) of cytokine-secreting cells with a memory/activated phenotype into blisters.

We herein describe a case and provide images of a bioprosthetic mitral valve thrombosis and a huge left atrial appendage thrombus occurring during atrial fibrillation 12 years after initial heart surgery. The patient was treated conservatively with oral anti-coagulation because he was a high surgical risk with complete resolution of the thrombosis after 2 months of therapy. This case suggests that in a high surgical risk patient, effective oral anticoagulation might be a good alternative to surgery.

The growing effect of CO2 and other greenhouse-gas (GHG) emissions on the extreme climate risks in the Western Cape, South Africa, calls for the need for better climate adaptation and emissions-reduction strategies to protect region’s long-term social-economic benefits. This paper presents a comprehensive evaluation of changes in the future extreme events associated with drought and heatwave under three different greenhouse gases (GHG) emissions scenarios: Representative Concentration Pathway (RCP) 2.6, RCP 4.5, and RCP 8.5, from moderate to severe, respectively. A variety of diagnostic indices are used to determine how future heatwaves and drought will response to each different RCP climate scenario in Western Cape based on Max Planck Institute-Earth System Model/REMO (MPI-ESM/REMO). The projected simulation results reveal that both drought-related and heatwave-related extreme climate indices suggest very strong relationships between the future extreme climate risks and the GHG emissions for Western Cape, South Africa. Anthropogenic activities and growing GHG emissions will lead to severer extreme climate stress in terms of drought as well as duration, frequency, and magnitude of heatwave stresses. As a result, we believe that reducing the GHG emissions to alleviate future extreme climate stress becomes a practical solution to protect the local’s socio-economic system and further maintain the region’s economic prosperity.