A dynamical model of echinococcosis transmission with optimal control strategies is presented. The basic reproduction number of the model is obtained and used to study the stability of the disease-free and endemic equilibrium points. Sensitivity analysis of the basic reproduction number to the model parameters and control variables is performed. It finds that the natural death of dogs has a strong impact on the basic reproduction and the only anthelmintic treatment against echinococcosis does not eliminate the disease. The optimal control problem is formulated and solved analytically. Numerical simulations show that optimal control strategies could effectively eliminate the transmission of echinococcosis and the disinfection or cleaning of environment may shorten the time of eliminating the disease. The cost-effectiveness analysis suggests that a combination of health education and anthelmintic treatment could provide the best cost-effective strategy to control the transmission of echinococcosis. The findings could be helpful for the prevention and control of echinococcosis in Ganzi Tibetan Autonomous Prefecture, China and other areas of echinococcosis.

The hazards and unpredictability of emergencies have made people pay more and more attention to emergency response. A reasonable reserve of emergency materials can play an important role in post-disaster rescue. This paper uses the uncertain comprehensive evaluation method to grade the emergency materials, and establishes a location model for the uncertain emergency materials.The location of the reserve point is determined by maximizing the rescue satisfaction, the maximum number of service demand points under the maximum coverage, and pursuing the minimum sum of the distance from the demand point to the reserve point. Based on the uncertainty theory, the uncertain emergency materials location model is converted into an equivalent deterministic emergency materials location model, and the model is solved by a tabu search algorithm. Finally, a numerical experiment is given to illustrate the idea of the uncertain model.

Pump thrombosis is a rare and infrequent complication of HeartMate III left ventricular assist device (LVAD). While there are reports of pump thrombosis in the postoperative period, to our knowledge, there have been no prior reports on pump thrombosis in the intraoperative period. Here we present a case of a 24-year-old female who required HeartMate III LVAD implantation for progressive heart failure and the intraoperative period was complicated with pump thrombosis (PT). Managing PT in the intraoperative period is challenging and time-sensitive because of its rare occurrence and paucity of recommendations in diagnosing the PT.

Title: Letter to the Editor: Management of aortic arch hypoplasia in neonates and infantsArticle type : Letter to the Editor.Correspondence: 1. Maida QaziContact: 03332132159 Email: maidaqazi10@gmail.comInstitution: DOW University Of Health SciencesAddress: Bihar Colony, Al-Falah Road, Karachi.Co-authors : 2. Satesh KumarContact: +923325252902 Email: kewlanisatish@gmail.comInstitute: Shaheed Mohtarma Benazir Bhutto Medical College Liyari, KarachiAddress: Parsa citi, Garden East, Karachi

Aortic valve stenosis is the most common adult valve disease in industrialized countries. The ageing population and the increase in comorbidities urge the development of safer alternatives to the current surgical treatment. Sutureless bioprosthesis have shown promising results, especially in complex procedures and in patients requiring concomitant surgeries. Objectives: Assess the clinical and hemodynamic performance, safety, and durability of the Perceval ® prosthetic valve. Methods: This single center retrospective longitudinal cohort study collected data of all adult patients with aortic valve disease who underwent aortic valve replacement with a Perceval ® prosthetic valve between February 2015 and October 2020. Of the 196 patients included (mean age 77.20±5.08 years; 45.4% female; mean EuroSCORE II 2.91±2.20%), the majority had aortic stenosis. Results: Overall mean cross-clamp and cardiopulmonary bypass times were 33.31±14.09 and 45.55±19.04 minutes, respectively. Mean ICU and hospital stay were 3.32±3.24 and 7.70±5.82 days, respectively. Procedural success was 98,99%, as two explants occurred. 4 valves were reimplanted due to intra-operative misplacement. Mean transvalvular gradients were 7.82±3.62 mmHg. Pacemaker implantation occurred in 12.8% of patients, new-onset atrial fibrillation in 21.9% and renal replacement support was necessary in 3.1%. Early mortality was 2.0%.  We report no structural valve deterioration, strokes or endocarditis and one successfully treated valve thrombosis. Conclusions: Our study confirms the excellent clinical and hemodynamic performance and safety of a truly sutureless aortic valve, up to 5-year follow-up. These results were consistent in isolated and concomitant interventions, solidifying this device as a viable option for treatment of isolated aortic valve disease.

