Rationale, aims, and objectives: Evidence-based medicine (EBM) has become increasingly widespread over the last 30 years. However, the ideal curriculum for undergraduate EBM education has yet to be developed. To establish an EBM curriculum suitable for the educational environment in Japan, a qualitative study was conducted to identify the elements needed to facilitate undergraduate EBM learning among Japanese medical students. Method: Participants were supervising physicians working in teaching hospitals or clinics. Six physicians who consented to participate in the study were interviewed individually from October 2019 to January 2020. In addition to basic demographics, the interviewees were asked about their own EBM learning and teaching experiences, what they kept in mind when teaching EBM to medical students and what they felt was needed to improve current undergraduate EBM education. Interview transcripts were analyzed using thematic analysis. Results: Thematic analysis extracted five themes: awareness of foreground questions in clinical practice, motivating learning through observation of role models, awareness of the role of medical students and active learning, understanding patient background as a starting point for practicing EBM, and prioritizing understanding “why” rather than “how” in EBM. Conclusions: Japanese medical students with limited clinical experience may first need to observe their supervisors practice EBM to develop the motivation to learn and grasp the bigger picture of EBM. It is important for medical students to develop an interest in their patients through conversations and to learn that EBM is a means to solve the patients’ problems. Focusing on learning the rationale rather than the skills for practicing EBM may be the key to facilitating initial interest in undergraduate EBM education for subsequent continuous learning.

In this paper, we study the normality of families of meromorphic functions concerning shared functions. Some example show that the condition in our result is best possible.

Non-viral gene carriers because of their limited side effects, biocompatibility, simplicity and taking the advantages of electrostatic interactions have shown noticeable potential in gene delivery. The low transfection rate of non-viral vectors under physiological conditions is a significant issue. Here, the aim of this study was to investigate the efficacy of hydrophilic and hydrophobic groups on gene carriers such as two synthesized amphiphilic polymer of dextran-stearic acid-spermine (DSASP) with verified lipid and amine conjugations that associated with Fe3O4 superparamagnetic nanoparticles to promote the target delivery and decrease the transfection time using static magnetic field. Our findings illustrate that magnetic nanoparticles are spherical with positive surface charges and superparamagnetic behaviors. The DSASP–pDNA/MNPs offered a strong pDNA condensation, protection against DNase degradation, significant cell viability in HEK 293T cells and. Although conjugations of spermine play a critical role in transfection efficiency, amphiphilic polymer with more derivatives of stearic acid showed better transfection yields. Therefore, DSASP amphiphilic magnetic carriers offer new insights for gene delivery due to the amine contents and ameliorate the uptake of complexes via cell membrane based on its hydrophilic surface.

In the present research the best structural descriptors for different cation and anion were investigated using quantitative structure−property relationship (QSPR) approach to find proper ionic liquid (IL) for extractive desulfurization. Five different datasets were collected from the literature containing{(Cation/[NTf2]−thiophene−n-heptane),(Cation/[NTf2]−thiophene−n-hexane),(Cation/[FAP]−thiophene−n-heptane),(Cation/[TCM]−thiophene−n-heptane),([C2MIM]/Anion−thiophene−hydrocarbon),([C8MIM]/Anion–thiophene−hydrocarbon)}. By investigating the various kinds of molecular descriptors, it was found that the increment of Spanning Tree Number (STN) descriptor as cation structure descriptor, causes a decrease in mole fraction of thiophene in IL-rich phase due to the increase in steric hindrance. Also, it was found that an increase in E1p which represents the density of atoms projected along the length or unfilled space of the anion value as anion structure descriptor leads to the decrement of mole fraction of thiophene in the IL-rich phase

Electronic structure of catalysts has a great influence on their performance and understanding these functional mechanism of electrons quantitatively in the molecular-scale is of importance to design efficient catalysts. Herein we study the regulation of electronic effect on gold catalysts by using the atmospheric oxidation of alcohols as probe reaction. Binding ligands results in a turnover frequency increase (6197 h-1 at 220 oC) closing to the best gold catalyst (twinning structure) reported before. Combining results from X-ray absorption spectroscopy along with a series of in-situ studies, we reveal that electronic-rich processes could provide additional active sites for the reactants under solvent free gas-phase conditions. Theoretical calculations clarify the regularity that gold surface with lower work function is favorable to the thermal oxidation process. It provides a pathway for us to rational design highly efficient precious metal catalysts in the gas-phase reaction.

