Far migrated IUCD is an uncommon condition that has different manifestations depending upon its location. We present the case of a 22-year-old primipara who had a spontaneous abortion after IUCD placement and suffered chronic right lower abdominal pain thereafter. Diagnostic laparoscopy revealed Cu-IUCD in the right iliac fossa.

Thrombotic Thrombocytopenic Purpura is a particular form of thrombotic microangiopathy, characterized by petechial lesions, anemia, renal failure and fluctuating mental status. It is usually associated with an infection, drugs, or neoplasias. Confusing and rare, it is a real diagnostic challenge.

In this work, general higher-order freak wave solutions of the focusing Kundu-Eckhaus equation can be calculated theoretically through a Darboux transformation by a separation of variable method. Moreover, the dynamics of first-order and second-order freak wave solutions are discussed with some graphics. In particular, we observe that one four-petaled freak wave and three eye-shaped ones can coexist, in contrast to the four eye-shaped ones reported before. They demonstrate that the structure of freak waves in this paper is richer than that in the well-known NLS equation.

Studying the interrelation of soil water and plant water is essential for an in-depth understanding of eco-hydrological processes. However, water use relationships and comparative studies between shrubs and alpine grassland of the northern Qinghai-Tibet Plateau remain poorly understood. In this study, we compared δ18O and δ2H values of water from soil, plant, precipitation, and groundwater between P. fruticosa shrub and alpine grassland locations at two neighboring sites in order to better understand the interface between plant and surrounding soils of shrubs and grasslands in the northern Qinghai-Tibet Plateau. Our results showed that δ18O and δ2H of soil water, precipitation, and plant water varied significantly over time and water sources in P. fruticosa shrub and alpine grassland sites. Both soil evaporation and plant transpiration at the P. fruticosa shrub site were relatively lower than they were at the alpine grassland site. Alpine grassland plant water had a stronger dynamic fractionation effect in the process of transportation and was more sensitive to environmental conditions. However, plants at the P. fruticosa shrub site displayed more flexible water use patterns, shifted their water sources between shallow soil water and deep soil water. Shrubs from alpine grassland leaded to changes in grassland water use, thereby changing soil water storage. The results of this study will provide theoretical basis for improving the availability and sustainability of soil water, provide guidance for meadow management from ecohydrological processes on the northern Qinghai-Tibet Plateau.

Objective: Compare the effectiveness and safety of the ECV when the procedure is performed by senior experienced obstetricians or by super-specialized professionals who composed a dedicated team. Design: Longitudinal prospective analysis. Setting: 1st of January of 2018 and 31st of December of 2019. Population: Pregnant women with non-cephalic presentation and no contraindication for vaginal delivery. Methods: Longitudinal prospective analysis of ECV performed in a tertiary hospital. From 1/1st/2018 to 10/1st/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, ECV complication rate, cesarean section 24 h after ECV. Results: 186 pregnant women were recruited (150 patients in group A and 36 patients in group B). ECV success rate increased from 47.2% (31.7-63.2) in Group B to 74.0% (66.6-80.5) in Group A. The greatest increase in the success rate of ECV was seen in nulliparae, from 38.5% (21.8-57.6) in group B to 69.1% (59.4-77.6). Complications rate decreased from 22.2% (11.1-37.6) in Group B to 9.3% (5.5-14.8) in Group A. Conclusions: The introduction of an experienced dedicated team improves ECV success rate, especially in primiparas, and it also reduces ECV complications rate. Funding: The authors received no financial support for the research, authorship, and/or publication of this article. Keywords: Sedation, Experience, ECV, Breech presentation

