Necrolytic Acral Erythema (NAE) is a rare cutaneous sign for hepatitis C virus, which generally presents as circumscribed keratotic plaques on the extremities. Many studies reported NAE in the absence of HCV. This case presents a female diagnosed with NAE and hypothyroidism in the absence of HCV infection.

Objectives: To study the effectiveness of Sucralfate suspension oral rinse compared to normal saline alone for pain reduction and wound healing promotion in open oral surgical wounds. The primary outcome of this study was postoperative pain VAS score reduction. The secondary outcome was wound healing promotion based on wound grade and maximal wound length reduction Study Design: Randomized controlled trial Setting: Department of Otolaryngology, King Chulalongkorn Memorial Hospital Materials and Methods: A total of 30 patients with secondary healing intraoral surgical wound were enrolled in this study. Sucralfate suspension (1g/5ml) was prescribed to a randomized experimental group as an oral rinse every 6 hours for 14 days in addition to standard postoperative care. Postoperative pain VAS score, wound grade and wound length were collected and compared with baseline from initial to final visit during a 2-week period. Results: The mean change of VAS score was significantly lower from baseline in the Sucralfate group at day3 (-0.77 in control and -2.15 in Sucralfate, p<0.05) and day 7 (-2.15 in control and -3.62 in Sucralfate, p<0.05). Wound grade distribution over time was the same in both Sucralfate and control groups. The mean change of wound length was not significantly different between the two groups. No adverse reaction to Sucralfate was reported during the study participation. Conclusions: Sucralfate suspension oral rinse can be recommended as an effective topical analgesic solution in postoperative secondary healing of intraoral wound with no significant interference. Benefits to wound healing promotion have yet to be proven. Keywords: Sucralfate, oral wound, oral surgery, pain, wound healing, postoperative, analgesia

Plant disease is one of the most threatening factors in agriculture field causing a decrease in the quality and quantity of produced products. Some of the diseases can be identified and recognized by the appearance of symptoms on the leaves of the plant. Non-destructive and accurate techniques for detection of diseases could be practical in increasing productivity and decreasing the waste of products. In this research, nine types of common diseases in tomatoes were evaluated by the machine vision method and using Gray Level Co-occuarance Matrix (GLCM), Gray Level Run Length Matrix (GLRM), and Local Binary Pattern (LBP) texture features. Linear Discriminant Analysis (LDA), Artificial Neural Network (ANN), K-Nearest Neighbor (KNN), and Support Vector Machine (SVM) were used to model the dataset. The best algorithm and model were introduced using SVM and KNN models. With the ANN model, the best results were obtained with the GLCM feature, while in other models, the features extracted from the GLRM algorithm exhibited the best outcomes. The SVM model with the cubic kernel function yielded the best results, which had the accuracy of 97.43% and 91.38% in training and test steps. The sensitivity and specificity of this modeling were 99.46% and 95.59% as well as 97.91% and 86.75% for training and test datasets, respectively. In addition, the results were improved using the Genetic Bee Colony (GBC) feature reduction algorithm. The results exhibited acceptable performance in detecting healthy and unhealthy leaves, and in accurately diagnosing the type of tomato disease.

Cardiac bradyarrhythmia and conduction disorder may be rare, but recurrent adverse events caused by bortezomib. Here we report a case with POEMS syndrome presenting severe heart block after bortezomib plus dexamethasone therapy. After permanent pacemaker implantation, bortezomib was restarted and maintained, resulting in sustained complete response for POEMS syndrome.

A document by Chunhua Lv. Click on the document to view its contents.

Venous thrombosis rarely occurs in patients’ after administered COVID-19 viral vector vaccination rather than mRNA vaccination. The occurrence of superior mesenteric vein (SMV) is rarer. We herein present an image of an SMV trunk thrombosis after COVID-19 mRNA vaccination.