Although severe acute respiratory syndrome coronavirus 2 is primarily known for its significant and potentially fatal pulmonary manifestations, case reports and literature review have linked the infection to multiple organ systems, including hematological manifestations. Scattered among these reports are cases of lymphopenia and neutropenia as well as evidence of children presenting in hypercoagulable states related to COVID-19. We present a case describing a pediatric patient who presented with leukopenia, thrombocytopenia, and severe neutropenia: a unique combination based on the current literature.

More than one year has been passed since the first report of COVID-19 from Wuhan city of China. Soon this virus was spread around the world and became a pandemic and till now, over 122 million people have been infected and over 2.69 million of them have been dead due to COVID-19 infection. Many efforts have been done regarding different aspects of COVID-19 pharmacotherapy and its challenges. Coronavirus can negatively affect the immune system. This complication can be exaggerated in pregnant women with micronutrient and elemental deficiencies. Also, coronavirus itself can induce micronutrients malabsorption and result in their severe deficiencies that can lead to increased risk of infection in these group of patients. The most important micronutrients that can support the immune system are zinc, selenium, iron, vitamin A, C, D, and E. So, it has been suggested that administration of supplemental micronutrients would be helpful to prevent the severe complications of COVID-19 infection in pregnant women [4]. Vitamin A deficiency during pregnancy can result in congenital defects, anorectal malformation, schizophrenia, gestational diabetes, and diabetes mellitus. Also, excessive administration of supplemental vitamin A should be avoided during pregnancy. Vitamin C deficiency during pregnancy could be accompanied by several pregnancy complications including gestational diabetes, gestational hypertension, and preeclampsia. So, administration of supplemental vitamin C would be promising in pregnant women who are infected with new coronavirus to prevent these complications during pregnancy and boosting of the immunity system. VitaminD can play an important role in protection against viral respiratory tract infection.

Objectives: To conduct a scoping review of the available literature and identify existing interventions for dysphagia rehabilitation among individuals with moderate to severe ABI during the acute and chronic phases of recovery. Design: Scoping review involving a literature search of multiple databases for studies published in English up to July 2018. Inclusion criteria: (1) moderate-severe ABI, (2) participants aged 18+ years, and (3) a dysphagia rehabilitation intervention was provided. The Physiotherapy Evidence Database (PEDro) tool was used to determine methodological quality. Results: 17 studies met inclusion criteria; nine of which had <50% ABI participants, four had >50% ABI, and four did not specify ABI percentage. Twelve studies were published between 2012-2018, and five were published between 1990-2007. Fifteen journal articles and two conference abstracts met inclusion. Five randomized controlled trials (RCTs) were included, two level 1b evidence, two level 2 evidence, and one was of unknown quality. Four prospective controlled trials (PCTs) provided level 2 evidence. Three post-test and three pre-post studies provided level 4 evidence, and two case reports provided level 5 evidence. Nine different interventions were investigated, with electrical stimulation, individualized management programs, and diet manipulation being the most common. Eleven unique outcome measures were used overall, which crossed several domains. Conclusions: The literature investigating dysphagia rehabilitation interventions for ABI, the vast majority of which are traumatic brain injury is limited, with wide variability in intervention type, study design, injury etiology, and outcome assessment across studies. There remains an important evidence gap for ABI dysphagia rehabilitation.

he Coiflet wavelet-homotopy method is extend to analyze the problemof natural convection in cavities under the effect of an inclined external magneticfield. The Coiflet wavelet solutions for a wide range of various physical parameterssuch as the Grashof number, the Hartmann number and the angle of the magneticfield are obtained via a very efficient homotopy iteration method. Rigid comparisonwith previous studies shows excellent computational efficiency and accuracy of theproposed method.

