Objective: Racial disparities in pre-existing diabetes (PDM) and gestational diabetes (GDM) remain largely unexplored. We examine national PDM and GDM prevalence trends by race/ethnicity, and the association between these conditions and fetal death. Design: Retrospective cross-sectional analysis Setting: United States Nationwide Inpatient Sample Survey Population/Sample: A total of 69,539,875 pregnancy-related hospitalization from 2002 to 2017 including 674,040 women with PDM (1.0%) and 2,960,797 (4.3%) with GDM. Methods: Joinpoint regression was used to evaluate trends in prevalence. Survey logistic regression was used to evaluate the association between exposures (PDM and GDM) and outcome. Main Outcome Measures: National trends in PDM and GDM prevalence by race/ethnicity, and the association between these conditions and fetal death Results: Overall, the average annual increase in prevalence was 5.2% (95% CI [4.2, 6.2]) for GDM and 1.0% (95% CI [-0.1, 2.0]) for PDM, over the study period. Hispanic (AAPC 5.3; 95% CI [3.6, 7.1]) and NH-Black (AAPC 0.9; 95% CI [0.1, 1.7]) women had the highest average annual percent increase in prevalence of GDM and PDM, respectively. After adjustment, odds of stillbirth were highest for Hispanic (OR 2.41:95% CI [2.23, 2.60]) women with PDM and decreased for women with GDM (OR 0.51;95% CI [0.50, 0.53), irrespective of race/ethnicity. Conclusions and Global Health Implications: PDM and GDM prevalence is increasing in the U.S. with highest average annual percent changes seen among minority women. Further, reasons for variation in occurrence of stillbirths among mothers with PDM and GDM by race/ethnicity are not clear and warrant additional research.

In this paper, we analyzed a priori and a posteriori error estimates for the h − p version of the finite element discretization of the elliptic Robin boundary control problem. The conforming $h−p$ finite element method is used. First, we established the optimality conditions for the continuous and discrete optimal control problems, respectively. Then, a priori error estimates of the $h−p$ finite element discretization for the optimal control problem are derived rigorously. Moreover, residual-based a posteriori error estimates are established for the coupled state and control approximations. Such estimators can be used to construct reliable adaptive methods for optimal control problems.

Background: Chronic pelvic pain (CPP) affects 2.1-24% of women, causing physical and psychological damage to women around the world. Objectives: Based on the efficacy of gabapentin in the treatment of chronic pain, we conducted this study to evaluate the efficacy and safety of gabapentin in reducing pain in female with CPP. Search strategy: Systematic searches were performed in the electronic databases of PubMed, Embase, Web of science, Scopus, Cochrane and Clinicalkey databases. Selection criteria: Studies focused on comparing the efficacy of gabapentin and placebo in the treatment of female CPP patients were included. Data collection and analysis: RevMan 5.4 was used to analyze the results and risk of bias. Two investigators independently selected eligible studies and extracted related pain scores and side effects for meta-analysis. Main results: In total, enrolled 4 RCTs totalling 425 patients in the meta-analysis. Among patients receiving gabapentin, the average pain scores in 3 and 6 months were significantly lower than those in the placebo group(P<0.00001). The results showed that there was no statistical difference between gabapentin and placebo in the reduction of pain scores from baseline(P=0.41). The incidence of side effects in the gabapentin group was significantly higher than that in the placebo group(P<0.00001). Conclusion: This systematic review and meta-analysis demonstrated that for female with CPP, gabapentin was significantly different from placebo in average pain scores at 3 and 6 months. Gabapentin can bring more significant side effects, whether it is a common side effect or a serious side effect. Funding: None.

In this paper, under effects of the largest primary radiation pressure the elliptic restricted Four-Body Problem is formulated in Hamiltonian form, the canonical equations are obtained which are considered as the equations of motion. The Lagrangian points within the frame of the elliptic restricted four-body problem are obtained. The true anomalies are considered as independent variables. An analytical and numerical approach had been used. A code of Mathematica is constructed to truncate these considerations and is applied on the Earth-Moon-Sun system. The stability and periodicity of the motion about the equilibrium points are studied by using the Poincare maps, The motion about the collinear points L2 is presented as an example for the obtained results, and some families of periodic orbits are presented.