IntroductionPractically all rivers are subject to morphological changes due to the dynamics of flow and sediment transport (Matsuda 2004). Alluvial rivers experience a frequent alteration in planform and cross-section due to the simultaneous sedimentation and erosion processes (Church 2006). River morphology and hydrology are recognized as essential elements for integrative studies that seek to develop an understanding of river behaviour to boost river management scenarios (Sear et al. 1995).The stability of a river channel over a certain period is controlled primarily by the flow and sediment regimes. If any of these driving factors experience a sudden or a prolonged change, the river channel responds by changing its morphology (Pollock et al. 2014). Alluvial river channels frequently display a three-dimensional morphodynamic alteration in the aspects of river channel planform. The morphology of an alluvial river channel is the consequence of deposition and erosion processes in the river. Morphological changes are affected mainly by the amount and calibre of the sediment passing through the channel. Alluvial river channels are formed due to the transported and deposited sediments passing through the channel. Accordingly, the channel is self-formed (Church 2006).The Nile River is the main source of water in Egypt. Nile River is known for its morphological changes related to alterations in the water flow regime (Farag et al. 2021). The Nile River travels 927 km from Aswan High Dam (AHD) till it reaches Nile Delta afterward it emerges into two branches; the Damietta branch towards the east and the Rosetta branch towards the west. Rosetta branch is approximately 240 km in length starting from Delta Barrage till it reaches its promontory on the Mediterranean Sea.The flow in the Nile River is controlled by (AHD) southern Egypt. (AHD) construction on the Nile River in the year 1964 altered the flow and sediment regime along the Nile River. The most common effect of dams is flattening the hydrograph curve of the flow passing through the downstream. Sediment transport is also affected as large amounts of sediment are trapped, releasing only a fragment of the trapped load into the river channel. Flow discharge passing through the Rosetta branch before AHD construction could reach 600 million m3/day, and about 220 million m3/day after AHD construction. Suspended sediment load concentration at El Gafaraa gauge Station on Nile River downstream the AHD decreased from 3800 ppm before the construction of the dam to 50 ppm after the dam construction as the total sediment load was decreased by a percentage of 98% (Shalash 1980).Conveyance capacity is described as the ability of a river channel to convey a specified flow of water (Venczel 2008). Maximum conveyance capacity is the amount of flow that a channel can convey before overtopping. Flow conveyance is the discharge conveyed through a given channel segment for a given stage. Modifications to the channel geometry or factors affecting the water velocity will modify how flow is conveyed through the channel. An important challenge in estimating conveyance capacity is how to account for the complexities of real rivers taking into account their shape, depth, length, sinuosity, meandering, and roughness, and the capability to represent them in numerical models (Samuels et al. 2002).(Venczel 2008) declared that the main type of factors affecting river conveyance capacity is “Instream factors”. The “Instream factors” refer to direct changes to the channel planform that affect the conveyance capacity of a river. These instream changes can be summarized as follows; Revetment structures, channel shape, flow velocity, meander cut-offs, dredging operations, locks, dams, levees, and human encroachment.Efforts to restore the conveyance capacity and flow regime of rivers across the world have caught huge attention due to the remarkable morphodynamic changes in natural channels. Dredging operations are the removal of the topsoil from the river bed. Dredging operations are considered a solution to increase the conveyance capacity of any river by offering a direct impact on river conveyance capacity in a short duration as the results are immediate but also has many disadvantages as it is considered a temporary solution demanding frequent dredging operations, lowering the surface water profile, and have a high operations cost.Numerical modeling is essential in evaluating river morphological changes. The conveyance capacity of the western branch at Warrak island in the River Nile, Egypt was investigated in a study by (Salama et al. 2020) using a two-dimensional numerical model. The study evaluated current conveyance capacity and proposed various scenarios to increase the flow conveyance of the study area mainly depending on dredging operations and removing the unmanaged human intervention at the island. Their study showed that dredging to a safe navigation elevation increased the conveyance capacity of the western branch of the island from 31.4% to 45.5%. (Enas 2021) used a two-dimensional numerical model to assess dredging operations’ impact on navigability of the second reach of the Nile River. Results revealed that dredging operations alone cannot be adopted as a permanent solution for river navigation bottlenecks as the riverbed returns to its original form within 10 years. (Magdy 2021) also used a two-dimensional numerical model to assess dredging operations as a solution for some navigation bottlenecks in the third reach of the Nile River with results proving that dredging can be a suitable solution.The main objective of this study is to estimate the maximum conveyance capacity of the Rosetta branch. Analyze morphological changes that occurred during a period of 17 years starting from the year 2003 to 2020 using a two-dimensional numerical model, conducting hydrological and inundated land analysis, proposing three rehabilitation scenarios to increase Rosetta branch maximum conveyance capacity, and assessing each scenario’s impact on surface water profile, stream velocity, and inundated lands related to different flow discharge scenarios.