Abstract In this paper, the effects of heat and mass transfer on oscillatory incompressible electrically conducting viscous nanofluid has been discussed under the influence of couple stress force is an asymmetric channel filled with porous medium. A uniform magnetic field is applied to this fluid flow. The governing equations of flow have been formulated using Boussinesq approximation. The effects of various fluid flow parameters are discussed using graphs.

Since December 2019 from Wuhan, China coronavirus affected worldwide and spread pneumonia-like illness, currently named as coronavirus disease (COVID-19). It is spread through infected droplets; the major symptoms are dry cough with fever and general weakness. Elders and peoples with multiple diseases are more like to infected with COVID-19. Using disinfectant and face mask in public is the main preventive measure. Here in this review, we revised current knowledge about the disease, complications, diagnosis methods, and preventive measures.

Hepatitis E virus (HEV) is an important public health problem and responsible for both acute and chronic viral hepatitis. The HEV transmission usually occurs through the fecal-oral route, and public health implications of its water-borne and food-borne transmissions along with environmental contamination raise high concerns towards its zoonosis. Apart from affecting developing countries, this virus is causing a rising number of cases in the developed countries. The spread of HEV particles to the environment can pollute surface waters, which could be an HEV infection source for humans and animals. HEV has also been identified in urban sewage samples in various countries. HEV virus quite frequently infects the European community and some animal species and identification of virus in polluted animal products suggest the circulation of HEV from water to food chain. Several studies indicating high seroprevalence and circulation of HEV in pigs as well as in environmental samples warrants to investigate the role of trade in carrier pigs, elucidate HEV virulence maintenance in the environment and meat supply chain to throw light on the possible sources of infection in humans and the degree of occupational risk, and zoonosis. The purpose of this review is to discuss the HEV infections and associated risk factors with an emphasis on pigs, presence in environment, food-borne, water-borne, and zoonotic transmissions.

Background: Oral corticosteroid use in asthma management can lead to serious adverse effects, but knowledge on usage trends are limited. We aimed to investigate this in a nationwide asthma cohort in Denmark from 1999-2018. Methods: By use of Danish nationwide registers, we identified all young adults (18-45 years) with two or more asthma drug collections within 12 months since the age of 15 as indicative of active asthma. Oral corticosteroid use was stratified by exposure level as high use (≥5 mg prednisolone/day) and low use (<5 mg/day) per year, age groups and gender. Lorenz curves were used to express the skewness of consumption among users. Results: We identified 318,950 unique individuals with active asthma during the study period with a median age of 29 years (interquartile range [IQR] 20-38 years) whereof 57% were women. The 1-year prevalence of oral corticosteroid users was stable at 4.8% (median, IQR 4.7%-4.8%), but with a nearly 40% decrease in high-users from 0.54% in 1999 to 0.33% in 2018. The median annual dose decreased from 500 mg/y in 1999 to 250 mg/y in 2018. We found a substantial skewness in the distribution of oral corticosteroid usage with 10% of users accounting for almost 50% of all oral corticosteroid use. Conclusions: Although the prevalence of oral corticosteroid users among young adults with active asthma in Denmark has been relatively stable from 1999-2018, we observed a decreasing trend in the prevalence of high-users and annual consumption.

A 27-year-old underwent a diseased kidney transplant. Three days after transplantation COVID-19 was diagnosed for our patient. Immunosuppressants were reduced and a renal biopsy was done which showed acute T cell-mediated rejection. We aimed to report a case to help clinicians better understand the risks to kidney transplant recipients.