Imaging and hysteroscopic findings in a patient with postpartum hemorrhage caused by acquired uterine arteriovenous fistulasSijie Yi,a, * Xia Jin,b, * Yuanhuan Xiong,c Xiuxiu Pengda Department of Obstetrics and Reproductive Health, Affiliated People’s Hospital of Nanchang University, Nanchang, Chinab Department of Anesthesia, Affiliated People’s Hospital of Nanchang University, Nanchang, Chinac Department of Gynecology, Affiliated People’s Hospital of Nanchang University, Nanchang, Chinad Medical Department, Graduate School, Nanchang University, Nanchang, ChinaCorrespondence: Yuanhuan Xiong, Department of Gynecology, Affiliated People’s Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China.Email: xiongyuanhuan@163.com*These authors contributed equally to the manuscript.Running head: acquired uterine arteriovenous fistulas

Background/purpose To date, molecular typing studies of Mycoplasma pneumoniae are limited in Henan. We researched the molecular types of Mycoplasma pneumoniae in pediatric patients in Henan in 2020. Methods M. pneumonia was detected by SAT-MP kit. The domain V of their 23S rRNA were sequenced for detection of macrolide-resistant point mutations. Molecular typing with multiple locus variable-number tandem repeat analysis (MLVA) was done for both macrolide-susceptible and macrolide -resistance M. pneumoniae samples. Results M. pneumoniae was detected in 9.8% (121/1237) respiratory samples in 2020. Among the M. pneumoniae-positive samples, 96% (116/121) had macrolide-resistant genotypes, and all of them were A2063G mutation. 105 macrolide-resistant strains and 4 macrolide-susceptible strains fulfill MLVA typing. MLVA 4-5-7-2 was the most frequent type (60/109, 55%), followed by 3-4-6-2 (49/109, 45%). There was no association between MLVA types and macrolide resistance (p >0.05). Conclusion The percentage of macrolide resistance M. pneumoniae was high (96%) in pediatric patients in 2020 in Henan, and A2063G was the dominant point mutation. MLVA types was independent to macrolide resistance.

Point-of-care ultrasound of the diaphragm has been proposed as a simple, noninvasive, dynamic bedside quantitative evaluation of diaphragm function that involves no ionizing radiation, does not require patient transport, and enables the serial evaluation of diaphragmatic function over time.In addition to the adverse effects on the diaphragm attributed to mechanical ventilation and ventilator-induced diaphragm dysfunction (longer weaning times, ventilation time and weaning failure), recent investigations of POCUS evaluating the expiratory muscles of the lateral abdominal wall have found similar adverse effects of mechanical ventilation on these important respiratory muscles resulting in weaning difficulty. Children with medical complexity have significant chronic health conditions that may involve multisystem disease (congenital or acquired), high medical fragility, functional and psychosocial impairment, technology dependence (tracheostomies, MV, feeding tubes) and high resource utilization (frequent and/or prolonged hospitalizations).We present a case of weaning difficulty in a child with medical complexity and the important role of point-of-care ultrasound in the evaluation of the diaphragm and expiratory muscles during a spontaneous breathing trial.

Knowledge of the sex determination system and sex-associated genes has important implications in physiology, ecology and evolution, but the mechanisms underlying sexual determination systems in turtles has not been fully elucidated, due to their remarkable variability and a lack of reference genomes in some species. In this report, we describe the first genome assembled at the chromosome scale for Mauremys mutica using Illumina and high-throughput chromatin conformation capture (Hi-C) technology. A total of 280.42 Gb of clean data were generated using the Pacific Biosciences platforms, which represented approximately 119× coverage of the Mauremys mutica genome. The assembly comprised 2.23 Gb with a contig N50 of 8.53 Mb and scaffold N50 of 141.98 Mb. Genome Hi-C scaffolding resulted in 26 pseudochromosomes containing 99.98% of the total assembly based on BUSCO analysis. Genome annotation predicted 24,751 protein-coding genes, and 97.23% of them were annotated. Comparative genomics analysis indicated that the lizard-snake-tuatara clade diverged from the bird-crocodilian-turtle clade at approximately 283.1-320.5 Mya. Additionally, positive selection of genes and gene families related to calcium signaling, neuroactive ligand-receptor interaction, and expansion of the hormone signaling pathway were identified, implicating their roles in sex regulation in Mauremys mutica. High-quality genome assembly may provide a valuable genomic resource for further research investigating gene-environment interactions in Mauremys mutica.