Background: The effect of prenatal secondhand smoke (SHS) exposure on childhood atopic dermatitis (AD) remains controversial. We aimed to investigate the association between prenatal SHS and childhood AD in a general population-based birth cohort. Methods: Patients included 2,360 mother–child pairs from the Cohort for Childhood Origin of Asthma and Allergic diseases (COCOA), stratified into 0–3, 4–6, and 7–9 years age groups. Prenatal SHS exposure was assessed using questionnaires. AD diagnosis and symptom assessments were conducted through annual visits by pediatric allergists. Skin prick tests for 18 allergens were conducted. Serum total IgE and eosinophil levels were measured at birth and ages 3 and 7 years. Maternal urine cotinine concentrations were measured at week 36 of gestation. Multivariate logistic regression was performed. Results: Children aged 7–9 years exposed to prenatal SHS were significantly more likely to have an AD diagnosis (aOR 1.670, 95% CI: 0.995–2.804) and current AD (aOR 1.823, 95% CI: 1.051–3.161). This association in AD diagnosis was stronger in children with sensitization (aOR 2.205, 95% CI: 1.048–4.642). Higher maternal urine cotinine levels increased the risk of current AD at ages 4–6 (aOR 2.816, 95% CI: 1.053–7.529). Children exposed to prenatal SHS were more likely to have a late-onset phenotype of AD (aOR 1.663, 95% CI: 1.038–2.664). Conclusion: SHS exposure during pregnancy was associated with late childhood AD. Prevention of prenatal SHS exposure is necessary to reduce the risk of AD in schoolchildren.

The dentigerous cyst is frequent in children under 12 years old. Surgical marsupialization or decompression are actually the most two conservative treatment option described for the management of dentigerous cyst with the preservation of involved teeth. we report two clinical cases of dentigerous cysts treated successufelly by decompression

Uncommon manifestations of COVID-19 have a great risk of going undiagnosed for longer time. Diabetes is reported to be a long-term consequence of SARS-CoV-2 infection. Thus, heightened awareness and timely recognition of diabetes after COVID-19 infection are important for occupational physicians treating healthcare workers with COVID-19.

Current research tools for pre-clinical drug development such as rodent models and 2D immortalised monocultures have failed to serve as effective translational models for human CNS disorders. Recent advancements in the development of iPSCs and 3D culturing can improve the in vivo-relevance of pre-clinical models, while generating 3D cultures though novel bioprinting technologies can offer increased scalability and replicability. As such, there is a need to develop platforms that combine iPSC-derived cells with 3D bioprinting to produce scalable, tunable and biomimetic cultures for preclinical drug discovery applications. We report a biocompatible PEG-based matrix which incorporates RGD and YIGSR peptide motifs and full length collagen IV at a stiffness similar to the human brain (1.5 kPa). Using a high-throughput commercial bioprinter we report the viable culture and morphological development of iPSC-derived astrocytes, brain microvascular endothelial cells, neural progenitors and neurons in our novel matrix. We also show that this system supports endothelial vasculogenesis and enhances neural differentiation and spontaneous activity. This platform forms a foundation for more complex, multicellular models to facilitate high-throughput translational drug discovery for CNS disorders.