As a non-protein amino acid, α-aminoadipate is used in the fields of medicine, chemical engineering, and others. In addition, α-aminoadipate is an important precursor for the synthesis of β-lactam antibiotics. In this study, we construct a biosynthesis pathway of α-aminoadipate in Escherichia coli using lysine as the precursor and produce α-aminoadipate using a microbial cell factory for the first time. In addition, we regulate the cell metabolism to improve the titer of α-aminoadipate via multi-strategy metabolic engineering. First, a novel synthetic pathway was constructed to realize the de novo synthesis of α-aminoadipate with the titers of 82 mg/L. Second, the key enzymes involved in enhancing precursor synthesis were overexpressed and the CO2 fixation process was introduced, and these led to 80% and 34% increases in the α-aminoadipate concentration, reaching 147 mg/L and 110 mg/L, respectively. Third, cofactor regulation was used to maintain the coupling balance of material and energy, with the intracellular α-aminoadipate concentration reaching 140 mg/L. Fourth, the weakening of the synthesis of acetic acid was used to strengthen the synthesis of α-aminoadipate, and this resulted in the enhancement of the α-aminoadipate concentration by 2.2 times, reaching 263 mg/L. Finally, combination optimization was used to promote the production of α-aminoadipate. The titers of α-aminoadipate reached 415 mg/L, which was 4 times higher than that of the parent strain. This study is the first to present the effective biosynthesis of α-aminoadipate in E. coli.

We introduce a new method to measure the concentration-dependent diffusion coefficient from a sequence of images of molecules diffusion from a source towards a sink. Generally, approaches measuring the diffusion coefficient, such as Fluorescence Recovery After Photobleaching (FRAP), assume that the diffusion coefficient is constant. Hence, these methods cannot capture the concentration dependence of the diffusion coefficient if present. Other approaches measure the concentration-dependent diffusion coefficient from an instantaneous concentration profile and lose the temporal information. These methods make unrealistic assumptions and lead to 100% error. We introduce a novel image analysis framework that utilizes spatial and temporal information in a sequence of concentration images and numerically solves the general form of Fick’s law using Radial Basis Functions (RBF) to measure the concentration-dependent diffusion coefficient. We term this approach as Concentration Image Diffusimetry (CID). Our method makes no assumptions about the sink and source size. CID is superior to existing methods in estimating spatiotemporal changes and concentration-dependent diffusion. CID also provides a statistical uncertainty quantification on the measurements using bootstrapping, improving the reliability of the diffusion measurement. We assessed CID’s performance using synthetically generated images. Our analysis suggests that CID measures the diffusion coefficient with less than 2% error for most cases. We validated CID with FRAP experimental images and showed that CID agrees with established FRAP algorithms for constant diffusion coefficient. Finally, we demonstrate the application of CID to experimental datasets of a concentration gradient-driven protein diffusion into a tissue replicate.

Letter to Editor

The design of a healthcare facility is one of the most challenging tasks because of the complexity associated with these facilities. The quality of healthcare is the primary objective of the healthcare facility. The design of healthcare facilities and their environments directly influence the facility’s productivity, the economic performance of the organisation, the experienced clinical outcomes in the hospital, patient and staff satisfaction, just to mention a few. The design of a healthcare facility is essential for ensuring a serene healing environment for the patients, which in turn influences their healing rates, reduces the amount of time spent in the facilities, and impacts their level of satisfaction with the care provided. In this study, the collected standards were weighted using the entropy theory as a weighting method for evaluating different departments in various hospitals. In addition, the layout score has been measured using the adjacent theory as one of the graph heuristic methods to be aware of the department or the whole hospital can be redesigned to meet international standards. The evaluation methodology is a step in the redesign process to improve the current hospital to meet international standards. The analysis of the results that our methodologies are applied in one selected hospital in Egypt reflects the average of the satisfied standards as 43%, standards that can be satisfied 24%, not applicable standards 34% and the average layout score is 25%.

Computational fluid dynamics (CFD) has been widely used to model the internal flow field of centrifugal pumps to analyze cavitation phenomena. However, accurate determination of cavitation in pumps remains a challenge. In this study, liquid-vapor two-phase flow in centrifugal pump at different conditions and impeller structural parameters were studied numerically and experimentally. Cavitation multiphase unsteady model was proposed to simulate the flow field in the centrifugal pump by CFD method, and an experimental platform was set up to obtain cavitation performance results. The simulation data were validated with experiment and good consistency was achieved. This study investigated the mass transfer and cavitation behavior of centrifugal pumps under various conditions and customizes a simulation process to obtain the optimal combination of impeller blade number, blade wrap angle, and blade installation angle, which was expected to provide helpful insights into the structural optimization design of centrifugal pumps with good cavitation resistance.