Quality control systems for assays and assay components are crucial to achieving optimum standards in healthcare. In human IVF, the mouse embryo assay is commonly used to assess the quality of media and instruments. Despite its popularity, there are some well-known issues with the assay, including insensitivity to sub-optimal conditions, ethical issues due to animal use and variation in end-point interpretation between operators. Here, we detail the development of a P19 embryonic carcinoma cell-based assay with the potential to be an alternative method for quality control testing of human IVF media, and we use this assay to test varying levels of the critical energy sources pyruvate, glutamine and calcium lactate in human blastocyst media. Trademark features of the mammalian cold stress response were also incorporated as potential tools for increasing assay sensitivity. Assessed by resorufin fluorescence, P19 cells responded to changes in pyruvate and glutamine in the presence of cold stress and the mTOR inhibitor rapamycin but demonstrated natural sensitivity to calcium lactate concentrations. In addition to increasing cell sensitivity, cold stress enhanced cell growth, whilst rapamycin treatment further amplified the effects of cold stress. The assay described is robust, suitable for detecting sub-optimal culture conditions and indicates the extent to which different energy substrates affect cell growth and proliferation.

Objective: The main objective is to compare ECV results when the procedure is performed by an experienced dedicated team or by seniors obstetricians. Design: Prospective longitudinal study. Setting: Prospective analysis of ECV performed in ‘Virgen de la Arrixaca’ University Hospital between 10/1st/2018 and 12/31st/ 2019. Population or Sample: All the patients who undergo ECV in this hospital. Methods: From 10/1st/2018 to 09/31st/2019, ECV were performed by two senior experienced obstetricians who composed the dedicated team for ECV, designed as Group A. From 10/1st/ 2019 to 12/31st/ 2019, ECV was performed by two seniors obstetricians, designed as Group B. Ritodrine was administered during 30 minutes just before the procedure. Propofol was used for sedation. Main Outcome Measures: ECV Success rate, complications rate, and Vaginal delivery rate after ECV. Results: 122 pregnant women underwent an ECV attempt. 90 (73.8%) were performed by Group A and 32 (26.2%) were carried out by Group B. The ECV success rate increased from 56.3% (B) to 67.8% (A) (P=0.241). The greatest increase in the success rate was seen in nulliparous (from 39.1% to 63.5%, P=0.043). Amniotic fluid pocket (OR=1.32; P=0.035) was associated with ECV success. The complications rate decreased from 18.8% (B) to 6.7% (A) (P=0.049). Conclusions: The introduction of an experienced dedicated team reduces ECV complications rate and, in nulliparous it improves the ECV success rate. Multiparity and normal or high amniotic fluid volume increase in the ECV success rate. Funding: The authors received no funding for this work. Keywords: External Cephalic Version, Super-specialization, Breech

Background and Purpose: Tau pathology is instrumental in the gradual loss of neuronal functions and cognitive decline in tauopathies, including Alzheimer’s disease (AD). Adenosine homeostasis is essential to brain metabolism and plasticity but the link to Tau remained ill-defined. Herein, we aimed at investigating whether modulating adenosine tone, through pharmacological manipulation of equilibrative nucleoside transporter 1 (ENT1), impacts Tau pathology, associated molecular alterations, and subsequent neurodegeneration. Experimental Approach: Thy-Tau22 and their littermate controls were continuously treated with J4, an ENT1 inhibitor, in drinking water. The animal behavior and electrophysiological recording were employed to evaluate the memory function and synaptic plasticity in the hippocampus. We have then conducted phospho-proteomics, immunohistological investigations, and bulk RNA-seq analysis to evaluate the mode of action of J4. Key Results: We demonstrated that treatment with J4 not only reduced Tau hyperphosphorylation and improved memory deficits and synaptic plasticity but also normalized mitochondrial dysfunction, synaptic loss, and abnormal expression of immune-related gene signatures in the Thy-Tau22 mice. These beneficial effects were particularly ascribed to the ability of J4 to suppress the overactivation of AMPK, suggesting that normalization of energy dysfunction mitigates neuronal dysfunctions in Tauopathy. Mechanisms targeted by J4 such as AMPK overactivation and neurotoxic astrocyte phenotype were found in brains from patients with primary tauopathies and AD. Conclusion and Implications: The present data, therefore, support an instrumental link between energy dysfunction and adenosine homeostasis in tauopathy. Together, our data support that targeting adenosine metabolism is a novel reliable strategy for tauopathies.