Background：Cardiopulmonary resuscitation (CPR) is a major rescue measure for cardiac arrest (CA) patients, and chest compression is the key of CPR. The Thumper devices has been invented to solve the deficiency of manual compression.However, current randomized controlled trials (RCTs) provide controversial findings. Objectives: This meta-analysis aimed to compare the clinical benefits of using the Thumper devices with manual chest compressions during the provision of CPR of patients in CA. Methods: Relevant studies were retrieved from the Ovid, PubMed, Web of Science, EMBASE, Cochrane, CNKI etc.,electronic databases and by manually searching the reference lists of research and review articles. All RCTs published in either English or Chinese until June 31, 2020, were included in the meta-analysis. The odds ratios (ORs) and their 95% confidence intervals (95%CIs) for the return of spontaneous circulation (ROSC), survival rate (SR), and the incidence of rib fractures (RFs) were compared between the manual and Thumper chest compressions. Results: A total of 2164 records were identified, of which 16 were RCTs with an overall risk of bias ranging from low to medium classification.Following CPR, the hazard ratios for ROSC, SR, and RF were significantly better for the Thumper chest compression with ORs of 2.56, (95%CI 2.11-3.11, I2=0%), 4.06, (95%CI 2.77-5.93, I2=0%), and 0.24 (95%CI 0.14-0.41, I2=0%), respectively. Conclusions: The Thumper compression device improved the ROSC, SR and decreased the incidence of RFs in CA patients when compared with manual chest compression. Its use is, therefore, recommended during the resuscitation of CA patients.

In the paper, we consider the penalty finite element methods (FEMs) for the stationary Smagorinsky model. Firstly, a one-grid penalty FEM is proposed and analyzed. Since this method is nonlinear, a novel linearized iteration scheme is derived for solving it. We also derived the stability and convergence of numerical solutions for this iteration scheme. Furthermore, a two-grid penalty FEM is developed for Smagorinsky model. Under $\varepsilon<

Objective: To evaluate the efficacy of lymphadenectomy for early-stage primary mucinous ovarian cancer (MOC). Design: Retrospective observation study Setting: Surveillance, Epidemiology, and End Results (SEER) database for 2000-2018 Population or sample: The study population comprised 1848 patients with early-stage MOC Methods: MOCs were divided into two groups according to lymphadenectomy. Propensity score matching were performed to correct for deviations. Independent risk factors for overall survival (OS) were determined by multivariate analysis using Cox regression. The role of lymphadenectomy was performed in different populations by stratified analysis applying interaction analysis. OS was calculated by Kaplan-Meier curves and compared by log-rank test. Main outcome measures: Overall survival Results: In the study, almost 65.8% (n = 1214/1848) experienced lymphadenectomy. Lymphadenectomy (HR = 0.692, 95% CI = 0.516-0.927, P = 0.009), age at diagnosis (HR = 3.028, 95% CI = 1.477-6.208, P = 0.002), and laterality (HR = 2.013, 95% CI = 1.145-3.54, P = 0.015) were found to be associated with OS. The role of lymphadenectomy varied by age group and tumor laterality, and the 5-year survival rates of patients with bilateral tumors who had experienced lymphadenectomy with sampling and dissection, or for MOC over age 50 and were higher than that of patients who did not undergo lymphadenectomy. Conclusion: Lymphadenectomy with sampling and dissection has little impact on OS in patients with early MOC. Lymph node therapy can be discontinued in patients younger than 50 years, and lymph node sampling is recommended for patients older than 50 years or with bilateral tumors.

Objective: To assess obstetrical outcomes, perceptions of childbirth experience and emotional adjustment in women with dyspareunia. Design: Cross-sectional study. Setting: The maternity ward of a single medical center. Population: Four-hundred forty women, recruited within two days postpartum. Methods: We administered self-report questionnaires addressing demographic and reproductive background, dyspareunia, pain and perceived threat during delivery, sense of control during labour, perceived professional support, and maternal adjustment (i.e., perinatal dissociation, acute stress disorder (ASD), bonding, anticipated maternal self-efficacy depression and positive and negative affect). Obstetrical information was retrieved from clinical files. Main outcomes measures: Obstetrical outcomes and emotional adjustment to childbirth in women with dyspareunia versus comparisons. Results: Three-hundred eighty-eight women filled the dyspareunia questionnaire. The dyspareunia group included 71 women (18.3%) and the comparison group 317 (81.7%). Demographic data were similar between groups. No difference was observed in labour onset, analgesia, route of delivery and perineal tears. More participants with dyspareunia had premature delivery versus comparisons (14.1% vs 5.6%, p=0.02). Women with dyspareunia reported lower sense of control (p=0.01), lower perceived support (p<0.001), more perinatal dissociation (p<0.001), ASD symptoms (p<0.001), depression (p=0.02), negative affect (p<0.001), lower maternal bonding (p<0.001) and anticipated maternal self-efficacy (p=0.01). Women who experienced pain during pelvic exams were less likely to have spontaneous labor onset, more likely to need cervical ripening (p=0.02), and reported higher levels of negative affect (p=0.03). Conclusion: Dyspareunia was associated with more premature deliveries, more emotional distress and poorer maternal adjustment. Perinatal caregivers should be cognizant of such emotional reactions during prenatal care.