Stomata are the key nodes linking photosynthesis and transpiration. By regulating the opening degree of stomata, plants successively achieve the balance between water loss and carbon dioxide acquisition. The dynamic behavior of stomata is an important cornerstone of plant adaptability. Though there have been miscellaneous experimental results on stomata and their constituent cells, the guard cells and the subsidiary cells, current theory of stomata regulation is far from clear and unified. In this work, we develop an integrated model to describe the stomatal dynamics of seed plants based on existing experimental results. The model includes three parts: 1) a passive mechanical model of the stomatal aperture as a bivariate function of the guard-cell and the subsidiary-cell turgor pressures; 2) an active regulation model with a targeted ion-content in guard cells as a function of their water potential; and 3) a dynamical model for the movement of potassium ions and water content. Our model has been used to reproduce different experimental phenomena semi and stomatal responses to environment conditions.

Objective: To evaluate the effectiveness of refined acoustic therapy in combination with cognitive therapy for tinnitus compared to common treatment modality. Study Design: A single-center, randomized, and controlled trial. Methods: Patients were randomised into either the treatment group (refined sound therapy combined with cognitive therapy) or the control group (post-auricular injections of lidocaine and methylprednisolone sodium succinate). Information pre- and post-treatment was collected using the Self-Rating Depression Scale (SDS), the Hamilton Anxiety Rating Scale (HAM-A), visual analogue score (VAS), Tinnitus loudness, and Tinnitus Handicap Inventory (THI) score. Results: The THI (33.54 versus 19.23), SDS (41.79 versus 35.54) and HAM-A (9.46 versus 6.19) scores of the treatment group improved significantly (p<0.05). In the control group, the THI scores improved significantly (31.7 versus 26.24, p<0.05), but the SDS (p=0.338) and HAM-A (p=0.574) scores did not. Tinnitus loudness (the treatment group 46.67 versus 41.19; the control group 43.12 versus 40.18) and VAS scores (the treatment group 5.67 versus 4.17; the control group 5.58 versus 4.73) were significantly improved in the two groups (p<0.05). There was significant difference in the reduction of THI (14.31 versus 5.45), SDS (6.25 versus 1.02), HAM-A (3.27 versus 0.45) and VAS (1.50 versus 0.85) scores between the two groups (p<0.05), and the treatment group showed a greater reduction. There was no significant difference in the reduction of tinnitus loudness (p=0.057). Conclusion: Refined sound therapy combined with cognitive therapy is more effective at treating tinnitus and improving psychological symptoms. Post-auricular injections of lidocaine and methylprednisolone sodium succinate has no effect at improving psychological symptoms.

An 85-year-old woman was diagnosed with traumatic ascending aortic dissection, right clavicle and left first rib fracture, and abdominal contusions after a vehicle accident. After admission, the aortic dissection progressed, and emergent surgery was performed. Although the risk of hemorrhagic complications needs to be evaluated, prompt aortic repair is required

Cystic fibrosis is the most common genetic disease characterized by the dysfunction of the CFTR protein and induces hydration and ionic transfers in the epithelium anomalies. This case report discusses about a pregnant woman, suffering from cystic fibrosis, who undertook the triple combination of CFTR modulators.

Integration of Distributed Energy Resources (DERs) in power systems exacerbates the existing information problems between power utilities and regulators. DER policies oblivious to the trilemma of information asymmetry between power utilities, DER aggregators, and regulators result in distorted price signals to DER investors, and socially inefficient DER roll-out. Therefore, in this paper, we propose a game-theoretic approach for modeling information asymmetry in distribution network information and consumer data between the DER aggregators and the power utilities. The proposed framework is based on Single Leader Single Follower (SLSF) games, reformulated as Mathematical Programs with Equilibrium Constraints (MPECs), and solved using the Scholtes’s relaxation technique. Our results, based on the 7-bus Manhattan power network, show that unless the DER aggregators have complete information about the distribution network characteristics, the welfare along with the realized installed capacity of DERs in the system decreases. Moreover, progressively decreasing DER investment costs alleviate the effects of information asymmetry, suggesting that early adopters face disproportionately high welfare losses attributed to incomplete information between the DER stakeholders. Hence, policy interventions to alleviate the rampant information problems are imperative to ensure an optimal DER roll-out.