The morphological characteristics of diatoms are useful for studying their taxonomy. However, the distinction between closely related taxa can be very difficult, especially when the morphological characters are modified by environmental constraints. In the present study, 13 fresh water diatoms were identified morphologically and cultured to have their axenic cultures. To check this PCR primers specific for multilocus genes were designed to amplify and screen 13 fresh water diatom monocultures. Among the multilocus PCR primers (DRR3, scfcpA, Lhcf11, SIT1, SIT3, SIT4, LOC101218388, COI-5P, rbcL, rbcL-3P, LSU D2/D3, UPA, psaA and 18S rRNA) we found that psaA gene, a plant pigment chlorophyll-based primer amplified all the diatoms. Out of 13 diatom amplicons only two fresh water diatoms DNA were sequenced. This included Cyclotella meneghiniana due and Sellaphora pupula. The Sanger sequencing results thus established that morphologically identified diatom, Sellaphora pupula exhibited close phylogeny to Sellaphora whereas Cyclotella meneghiniana had close lineage to marine diatom Thallosiosira.

Objective: To determine the frequency of uterine abnormalities in PCOS patients compared to normo-ovulatory patients and their relationship to androgen levels. Design: Retrospective cohort study. Setting: Tertiary University Hospital Population: Total of 103 women, 51 PCOS, and 52 male factor infertility Interventions: HSG images of all patients were numbered and evaluated by ten senior reproductive endocrinologists blinded to the research and chose the most appropriate figure for each patient’s HSG image and marked the shape of cavity according to the ASRM and ESGE/ESHRE classification. Main outcome measures: Abnormal HSG Rates, serum AMH and androgen levels Results: The percentage of the normal uterine cavity was significantly lower in the PCOS group than control group as 51 % and 66.7 %, 77 % and 94.2 % according to the ASRM and ESHRE/ESGE classifications, respectively. The frequency of Partial Septate Uterus (ESHRE-ESGE U2a / ASRM Va, 21.6% vs 5.8 % p<0.05), Complete Septate Uterus (ESHRE-ESGE U2b / ASRM Vb, 7.8% vs 0% p<0.01) and Dysmorphic Uterus (ESHRE-ESGE U1c) / ASRM VII) 3.9 % vs 0 p<0.05) were significantly higher in PCOS patients than controls. The frequency of arcuate uterus classified as VI in ASRM and considered normal in ESHRE/ESGE was 16 % and 17.3 % in PCOS and control groups, respectively, without statistically significant difference. The increased frequency of intrauterine cavity abnormalities was correlated with serum-free testosterone levels. Conclusion: This study provides that the frequency of uterine cavity abnormality is clearly higher in PCOS patients compared to the healthy population.

Epichloë endophytes can improve the resistance of host grasses to pathogenic fungi. However, little is known about the mechanisms involved. We studied the effect of Epichloë sibirica on the resistance of Achnatherum sibiricum to Curvularia lunata. Then, the global gene expression between endophyte-infected and endophyte-free leaves was compared. Finally, exogenous hormones were applied to verify the action mechanism of the endophyte. The endophyte improved pathogen resistance of host. Before pathogen inoculation, the endophyte had activated the host’s immunity by increasing jasmonic acid (JA) accumulation, and upregulating the expression of genes encoding pathogenesis-related proteins and EIN3/ERF1 transcription factors. After pathogen inoculation, the endophyte increased the accumulation of both JA and ethylene (ET), and amplified the gene response in the EIN3/ERF1 transduction pathway. Moreover, the endophyte altered the expression of genes encoding putative WRKY transcription factors and glutathione-S-transferase, which are related to disease resistance. Overall, this work first revealed that E. sibirica enhanced the resistance of A. sibiricum to C. lunata by inducing the response of EIN3/ERF1 transduction pathway regulated jointly by JA/ET. Before pathogen inoculation, the endophyte induced JA accumulation to improve constitutive resistance in the host. After pathogen inoculation, the endophyte enhanced the induced systemic resistance by promoting ET synthesis.