Single-atom catalysts with optimal atom utilization and outstanding activity have penetrated the frontier of heterogeneous catalysis. However, the large-scale synthesis of this class of catalysts is still a bottleneck for their industrialization. Herein, we suggest a two-stage micro-dispersion approach to synthesize mesoporous MgAl2O4-supported atomically dispersed Rh, which is more competitive than the batch method for boosting the uniform dispersion of Rh. By increasing the Rh loading, SACs (< 0.05wt%), SACs + NPCs (0.05–0.17 wt%), and NPCs (0.17–1.10 wt%) were obtained and then characterized by the HADDF-STEM technique. For n-octane steam reforming, the TOF of the SAC (0.01 wt%) was approximately 30 times that of the NPC (1.10 wt%), while the Rh amount of SAC was only 3% that of the NPC for the same fuel conversion. Under a high-temperature (750 ℃) steam atmosphere for 15 h, the hydrogen formation rate only declined from 25.1 to 23.8 mol/mol-C8H18.

Background and purpose Migraine represents one of the major causes of disability worldwide and is more prevalent in women, it is also related to anxiety symptoms. Stress is a frequently reported trigger in migraine patients, such as sound stress, but the underlying mechanisms are not fully understood. However, it is known that patients with migraine have higher levels of plasma inflammatory cytokines and calcitonin gene-related peptide (CGRP). Stress mediated by unpredictable sound is already used as a model of painful sensitization, but migraine-like behaviors and sexual dimorphism have not yet been evaluated. This study characterized the nociception and anxiety-related symptoms after the induction of unpredictable sound stress in mice. Experimental approach C57BL/6 mice (20-30 g) were exposed to unpredictable sound stress for 3 days. Mainly, after 7 days of the last stress session mice developed hind paw, periorbital mechanical allodynia, grimacing pain behavior, anxiety-like, and reduced exploratory behavior. Key results These nociceptive and behavioral alterations detected in this model were shown mostly in female stressed mice. Besides, 7th-day post-stress nociception, these behaviors were consistently abolished by CGRP receptor antagonist olcegepant (BIBN4096BS, 100mg/kg by intraperitoneal route) until 3 h after treatment in stressed mice. In addition, we demonstrated an increase in levels of IL-6 and TNF-α and CGRP levels in stressed mice plasma, with female with higher levels when compared to male mice. Conclusions and implications This stress paradigm allows further preclinical investigation of mechanisms contributing to migraine pain, which appear to be distinct in male and female mice.

Waterlogging induces growth and developmental changes in sensitive crops such as cucumber ( Cucumis sativus L.) during early plant development. However, information on the physiological mechanisms underpinning the response of cucumber plants to waterlogging conditions is limited. Here, we investigated the effects of 10-day waterlogging stress on the morphology, photosynthesis, and chlorophyll fluorescence parameters in two cultivars of cucumber seedlings. Waterlogging stress hampered cultivars’ growth, biomass accumulation, and photosynthetic capacity. Both cultivars also developed adventitious roots (ARs) after 10 days of waterlogging (DOW). We observed differential responses in the light- and carbon-dependent reactions of photosynthesis, with an increase in light-dependent reactions. At the same time, carbon assimilation was considerably inhibited by waterlogging. Specifically, the CO 2 assimilation rate ( A) in leaves was significantly reduced and was caused by a corresponding decrease in stomatal conductance (g s). The downregulation of the maximum rate of Rubisco (V cmax) and the maximum rate of photosynthetic electron transport (J max) were non-stomatal limiting factors contributing to A reduction. Exposure of cucumber to 10 DOW affected the PSII photochemistry by downregulating the PSII quantum yield (Φ PSII). The redox state of the primary quinone acceptor in the lake model (1-qL), a measure of the regulatory balance of the light reactions, became more oxidized after 10 DOW, indicating enhanced electron sink capacity despite a reduced A. Overall, the results suggest that waterlogging induces alterations in the photochemical apparatus efficiency of cucumber. Thus, developing cultivars that resist photodamage while maintaining PSII photochemistry is a potential approach for increasing crops’ tolerance to waterlogged environments.