Antineutrophil cytoplasmic antibody (ANCA) vasculitis is a rare multisystem small vessel vasculitis in children. Apart from usual clinical management, psychosocial issues are also need to be addressed. We report a young girl with ANCA vasculitis and associated psychosocial stressors who responded to timely intervention through cognitive behavior therapy.

Background: Serum tumor abnormal protein (TAP) level has been confirmed to be associated with the progress of tumor cells. Objective: This study aimed to investigate the diagnostic value of TAP in lung cancer patients. Methods: 159 patients with lung cancer and 45 patients with benign pulmonary nodules were enrolled in this study. We measured serum TAP level and explored the relationship between TAP level and disease. Results: Serum TAP level of lung cancer patients were higher than that in benign diseases (123.4±45.4µm2 versus 104.2±25.4 µm2, P=0.0073). The results showed that TAP levels were reliable in distinguishing lung cancer from benign diseases with an area under the curves (AUC) value of 0.6222 (95% CI, 0.5360-0.7083). In addition, we observed that TAP level were associated with the pathological classification of lung cancer. The AUC values for ADC, SCC and SCLC were 0.6031(95%CI, 0.5110-0.6952), 0.6656(95%CI, 0.5373-0.7939) and 0.8089(95%CI, 0.5531-1.065), respectively. Conclusion: TAP might be a valuable biomarker for the diagnosis of lung cancer.

Objective: To assess the impact of the Covid-19 pandemic on the diagnosis and treatment of patients at tertiary hospital in Poland. Design, setting, participants: This was a retrospective review of head and neck cancer patients presented to the multidisciplinary tumour board (MTB) during the 12-month period from March 2020 through February 2021 and compared to patients presented to the MTB during the prior, pre-pandemic 12-month period from February 2019 to March 2020. Main outcomes and measures: Patient demographic and clinical variables were compared: sex; age at diagnosis; distance from hospital; date of first visit, radiological diagnosis, pathology specimen, MTB meeting, and initiation of primary and adjuvant treatment Results: The number of patients presented to the MTB increased by 22% (278 to 340) from the pre-pandemic to the pandemic period. The mean time from MTB presentation to treatment initiation increased significantly from 17.1 to 21.7 days. The mean time from first visit to treatment start increased from 44.7 to 54.4 days. The proportion of patients with early-stage oropharyngeal cancer who underwent primary surgery rose from 47.3% to 86.6%. The percentage of patients who received palliative radiotherapy increased from 20.5% to 32.9%. The proportion of patients who received best supportive care rose from 1.8% to 6.2%. Conclusion: One of the most notable findings of this study was the increased time from first visit to treatment initiation, which could negatively impact patient outcomes. The differences in the treatment received in these two periods should be further evaluated to determine their influence on survival

A catalytic membrane nano reactor (CMNR) with deep-permeation nanocomposite structure (DPNS) has been fabricated by flowing synthesis for methanol dehydrogenation to formaldehyde. In this structure, Cu/ZnO nanoparticles are in situ immobilized in the pores of Ti membrane substrate. The characterization by XRD, TGA, XPS, SEM and TEM indicates that the Cu/ZnO nanoparticles with mean size 82 nm was successfully embedded into the membrane pores, and well distributed along the thickness direction of the membrane. In the methanol dehydrogenation reaction, for one sheet of membrane setting up, the selectivity of formaldehyde 98%, the catalyst turnover frequency (TOF) 183 mmol·h-1·g-1, the pressure drop 2.7 kPa with gas permeating the membrane have been measured, under reaction temperature 360 ℃, the gas flux 8 m3·m-2·h-1 through the membrane.

Here we present a process of producing AuNPs in large scale upon further development of the bench scale experiment. We produce the AuNPs-based medical dressing by using the dyeing and finishing machine. The AuNPs and related products are very promising in medical applications.