A 73-year-old patient who was admitted secondary to acute asthma exacerbation that required frequent salbutamol and adrenaline nebulization. Takotsubo cardiomyopathy was diagnosed after new onset of chest pain with modest troponin elevation and normal coronary angiogram. Low ejection fraction and apical akinesia were completely resolved after her symptoms got improv

Intussusception in adults is quite rare. The computed tomography scan has proved to be more accurate.The surgical approach is influenced by the prevalence of associated malignancy, the anatomic site, and various local factors. Primary surgical resection without prior reduction is the treatment of choice in colocolic adult intussusception.

Background: Pediatric brain tumor survivors can experience detrimental effects from radiation treatment. Proton radiation therapy (PRT), which enables better targeting of radiation to tumors, may result in fewer sequelae. This follow-up cross-sectional study examined psychosocial and executive functioning in children and young adults treated with PRT. Procedure: Psychosocial and executive functioning was assessed by standardized parent rating scales for 187 patients. The sample was divided by age at baseline (<6 years [35.8%] and ≥6 years [64.2%]) and PRT field (craniospinal irradiation (CSI [36.9%]) and focal [63.1%]). Rates of impairment were calculated. Results: Mean age was 8.49 years at baseline; mean follow-up interval was 3.84 years. All mean scores were within the normal range and within normative expectation. Younger CSI group had significantly more problem behaviors and lower adaptive skills compared to older CSI or focal groups; however, no significant differences were found between younger PRT groups. There were no significant differences in executive functioning between the four age-by-PRT-field groups. Rates of impairment exceeded expected rates in social withdrawal, somatic concerns, activities of daily living, and metacognitive executive functioning. Age group was not significantly related to impairment rates, although the younger group had more problems with withdrawal, anxiety, activities of daily living, and executive functioning with relatively higher anxiety and withdrawal in the younger CSI group. Conclusions: Psychosocial and executive functioning was within the normal range at follow-up. Younger patients, particularly those treated with CSI, appeared more vulnerable. Screening and proactive intervention are needed to support psychosocial well-being and executive functions.

Objective Measuring serum and cerebrospinal fluid human chorionic gonadotropin (hCG) is essential for the diagnosis of intracranial germ cell tumors. There are three types of hCG-related markers in clinical use: hCGβ, intact hCG, and total hCG. The best marker for the diagnosis of intracranial germ cell tumors, especially germinoma, is currently unknown. This study aimed to evaluate the usefulness of these hCG-related markers. Materials and Methods We report six patients with histologically diagnosed germinoma treated at our institute. Serum hCGβ, intact hCG, and total hCG were measured before, during, and after treatment. Results The positivity rates of serum hCGβ, intact hCG, and total hCG were 6% (1/17), 47% (7/15), and 42% (8/19), respectively, with the latter two having significantly higher positivity rates than hCGβ (p = 0.041). Both intact and total hCGs showed similar values. The median value of hCGβ, intact hCG, and total hCG before treatment was 0.1 ng/mL, 4.6 mIU/mL, and 4.5 mIU/mL, respectively. Conclusion Serum intact and total hCGs have higher detection rates than hCGβ for patients with germinoma using available commercial measurement tools.

Flexural or membrane-coupled or capillary gravity wave scattering by a submerged or a piercing vertical porous barrier is analytically studied based on a connection that involves the solution potentials and few auxiliary potentials. The problems for the auxiliary potentials are relatively easy to handle for their solutions. The original problem is decomposed into two scattering or radiation problems of this type. The solution wave potential is determined in terms of those resolved wave potentials. Numerical results for the explicitly obtained scattering quantities are also presented.