Early detection concomitant with appropriate treatment intervention for pre-invasive cervical cancer has proved effective in the ‘war on cervical cancer’ in the developed world. Unfortunately, these advances have not been mirrored in the developing world, where incidence and mortality rates are currently approximately 90% of the world’s burden. Due to economic, infrastructure and skilled personnel constraints, the impact of cytology screening as a method for early detection and reducing mortality rates from cervical cancer is lower. Typically, women present with advanced disease that is difficult to treat because of de novo and pharmacokinetic resistance. Whilst the HPV vaccine is a welcome development in the fight against cervical cancer, for women who are outside the target age of vaccination, or indeed do not have access to vaccination, screening remains the only form of protection. Current excisional treatments available for cervical dysplasia are effective but have limitations, including increased incidence of obstetric complications and risk of recurrence. This is a particular issue in cases of HIV, which is endemic in the regions most affected by cervical cancer. Therefore, early detection combined with early treatment is an attractive strategy to reduce the number of women presenting with drug resistant disease in developing countries where cytology screening and vaccination services are poorly developed. This review makes the case for developing a locoregional treatment therapy for cervical dysplasia which could be incorporated into a cervical cancer screening strategy in a rural setting within a developing country.

A 5-month-old German Shepherd dog was presented with cluster seizures. MR imaging showed a large irregular pseudomass in the central region of the cranial cavity, compatible with a malformation of cortical development (MCD). Despite the extensive changes, the patient was neurologically normal interictally one year following diagnosis.

Cardiac tumors (CT) in children are very rare lesions, but their diagnosis is crucial for patient management. Echocardiography is the most used cardiovascular imaging modality in clinical practice for the initial diagnosis of CT in pediatric patients. Knowing the echocardiographic characteristics of CTs can enable an increasingly early diagnosis and the identification of its most likely etiology. Primary CTs are the most frequent in children, with benign ones being the most prevalent. Among benign CTs, the most frequent in fetuses and neonates are rhabdomyomas and teratomas, while in older children, they are rhabdomyomas and fibromas. In this article we describe the echocardiographic characteristics of the main CTs in pediatric ages.

The dynamical behavior of a perturbed Human Immunodeficiency Virus (HIV) model is investigated in this paper. We first determine a positively invariant set in which the perturbed system admits a unique, positive, global solution. Following that, we discuss the stability of infection-free equilibrium of the deterministic model. We also obtain the conditions required for the p th -moment exponential stability, for the perturbed system. Later we show that if R0 >1 for smaller intensity of noise, the solution of stochastic system oscillates around E*. Our results demonstrate that a large value of noise suppresses the disease from persistence exponentially. We also derive the condition for the persistence of the disease. Finally, comparison of our analytical results with simulations is to be done.

Microheterogeneity of mAbs can impact their activity and stability. Formation of charge variants is considered as the most important source the microheterogeneity. In particular, controlling the content of the acidic species is often a major importance for the production process and the regulatory approval of therapeutic proteins. In this study, the preferential precipitation process is developed for reducing the content of acidic variant in mAb downstream pools. The process design was preceded by determination of phase behavior of mAb variants in the presence of different precipitants. It is shown that the presence of polyethylene glycol (PEG) in protein solutions favors precipitation of acidic variants of mAbs. Precipitation yield is influenced by the variant composition in the mAb feed solutions, the concentration of the precipitant and the protein and the ionic strength of the solutions. To improve yield, the precipitate is repeatably dissolved and recycled to the precipitation process. The final product is as a mixture of supernatants pooled together from the recycling steps, in which the content of the acid variant is reduced. In addition, mAb aggregates present in the feed solutions accumulate in the precipitate., which is discarded as a waste. Such an approach can be potentially used either instead or in a combination with chromatography for adjusting the acidic variant content of mAbs, which can benefit in improvement in throughput and reduction in manufacturing costs.