Background: Diabetes self-management education is an essential component of caring for the disease, and evidence shows that it can even reduce overall mortality in patients with type 2 diabetes. However, no study was found to compare the effects of these interventions on patients’ quality of life. Therefore, we decided to systematically review the interventions that have been done to promote self-management of type 2 diabetes and their effect on Quality of life. Methods: Twelve databases were searched for systematic reviews without date and language restrictions, the data extracted and the quality of the studies was assessed using the AMSTAR2 checklist. Quality of life was considered as the main outcome of the study and the results of the studies were presented qualitatively. Results: The present study includes the results of 51 systematic review studies in 16 countries over 20 years, covering a wide range of self-management interventions and quality-of-life assessment tools. The highest number of studies was presented in the form of telemedicine. The most effective interventions on patients’ quality of life were self-management interventions that included the patient’s social network (family, friends, etc.) and interventions that provided individual strategies for managing the individual’s illness. Conclusion: Self-management interventions in diabetes cover a wide range, and their effects on quality of life are a matter of debate.

OBJECTIVE: To evaluate agreement of hospital physicians and older patients with individualised STOPP/START based medication optimisation recommendations from a pharmacotherapy team. METHODS: This study was embedded within a large European, multicentre, cluster randomised controlled trial examining the effect of a structured medication review on drug-related hospital admissions in multimorbid (≥3 chronic conditions) older people (≥70 years) with polypharmacy (≥5 chronic medications). Data from the Dutch intervention arm of this trial were used for this study. Medication review was performed jointly by a physician and pharmacist (i.e. pharmacotherapy team) supported by a Clinical Decision Support System with integrated STOPP/START criteria. Individualised STOPP/START based medication optimisation recommendations were discussed with patients and attending hospital physicians. RESULTS: 139 patients were included, mean (SD) age 78.3 (5.1) years, 47% male and median (IQR) number of medications at admission 11 (9-14). 371 recommendations were discussed with patients and physicians, overall agreement was 61.6% for STOPP and 60.7% for START recommendations. Highest agreement was found for initiation of osteoporosis agents and discontinuation of proton pump inhibitors (both 74%). Determinants associated with higher agreement in multivariate analysis were: female gender (+17.1% [3.7;30.4]), ≥1 falls in the past year (+15.0% [1.5;28.5]) and eGFR 30-50 ml/min/1.73m2; (+18.0% [2.0;34.0]). The main reason for disagreement (40%) was patients’ reluctance to discontinue or initiate medication. CONCLUSION: Better patient and physician education regarding the benefit/risk balance of pharmacotherapy, in addition to more precise and up-to-date medical records to avoid invalid recommendations, will likely result in higher agreement with future pharmacotherapy optimisation recommendations.

Aim To summarise and describe the burden of serious adverse drug reactions (ADRs) in sub-Saharan Africa (SSA) in the era of antiretroviral therapy. Methods We searched Medline, CINAHL, Africa-Wide Information, Scopus, and Web of Science, without language restriction up to March 2021. We hand-searched reference lists, conference abstracts, and dissertation databases. We included studies reporting proportions of admissions attributed to ADRs, admissions prolonged by ADRs, or in-hospital deaths attributed to ADRs. Two reviewers independently screened studies, reviewed study quality using a previously published tool, and extracted data. We tested for heterogeneity using I2-statistics and summarised study results using medians and interquartile ranges. Subgroup analyses summarised results by study quality, setting, methodology, and population. Results From 1005 unique references identified, we included 15 studies. Median study quality was 7/10; heterogeneity was very high. Median [IQR] proportion of admissions attributed to ADRs was 4.8% [1.5% to 7.0%] (14 studies), and 6.4% [4.0% to 8.4%] in nine active surveillance studies in adults. Two paediatric studies reported the proportion of admissions prolonged by ADRs (0.29% and 0.99%). Three studies reported the proportion of in-hospital deaths attributed to ADRs (2.5%, 13%, and 16%). Antiretroviral and antituberculosis drugs were often implicated in serious ADRs. Conclusion Evidence of the burden of serious ADRs in SSA is patchy and heterogeneous. A few high-quality studies suggest the burden is considerable, and that it reflects the regional impact of the HIV pandemic. Further characterisation of this burden is required, ideally in studies of standardised methodology.