Objective: Evaluation of the implementation of a new guideline for diagnosis and treatment of women with pregnancy of unknown location (PUL) or ectopic pregnancy (EP). Design: Multicenter retrospective cohort study Setting: Six hospitals in the Northern part of the Netherlands Population and methods: Women above 18-years old with a final diagnosis of PUL or EP between January 2012 to April 2020. Main outcome measures: Diagnostic findings, type of treatment and outcomes, before and after implementation of the guideline. User interpretation of the guidelines. Results: 1306 women with PUL or EP were included. The amount of women diagnosed with PUL has significantly increased between the guideline cohorts (28.4%;174/693 versus 16.6%;115/613 P<0.001). A significantly lower percentage of women using the new guideline underwent surgical management versus treatment with MTX (odds ratio [OR] =0.516, 95% confidence interval [CI] 0.399 – 0.668 P<0.001). Among women treated with MTX, the overall success rate was significantly lower compared to surgery (80.5%;103/128 versus 95.2%; 943/991 P=0.007). There was no observed difference in adverse events or guideline adherence between the guidelines. Conclusion: The implementation of the new guideline contributes to an increase in women diagnosed with PUL and treated with MTX. Treatment with MTX caused more complications and a lower treatment success compared to women undergoing surgery. This did not lead to an increase in adverse events between the guidelines. The overall adherence to the guidelines was equal.

Since the discovery of pulmonary venous triggers,[1](#ref-0001) catheter ablation with pulmonary vein isolation (PVI) has matured as an important therapy for patients with atrial fibrillation (AF). However despite advances in ablation technology, for non-paroxysmal forms of AF, outcomes remain suboptimal with PVI alone.[](#ref-0002)2 ,3 Adjunctive strategies addressing the atrial substrate or targeting of non-pulmonary vein triggers have not shown consistent efficacy across studies and may carry additional complication risks or higher rates of recurrent organized atrial tachycardias. Recently, ethanol infusion into the vein of Marshall (VOM) has gained popularity with the publication of the VENUS randomized trial[4](#ref-0004) and the positive accumulating experience reported from a single center in Bordeaux.[](#ref-0005)5 ,6 However, adoption has been tempered due to the technical requirements of the procedure and unclear dominant mechanism of putative benefit. Thus, more widespread experience is needed to clarify the real-world impact on procedural success. This report aims to describe a single center experience with VOM ethanol infusion over three years, with description of technical approach, associated procedural success rates, and complications.

The clearing price in electricity spot market is an important reference that guides marker participants in making energy purchase. Current electricity price forecasting methods consider the numerical accuracy of the forecast result only, ignoring the need to optimize economic benefits, while higher numerical precision sometimes leads to lower electricity-purchase gain. This paper proposes a price forecasting method that considers both economic benefits and numerical accuracy. A function representing the relationship between the predicted electricity prices and the cost reference for making energy purchase decisions is calculated, and then introduced to the loss function of the prosumers' forecasting model as a revenue-optimizing term. A sequence comparison neural network structure is designed and added to consumers' forecasting model, so that the results of numerical prediction and comparison both contribute to predicting better prices. By co-optimizing numerical precision and electricity-purchase gain, the prediction is more conducive to reducing the cost of purchasing power. Actual electricity market price data are used to verify the feasibility of the proposed forecasting method in improving economic benefits.

A document by W John Martin. Click on the document to view its contents.

Fine target status can be represented by the extracted micro-Doppler (m-D) components from the radar echo. However, current methods do not consider the specialty of the m-D components and their performance to irregular components are poor. In this paper, neural network is applied to m-D signal extraction for the first time. Specifically, a novel and effective dual-branch network based m-D components extraction method is proposed. The dual-branch network consisting of a continuous m-D components extraction branch and a crossing point detection branch is designed to obtain components and cross points at the same time. To solve the error correlation problem of multi-component signals, the first-order parametric continuous condition and cubic spline interpolation are employed to obtain complete and smooth components curves. Simulation and measurement results show that this method of good robustness is a good candidate to separate the non-sinusoidal m-D components with intersections.

A document by Guangping Li. Click on the document to view its contents.

Due to surface defects on inner ring of Si 3N 4 ceramic bearing are tiny and difficult to defect, the defects accelerate the wear of ceramic parts and reduce the performance of ceramic parts. A surface defect detection method based on RetinaNet method and NAM attention mechanism is proposed. Besides, the performance of RetinaNet method and Faster RCNN method is compared. The platform for surface defects of Si 3N 4 ceramic bearing inner ring is built independently to collect images. The dataset is made up of collected images and expanded by online data augmentation. Resnet-50 is used as the feature extraction network. The NAM attention mechanism is added to the tail of Resnet-50 to form an attention module to improve the model accuracy. As the bounding box regression loss function, loss is used for learning bounding box regression and localization uncertainty. A multi-scale feature pyramid is constructed by a feature pyramid network to integrate multi-level feature information. And a small full convolutional network is used as a classification sub-network and a bounding box regression sub-network. The results show that the mAP of the method reaches 91.84%, which is 13.45% and 2.1% higher compared to Faster RCNN and RetinaNet, respectively. The method has good detection effect on the identification and classification of surface defect species.