Beta-lactams are widely utilized as a first-line therapy with a broad-spectrum coverage, bactericidal properties and few side effects as they are commonly considered as safe drugs. Although these antibiotics are essential in the treatment of infections, their misuse and unnecessary prolonged duration may cause harm. Drug-induced neurotoxicity is a rare adverse reaction associated with beta-lactams. Encephalopathy is a type of neurotoxicity that is defined as a diffuse disease of the brain that alters brain function or structure. We report a case of a patient with normal renal function that developed beta-lactam induced encephalopathy with full resolution of her symptoms following discontinuation of the offending antibiotics. This case highlights the importance of early recognizing this rare adverse effect and its impact on clinical outcomes.

Aims: Acute kidney injury (AKI) is occasionally detected in patients receiving anti tuberculosis (TB) treatment. This prospective cohort study is the first to investigate the true incidence, risk factors, and renal outcomes. Methods: This study was conducted from January 1, 2016, to May 31, 2018, and patients with a new diagnosis of TB and receiving standard anti-TB treatment were enrolled; the patients received regular laboratory monitoring. AKI was defined according to the Kidney Disease: Improving Global Outcome (KDIGO) criteria. Urinalysis, measurements for blood erythrocyte morphology and the fractional excretion of sodium, and renal ultrasonography were performed at AKI onset. Anti-TB drugs were adjusted by the primary physician. Risk factors for AKI were identified using a Cox regression analysis. Results: In total, 106 patients were recruited (mean age: 52.6 years, 71.7% men). Eleven (10.3%) patients experienced AKI. An increase in serum uric acid and hemoglobin levels was noted at AKI onset. All patients with AKI exhibited renal function recovery and completed rifampin-containing anti-TB treatment. Age (hazard ratio (HR): 1.06 [1.02–1.11]), a higher baseline estimated glomerular filtration rate (eGFR; HR: 1.04 [1.02–1.06]), and a blood eosinophil count >350 (109/L) (HR: 10.99 [2.28–53.02]) were associated with AKI development during anti-TB treatment. Conclusions: Under regular pharmacovigilance monitoring, the incidence of renal function impairment during anti-TB treatment was higher than expected. AKI frequently occurred in older patients with a higher eGFR and blood eosinophil count. However, the complication had no influence on anti-TB treatment completion, and no permanent renal impairment occurred.

Aims: To describe the medication changes implemented during physician-led medication reviews that resulted in improved health-related quality of life; and to explore factors that could identify patients with overprescription.Methods: Post-hoc analyses of data from a pragmatic, non-blinded, randomized clinical trial investigating a medication review intervention (NCT03911934) in 408 geriatric outpatients taking \(\geq\)9 medicines.Results: The most frequent medicine change in the medication review group (n=196) was discontinuation (26% of the medicines) due to lack of indication (72% of the discontinuations). After 13 months, 82% of the discontinued medicines were persistently discontinued. The medicines most often discontinued in the medication review group compared with usual care included: metoclopramide (11/5=73% discontinued vs 1/12=8% in usual care), acetylsalicylic acid (20/48=42% vs 2/47=4%), simvastatin (18/48=38% vs 2/58=3%), zopiclone (23/59=39% vs 4/54=7%), quinine (9/14=64% vs 6/16=38%), citalopram (4/18=22% vs 0/20=0%), and tramadol (18/37=49% vs 8/30=27%). Factors associated with the number of overprescribed medicines included: number of prescribed medicines (8% increase per medicine), Drug Burden Index (15% increase per 1 increase), and patient motivation for medicine changes (26% less if not motivated). Prescriptions of metoclopramide, iron preparations, antidepressants other than SSRIs, NSAIDs, or drugs for urinary incontinence were associated with a higher number of overprescribed medicines.Conclusion: Medication reviews can be used to persistently discontinue overprescribed medicines in older polypharmacy patients. Motivation for having their medicine changed, treatment with a higher number of medicines, and a higher burden of sedative and anticholinergic drugs characterized patients most likely to benefit from physician-led medication reviews.