Abstract Objective: To appraise the added benefit of refixation saccades (RS) towards the improvement of the video head-impulse test (vHIT) diagnostic accuracy in cases of suspected left horizontal semicircular canal dysfunction. Study Design: Case-control. Setting: Tertiary referral center. Participants: Twenty patients with a final diagnosis of left horizontal semicircular canal dysfunction and 20 patients for whom vestibular dysfunction was ruled out. Intervention: vHIT recordings of 40 patients with left horizontal semicircular canal (LHSCC) vestibulo-ocular reflex (VOR) gain <0.8. Main outcome measures: LHSCC VOR gain; Presence of RS and their frequency, latency, and velocity characteristics. Results: Gain values > 0.72 were found in all patients with no vestibular disease and in 4 (20%) patients having vestibulopathy. Significantly higher average left-sided RS velocity and frequency were found among the vestibular patients. VOR gain < 0.72 was found to be highly specific for the diagnosis of vestibular dysfunction. However, for gain values in the range of 0.72-0.79 the presence of RS with frequency > 80% largely improved vHIT diagnostic accuracy. CONCLUSIONS: Although VOR gain<0.8 is considered to reflect dysfunction a significant false positive rate for left-sided horizontal vHIT was found for gains in the range of 0.72-0.79. The presence of RS with frequency >80% could improve vHIT diagnostic ability in these patients. Key words: video head impulse test, re-fixation saccades, peripheral vestibular pathology, gain asymmetry in vHIT, lateral semicircular canal hypofunction, saccadic frequency, corrective saccade velocity

Little seems to be known about the sensitivity of steady states for stochastic systems. This paper discusses the problem of whether there is an invariant measure in a degenerately damped stochastic Lorenz-Stenflo model. Precisely, the solution is proved to be a nice diffusion via the Lie bracket technique and non-trivial Lyapunov functions. The finiteness of the expected positive recurrence time entails the existence problem. On the other hand, a cut-off function is constructed to show the non-existence result via proof by contradiction. For other interesting cases, the expected recurrence time is shown to be infinite.

The study of cellular metabolism is often hindered by limitations in the amount of exper- imental data available. Therefore computational methods that exploit maximally the possible measurements, and are able to extract relevant predictions from a minimum of information are always welcome. Maximum Entropy (ME) inference has been succesfully applied to genome-scale models of cellular metabolism in various cell culture contexts, yielding insights into biologically relevant properties which are not accessible to traditional optimization based methods. Recent data-driven studies have suggested that in chemostat cultures, the growth rate and uptake rates of limiting nutrients are the most informative parameters about the metabolism. In this work, we propose the thesis that chemostat dynamics typically drives the culture towards maximally restricted metabolic states. A practical consequence is that experimental values of limiting up- take rates can be replaced by more readily available measurements of metabolite concentrations in the feed media and the steady state cell concentration. We show how these results can be justified from a mechanistic perspective by studying simulations of a simplified model where we test the quality of the inference, and unveil the mechanisms defining the performance of our approach. We then apply our method to E. coli experimental data. We evaluate the effects of heterogeneity in chemostat cultures and its potential impact on flux inference quality of ME and optimization based strategies. Additionally, we evaluate the quality of the inference comparing M E to alternative formulations that rest on a Flux Balance Analysis (F BA).

Introduction: A spirometry with a significant bronchodilator response (SBDR) in FEV1, a methacholine concentration that produces a 20% drop in FEV1(PC20) ≤ 2 mg/ml and a positive exercise test (ET), have high specificity for the diagnosis of asthma in children. The value of FEF25-75 in spirometry has been questioned. The objective of this study was to relate SBDR in FEF25-75 of spirometry with normal FEV1 and FEV1/FVC, with bronchial hyperresponsiveness (BHR) to methacholine or exercise in children aged 5 to 15 years with clinical suspicion of asthma. Material and method: Cross-sectional study of spirometries performed between January 2017 and December 2019 in children aged 5-15 years with suspected asthma, who had a methacholine and/or exercise test within a period not exceeding 60 days. It was analyzed using STATA 14-0 and Microsoft Excel 2016 applying Chi-square tests. Results: The average age was 9.04 years (range: 5 – 14 years), 56.17% male. Of 324 spirometries with normal FEV1 and FEV1/FVC, 66 (20.4%) presented SBDR at FEF25-75. 47% and 33.3% of the children with and without RSB in FEF25-75, respectively, had PC20 ≤ 2 mg/ml and/or positive TE (p = 0.0396). Conclusions: children with suspected asthma and normal spirometry, with SBR in FEF25-75, had greater BHR than those without SBDR in FEF25-75. The SBDR in FEF25-75 was not always accompanied by an BHR that can confirm the diagnosis of asthma with high probability.