Talaromyces marneffei (T. marneffei) is an opportunistic pathogen that infects immunodeficient and immunocompromised patients. We presented a pediatric patient with a diagnosis of T. marneffei infection who were followed up in the Guangzhou Women and Children’s Medical Center. The child was a 5-year-old girl with persistent coughed and gasped for two months, and she was confirmed with T. marneffei infection by bronchoalveolar lavage fluid(BALF) culture and high-throughput sequencing technology. Human immunodeficiency viru(HIV) was negative according to a serum-specific antibody test. She was treated with amphotericin B and itraconazole as antifungal agents with good clinical response. At the follow up, the high resolution computed tomography (HRCT) showed mosaic sign in the whole lung field with a diagnosis of post-infectious bronchiolitis obliterans (PIBO) as the sequela. She has a mutated COPA gene with uncertain pathogenic potential by the whole-exome sequencing. This is the first report of PIBO sequelae from T. marneffei infection in child with non-HIV infection and she was identified with a mutation in COPA gene.

Rationale, aims and objectives: The Post Stroke Checklist (PSC) is not capable of enforcing post-stroke follow-up and needs to be further optimized. The objective of this study is to describe an evidence-based optimization of the PSC (the Chinese version of the PSC, C-PSC), and evaluate its feasibility and usability in clinical practice. Method: Participants were consecutively recruited from 13 departments in a specialized hospital. Data were collected from April 2021 to May 2021. The trained clinicians contacted stroke survivors by telephone calls at six months since diagnosis. A satisfaction questionnaire was sent to the participant whilst clinicians completed a satisfaction questionnaire and the Pragmatic Face and Content Validity Test (PRAC-Test). Then, a debriefing meeting was held. Quantitative and qualitative data were both collected. Results: A total of 167 individuals consented to take part in the study.113 participants completed the assessment at six months and three were excluded due to missing data. The C-PSC identified a wide range of unmet needs related to stroke and at least one need was reported in 76.4% of individuals. The average time taken to administer the C-PSC was 8 mins. The minimum content validity index for each item exceeded 0.78 and the average was 0.98 with a scale-content validity index greater than 0.90. Satisfaction ratings were high for individuals (8.5/10) and clinicians (9.6/10). The average rating measured by PRAC-Test was higher than 9.0/10 except for two items. Totally 31 further screenings were conducted and 33 appropriate referrals were accomplished. Several areas for improvement were identified and revised. Conclusions: The C-PSC is a feasible and useful measure in enforcing follow-up caring and promising to be an approach in standardizing post-stroke follow-up practices.

Background: Sepsis is one of the dominating causes of mortality and morbidity in-hospital especially in intensive care units (ICU) patients. The purpose of this study was to develop an eXtreme Gradient Boosting (XGBoost) based model and explore whether it performs better in predicting sepsis from the time of admission in intensive care units (ICU) than other machine learning (ML) methods. Methods: The source data used for model establishment in this study were from a retrospective medical information mart for intensive care (MIMIC) III dataset. Model performance of the XGBoost model was compared to logistic regression (LR), recursive neural network (RNN), and support vector machine (SVM). Then, the performances of the models were evaluated and compared by the area under the curve (AUC) of the receiver operating characteristic (ROC) curves. Results: A total of 6430 MIMIC-III cases are included in this article, in which, 3021 cases have encountered sepsis while 3409 cases have not, respectively. As for the AUC (0.808 (95% CI): 0.767-0.848,DT), 0.802 (95%CI: 0.762-0.842，RNN), 0.790 (95%CI: 0.751-0.830,SVM), 0.775 (95%CI: 0.736-0.813,LR) , results of the models, XGBoost performs best in predicting sepsis. Conclusions: Amongst other ML methods, the XGBoost model demonstrated the best ability in detecting the sepsis.