Cold acclimation is a multigenic process by which many plant species of the temperate zone increase their freezing tolerance. Stabilization of photosynthesis and carbohydrate metabolism plays a crucial role in cold acclimation, and amounts of transient leaf starch, soluble carbohydrates and secondary metabolites, e.g., flavonoids, show significant cold-induced dynamics. To study regulation of primary and secondary metabolite accumulation during cold acclimation of Arabidopsis thaliana, metabolic mutants with deficiencies in either starch or flavonoid metabolism were exposed to 4°C over 14 days and sampled before as well as at early and late time points of cold acclimation. Photosynthetic activity was determined together with amounts of carbohydrates, anthocyanins, organic acids and maximum enzyme activities of the central carbohydrate metabolism. Starch deficiency was found to significantly delay soluble sugar accumulation during cold acclimation, while starch overaccumulation did not affect accumulation dynamics but resulted in lower total amounts of sucrose and glucose. Anthocyanin amounts were lowered in both starch deficient and overaccumulating mutants. Vice versa, however, flavonoid deficiency did not result in a changed starch amount which suggested a unidirectional signalling link between starch and flavonoid metabolism. Mathematical modelling of carbon metabolism indicated kinetics of sucrose metabolism and its export form source to sink tissue to be limiting for carbon partitioning in leaf tissue during cold exposure. Together with cold-induced dynamics of fumarate and malate amounts this provided evidence for a central role of sucrose phosphate synthase activity in carbon partitioning between biosynthetic and dissimilatory pathways which stabilizes photosynthesis and metabolism at low temperature.

N-terminal cysteine oxidases (NCOs) use molecular oxygen to oxidize the amino-terminal cysteine of specific proteins, thereby initiating the proteolytic N-degron pathway. To expand the characterization of the plant family of NCOs (PCOs), we performed a phylogenetic analysis across different taxa in terms of sequence similarity and transcriptional regulation. Based on this survey, we propose a distinction of PCOs into two main groups. A-type PCOs are conserved across all plant species and are generally unaffected at the mRNA level by oxygen availability. Instead, B-type PCOs differentiated in spermatophytes to acquire transcriptional regulation in response to hypoxia. The inactivation of two A-type PCOs in Arabidopsis thaliana, PCO4 and PCO5, is sufficient to activate the anaerobic response in young seedlings, whereas the additional removal of B-type PCOs leads to a stronger induction of anaerobic genes and impairs plant growth and development. Our results show that both PCO types are required to regulate the anaerobic response in angiosperms. Therefore, while it is possible to distinguish two clades within the PCO family, we conclude that they all contribute to restrain the anaerobic transcriptional program in normoxic conditions and together generate a molecular switch to toggle the hypoxic response.

1. The Millennium Ecosystem Assessment assessed ecosystem change, human well-being and scientific evidence for sustainable use of biological systems. Despite intergovernmental acknowledgement of the problem, global ecological decline has continued, including declines in insect biodiversity, which has received much media attention in recent years. 2. Several roadmaps to averting biological declines have failed, due to various economic and political factors, and so biodiversity loss continues, driven by several interacting human pressures. Humans are innately linked with nature but tend to take it for granted. The benefits we gain from the insect world are broad, yet aversion or phobias of invertebrates are common, and stand firmly in the path of their successful conservation. 3. Providing an integrated synthesis for policy teams, conservation NGOs, academic researchers and those interested in public engagement, this article considers: (1) the lack of progress to preserve and protect insects. (2) Examples relating to insect decline and contributions insects make to people worldwide, and consequently what we stand to lose. (3) How to engage the public, governmental organisations and researchers through “insect contributions to people” to better address insect declines. 4. International political will has consistently acknowledged the existence of biodiversity decline, but apart from a few narrow cases of charismatic megafauna, little meaningful change has been achieved. Public values are reflected in political willpower, the progress being made across the world changing views on insects in the public should initiate a much-needed political sea-change, but only if we as entomologists enormously expand our engagement efforts.