Background: Metronomic chemotherapy (MC) is based on chronic administration of chemotherapeutic agents at minimally toxic doses without prolonged drug-free breaks. MC has a multitargeted action of tumor angiogenesis inhibition and anticancer immune response stimulation and may also directly affect tumor cells to induce tumor dormancy. At our institute, MC has been introduced to treat patients with refractory/relapsed pediatric tumors. Methods: We retrospectively analyzed the data of pediatric patients with relapsed/refractory solid tumors who received treatment, including low-dose continuous administration of anti-cancer drugs. Results: Of the 18 patients, the disease statuses at the initiation of MC were complete remission ( n = 2), partial remission/stable disease ( n = 5), and progressive disease ( n = 11). The overall survival rate was 61% at 12 months and 34% at 24 months, and the progression-free survival rate was 21% at 12 and 24 months. Eleven of 18 patients, with tumor stabilization or maintained remission/stable disease, showed certain advantages in terms of overall survival rate. Even if limited to progressive disease, the survival time of responders was prolonged compared to non-responders (median 19.4 months vs. 4.7 months, P = 0.012). Conclusion: Approximately half of the patients demonstrated temporal tumor stabilization and improved survival time, although most patients had progressive disease, and MC was administered as palliative therapy. Large-scale studies on pediatric MC are rare; however, previous reports and the present study support the conclusion that MC has the potential to play an important role in pediatric cancer treatment during the advanced stage, both in terms of prolonging life and maintaining quality of life.

Type of manuscript : CorrespondenceTitle : Stomatocytes - a whistleblower for future familial cardiovascular events- unraveling the diagnosis of Sitosterolemia in an Indian family. Running title : Hemolytic manifestation of sitosterolemia in an Indian familyAuthors : Richa Chauhan¹, Manas Kalra², Surbhi Singh ¹*, Anupam Sachdev², Jyoti Kotwal¹Affiliation : Departments of Hematology¹ and Pediatric hemato-oncology2, Sir Gangaram Hospital, New DelhiAuthor’s contribution: The manuscript is original and all authors have contributed equally to manuscript preparation.Text word count : 1091Number of Figures : 01Keywords : macrothrombocytopenia, stomatocytosis, sitosterolsDisclosure statement : NoneFunding : NilConflicts of interest : There is no conflicts of interest.

A document by Peter B Reich. Click on the document to view its contents.

Electrochemical conversion of NO3- to NH3 production is of great environmental significance for water pollution treatment and can artificially close the nitrogen cycle. However, direct nine proton and eight electron transfer leads to low Faraday efficiency (FE) and yield. Herein, the single copper site immobilized on N, P co-doped carbon substrates (Cu-N4/P) was prepared for efficient NO3–to-NH3 conversion. Benefiting from electronic redistribution of Cu site induced by the introduction of the less electronegative element P, Cu-N4/P catalyst has superior catalytic properties to the comparison sample, including 100% NO3- conversion, high FE (96.12%) and NH3 yield (124.22 mmol/(h·gcat)). Density functional theory (DFT) explains the effective operation mechanism that P doping can promote the spontaneous hydrogenation of *NO to form *NOH, thus promoting the formation of NH3 from NO3- reduction reaction. The heteroatom doping strategy mentioned proposes a new approach for promoting NO3–to-NH3 conversion at atomic level catalytic sites.

In this letter, a low-complexity suboptimal joint beamforming and power allocation (PA) design scheme for distributed multiple-input multiple-output (D-MIMO) system is proposed. With the objective of maximizing energy efficiency (EE), the developed suboptimal joint scheme can provide closed-form expressions of PA and beamforming. Compared with the existing schemes, the proposed suboptimal joint scheme needs no iterative calculation and yields a lower complexity. Moreover, it can achieve excellent EE quite close to that of the existing algorithms. Simulation results demonstrate the effectiveness and superiority of the proposed joint scheme.