Background: Ensuring the comfort of the patient during Percutaneous Coronary Interventiıon (PCI) is one of the nursing care goals. During procedure, the patient’s comfort level may vary depending on the vascular access method. Studies examining comfort from a nursing perspective in coronary interventions are very limited. Objective: This study is a descriptive cros-sectional study to identify the general comfort levels of the patients and to determine whether transradial or transfemoral access method affects the comfort level in PCI. Methods: The study was conducted on 200 volunteer patients in a private university hospital in Istanbul between May 2018 and May 2019. General Comfort Questionnaire (GCQ) was used in this study. In the evaluation of the data, t-test as well as percentage, mean, standard deviation, row mean descriptive statistical methods were used. Results: In this study, 46% of the participants were in the 40-59 age group, 47% were over 60 years old, 74% were male, 92% were married. Angiography was performed in 67% of the patients from the radial artery and 33% from the femoral artery. The average overall comfort score was found to be 3.03 ± 0.3. The patients received the highest score from psychospiritual comfort subscale and the lowest score from physical comfort subscale. The score averages of physical, psychospiritual, environmental, general comfort of the patients who underwent transradial PCI were statistically higher than transfemoral (p<0.05). According to both access methods, a significant difference was found between the mean scores of the levels of relief and ease. Conclusions: As a result, the general comfort level of the patients who underwent PCI was found above medium level. The patients received the lowest score from physical comfort subscale. The comfort level of the patients who underwent transradial method was found to be higher than those transfemoral.

Among all the limiting factors in plant growth, soil salinity is one of the critical factors, but mechanisms of its effects in Spinacea oleracea especially the compartmentalization of Na+ and K+ need further investigations. In this study different concentrations of Nacl to S. oleracea . The objective was to study the growth, anatomy, physiology and non-structural carbohydrates. The other objective was to investigate Na+ and K+ compartmentalization in different plant tissues. We found that application of sodium significantly reduced the studied parameters of growth, anatomy, and physiology. Maximum amount of Na+ was compartmentalized in leaf-blade while the minimum in roots. Similarly, maximum K+ was compartmentalized in mid-rib and minimum in stem. The Na+: K+ decreased significantly with the increasing salinity application. Non-structural carbohydrates also decreased. Further, some significant relationships were also found between Na+, K+ and other traits. The study concludes that S. oleracea can tolerate salinity stress up to 80 mML-1. The findings can be helpful to cultivate S. oleracea in saline areas and can also be useful to cultivate other crops when successive cultivation of S. oleracea is carried out and Na+ is absorbed by crop from soil.

We are reporting the therapeutic effect of a Persian herbal formula (Triphala) on male infertility. A 27-year-old man was diagnosed with male infertility based on sperm analysis and World Health Organization (WHO) manual for semen analysis. Over three months, the patient was treated with a Persian herbal preparation named Triphala.

Introduction Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF), and high-power, short-duration (HP-SD) radiofrequency ablation has been reported to be effective. Since the depth of the myocardial scar created by HP-SD ablation can be shallower than that of conventional middle-power, middle-duration (MP-MD) ablation, which might be a partial limitation of HP-SD ablation, we investigated the differences between HP-SD and MP-MD ablation. Methods and Results A total of 158 patients who underwent lesion size index-guided PVI were enrolled. The first half of the consecutive patients (n=83) underwent MP-MD ablation, while the second half (n=75) underwent HP-SD ablation. The PVs on both sides were divided into six segments of anterior, posterior, roof, bottom, and on the anterior and posterior of the carina. The patient characteristics, procedure features, remnant and early reconnections (RERs) of PV conduction after initial PVI, and clinical outcome were compared between the groups. The procedure time was significantly longer in the MP-MD group than in the HP-SD group (176.9 ± 56.0min vs. 132.1 ± 45.9min, respectively, p<0.001). The rates of RER at the right anterior carina was significantly less frequent in the MP-MD group than in the HP-SD group (12.1% vs. 25.3%, respectively, P=0.04). The cumulative recurrence rate expressed in the Kaplan-Meier curve was comparable between the MP-MD and HP-SD groups. Conclusions Each method showed distinguished features. Combination use of MP-MD and HP-SD depending on the segment of the PV, especially the right PV anterior carina, may be reasonable.

In atrial fibrillation (AF) procedures, fluoroscopy remains the main technology used to guide the transseptal puncture. We present a workflow to perform a zero-fluoroscopy ablation procedure of both paroxysmal and persistent AF using a 3D electro anatomical mapping (EAM) system, intracardiac echocardiography (ICE) and a novel steerable guiding sheath that can be visualized on the mapping system. We present two case reports during which we applied this novel workflow achieving a successful pulmonary vein isolation without complications and zero-fluoroscopy exposure.