Cucumber target leaf spot caused by Corynespora cassiicola has devastated greenhouse cucumber production. In our previous study, the monitoring of C. cassiicola resistance to carbendazim was carried out and a large number of resistant isolates which conferred various mutations (M163I&E198A, F167Y&E198A, F200S&E198A or E198A) in the β-tubulin of C. cassiicola were detected in the field. However, the single-point mutations M163I, F167Y, and F200S have remained undetected in the field. To investigate the resistance evolution mechanism of C. cassiicola to benzimidazoles, site-directed mutagenesis was used to construct alleles with single-point mutation M163I, F167Y, F200S, E198A, and double mutation M163I&E198A, F167Y&E198A or F200S&E198A in β-tubulin. Through PEG-mediated protoplast transformation, all the mutants except for the M163I mutation were obtained and conferred resistance to benzimidazoles. A similar sensitivity to benzimidazoles was observed between the F167Y and F200S mutations. However, in comparison to the F167Y or F200S mutations, double mutations (M163I&E198A, F167Y&E198A, F200S&E198A) and single mutation E198A caused significantly decreased sensitivity to benzimidazoles. The sensitivity to benzimidazoles for the double mutations (M163I&E198A, F167Y&E198A, F200S&E198A) did not differ from the single mutation E198A. Based on biological characteristics, the findings showed that the mutants conferring the F167Y or F200S mutations suffered fitness penalty, but not the mutants conferring the double mutations (M163I&E198A, F167Y&E198A, F200S&E198A) or the single mutation E198A. Thus, we concluded that to avoid the intrinsic fitness penalty and survive in the field, the double mutations (F167Y&E198A, F200S&E198A) evolved from the single mutations F167Y and F200S, respectively, and not the single mutation E198A.

Objective: To examine the association between maternal stature and adverse perinatal outcomes, and the modifying effect of race/ethnicity. Design: Retrospective cohort study. Settings: USA, 2016-2017. Population: Women with a singleton stillbirth or livebirth (N=7,361,713). Methods: Using data from the National Center for Health Statistics, short and tall stature were defined as <10th and >90th centile of the maternal height distribution. Logistic regression was used to obtain adjusted odds ratios (AOR) and 95% confidence intervals (CI). Main Outcome Measures: Preterm birth (PTB, <37 weeks’ gestation), perinatal death, and the composite of perinatal death/severe neonatal morbidity (PD/SNM). Results: Short women had elevated risk of adverse outcomes, while tall women had a decreased risk relative to average stature women. Short women had an increased risk of perinatal death and PD/SNM (AOR=1.14, CI: 1.10-1.17; AOR=1.21, CI: 1.19-1.23, respectively). The association between short stature and perinatal death was attenuated in non-Hispanic Black women compared with non-Hispanic White women (AOR=1.10, 95% CI 1.03-1.17 vs AOR=1.26, CI 1.19-1.33). Compared with women of average stature, tall non-Hispanic White women had lower rates of PTB, PD/SNM (AOR=0.82, CI 0.81-0.83; AOR=0.95, CI 0.91-1.00; AOR=0.90, CI 0.88-0.93, respectively). Conclusion: Relative to women of average stature, short women have an increased risk of adverse perinatal outcomes; these effects are attenuated in Hispanic women, and for some adverse outcomes in non-Hispanic Black women. All tall women have a lower risk of preterm birth, and tall non-Hispanic White women have also lower risk of perinatal death/severe neonatal morbidity.