Objective: The aim of this clinical trial was to compare the incidence of pain and alveolar osteitis following the administration of a wound-dressing material after the extraction of maxillary premolar teeth. Material and methods: A total of 112 maxillary premolar teeth (right and left) in 56 patients were extracted simultaneously. Patients were randomly divided into two groups: a cotton/gauze pack was applied in the control group and a wound dressing material was applied in the experimental group. Incidence of pain (+/-) and alveolar osteitis (+/-) were recorded after three days. Chi-square test and multiple logistic regression analysis were used for the statistical analysis (p<0.05). Results: The final analysis included 51 patients and 102 teeth. A pain was reported by 44 patients (86.27%) at 88 sockets (86.27%) and alveolar osteitis was detected in 8 sockets (7.84%) of 8 patients (15.68%). A positive pain score was significantly associated with the sockets in the control group (Odds ratio [OR] = 1.828, 95% CI = 1.212-3.66, p=0.18), smoking (OR = 1.214, 95% CI = 1.101-3.25, p=0.012) and insufficient oral hygiene (OR = 1.154, 95% CI = 1.011-3.11, p=0.014). All the sockets with alveolar osteitis (n=8) were in the control group. Conclusion: The wound dressing material used in this study might alleviate the pain experienced after the extraction of maxillary premolar teeth.

A special class of hydrogen-binding metal complexes are complexes able to bind hydrogen molecules at one or more of their ligand positions. One of such complexes, Fe(H)2(H2)(PEtPh2)3, was characterized experimentally and theoretically in previous works. Its specific properties were related to the asymmetry of the non-hydrogen ligands. Following this reasoning, attachment and dissociation of hydrogen molecule to and from the 5-coordinated and 6-coordinated complex were investigated theoretically. Relaxed and partially constrained potential-energy scans were performed and transition-states for these processes were investigated. Non-hydrogen ligand asymmetry seems to reflect on the different barrier energies for approach to and dissociation from the two dihydrogen ligand positions. Steric and environment effects are estimated comparing behavior for partially constrained and gas-phase models. On the basis of these findings, theoretically predicted pathways for single-step dihydrogen binding and dissociation processes are established, and means for experimental verification proposed.

The statistical analysis of the different versions of the Atom-Bond Connectivity (ABC) Descriptors (indices) are used to infer the drug molecular structures that are helpful for chemical and medical scientists to nd out the chemical and biological characteristics of drugs. In this article, we compute and analyze the linear and non-linear regression models of the different versions of ABC indices and their polynomials of some Molecular structures of COVID-19 drugs.

Background: We aim to determine the characteristics of the HB potentials in atrioventricular nodal reentrant tachycardia (AVNRT), and elucidate whether these can provide clues for identification of patients with slow pathway (SP). Methods：We studied the electrophysiological findings of 162 consecutive patients with symptomatic AVNRT due to slow-fast or fast-slow type reentry (n=112) and AV reentrant tachycardia (AVRT) (n=50). Maximal HB potential (taken as HBmax, which was highest in amplitude) among HB cloud was recorded for comparison. For AVNRT patients: (1)The AH interval (A2H2) at the “jump” during programmed atrial stimulation (taken as a reflection of slow-pathway conduction time); (2)The distance from HBmax to the successful SP ablation site (HBmax-ABL) and from HBmax to the ostium of coronary sinus (HBmax-CSO). Results: HBmax was 0.29±0.10mV in AVNRT patients, whereas it was 0.17±0.05 mV in AVRT group (p<0.0001). Likewise, the HBmax duration was 22±5 ms in the AVNRT group and 16±3 ms in the AVRT group(p<0.0001). The area under the ROC curve of HBmax amplitude in AVNRT patients was 0.86 and the optimal HBmax cut-off to predict AVNRT was≥0.22 mV with a sensitivity of 0.78 and specificity of 0.84. HBmax-CSO was positively correlated with HBmax-ABL, and HBmax-ABL was positively correlated with A2H2. Conclusions: HBmax amplitudes were higher and durations longer in patients with AVNRT, as compared to those with AVRT. Moreover, the distance between HBmax and successful ablation site was positively correlated with the SP conduction time and with the distance from HBmax to the CS ostium.