In this paper, we deal with orbital stability and Zhukovski\v{\i} quasi-stability of periodic or recurrent orbits in an impulsive dynamical system defined in the $n$-dimensional Euclidean space $\mathbb{R}^n$. In fact, we show that for a periodic orbit of an impulsive system its asymptotically orbital stability is equivalent to the asymptotically Zhukovski\v{\i} quasi-stability, and for a recurrent orbit the orbital stability is equivalent to the Zhukovski\v{\i} quasi-stability.

In this paper, we establish the existence of solitary wave in some KdV-mKdV equation with dissipative perturbation by applying geometric singular perturbation technique and Melnikov function. The distance of the stable manifold and unstable manifold are computed to show the existence of the homoclinic loop for the related ordinary differential equation systems on the slow manifold, which implies the existence of a solitary wave for the KdVmKdV equation with dissipative perturbation

Background and Objective: Clinical Pathways are expected to make health care delivery more efficient and effective. Yet we have very little research on how Clinical Pathways are followed. This study assesses the functioning of a Clinical Pahway for elderly people in a Finnish case. At the same time it documents the hardships of getting information on the patient flows in a Clinical Pathway. Study Design/Materials and Methods: The data on all patients aged 75 years or more who had visited the emergency unit of the city hospital in 2006–2008 was collected. The study sample comprised 24,195 admissions. The flow of patients after the first care at the emergency unit was analysed, collecting data from various scattered sources. Results: The results show that the planned Patient Pathways seem not to be followed always. Yearly about 17% of the patients were referred to the university hospital, the more expensive care, but about 74% of these referrals did not follow the agreed procedure. The excess costs of referring patients to a non-standard, more expensive Clinical Pathway were 2,57 Million Euros over a period of three years for the studied population of 24,195 admissions, also averaging 106 Euros per admission. Conclusion: Clinical Pathways were not followed in the case as planned and expected. Reasons for this should be better understood and studied in more depth. In addition, follow-up information of Clinical Pathway flows is often hard to collect because of fragmented information systems, that are not designed to document patient flows in Clinical Pathways.

Objectives: In this study we aimed to investigate the prevalence of abnormal nasality in patients with unilateral rhinosinusitis and their nasality outcomes following functional endoscopic sinus surgery (FESS). Design, Setting, Participants: A total of 42 patients with unilateral chronic rhinosinusitis who underwent unilateral FESS between April 2016 and November 2017 were enrolled. The patients were divided into two groups, wide opening surgery and limited surgery, according to the severity of the disease. Questionnaires on sinonasal symptoms and nasality were recorded. Main outcome measures: The change in the nasalance score and symptoms were measured preoperatively, 6 months, and 12 months after the operation. Results: Among 42 patients, the subjective reports showed that one-third of unilateral chronic rhinosinusitis (CRS) patients had abnormal nasality preoperatively and significant improvement following FESS. The Lund-Mackay score was significantly negatively correlated with preoperative nasalance of [i] and positively correlated with change of nasalance of [i]. The increase in the value of [i] is statistically significant (p=0.01) following FESS. In the wide opening surgery group, the change in nasalance was significant, but not in the limited surgery group. Conclusion: Although only one side of the nasal airway was involved, one-third of the patients reported abnormal nasality. In patients with more disease severity who underwent wide opening surgery, the nasalance significantly increased 1 year after FESS. The increase in the nasalance score may represent a return to a normal status since the self-reported nasality assessment was significantly improved postoperatively.

Heat stress alters photosynthetic components and antioxidant scavenging system, negatively affecting plant growth and development. Plants overcome heat stress damage through an integrated network involving enzymatic and non-enzymatic antioxidants. The aim of the study was to assess physiological and biochemical responses in contrasting thermotolerant wheat varieties exposed to 25°C (control) and 35°C (heat stress), during seedling stage. Our results revealed a substantial decrease in the photosynthetic pigments, carotenoids, anthocyanin content, and increased membrane injury index, malondialdehyde, lipoxygenase, methylglyoxal and H2O2 contents compared to non-stress wheat seedlings. Comparatively the heat tolerant variety BG26 maintained a high level of stability compared to the heat susceptible variety Pavon, perpetuated by higher accumulation of proline, glycine betaine, ascorbate-glutathione cycle associated enzymes, reduced glutathione and ascorbate contents. In addition, significantly lower MG detoxification and activities of antioxidant system and ascorbate-glutathione cycle related enzymatic activities lead to increased susceptibility in Pavon. Hierarchical clustering and principal component analysis revealed BG26 possessing a combination of biochemical responses that induced higher level of tolerance. Taken together, our results provide a reference for utilizing BG26 and Pavon as highly contrasting heat-responsive varieties for comparative genomics and translational research to unravel underlying mechanisms to better adapt wheat to heat stress.

Background: Tuberculosis remains a major health problem in developing countries and genital tuberculosis is responsible for affecting a considerable number of women who presented in different manners as chronic pelvic pain, pelvic inflammatory infection, infertility and ectopic pregnancy. The average world-wide incidence of female genital tuberculosis in infertile population has been reported as 5-10%, with the range varying between <1% in USA and about 10% in India. Objective: Present study is an attempt to find out the prevalence and relationship of Genital tuberculosis(GTB) and ectopic pregnancy. Design: It was a cross sectional case control study. Setting and population: The study was conducted in department of Obstetrics and Gynecology in association with Department of Microbiology, VMMC & Safdarjung Hospital, and New Delhi including: • Case: Women (n=95) presenting with ectopic pregnancy. • Control group: Women (n=95) subjected to tubal ligation. Methods: After thorough history and examination, tubal sample is collected from case and control group. Main outcome measures: Prevalence of ectopic pregnancy with genital tuberculosis Results: The prevalence of the genital tuberculosis in general population was 1.1% and with ectopic pregnancy was 16.8%, that was quite significant so genital tuberculosis should be kept in mind and punctiliously anticipated in cases of ectopic pregnancy to prevent the countercoups of genital tuberculosis. Conclusion: It is inferred that the prevalence of ectopic pregnancy is higher among the women who had genital tuberculosis and Funding : No funding received from any agency. Key Words: genital tuberculosis, ectopic pregnancy, infertility, maternal morbidity

A document by Giulio Ricotta. Click on the document to view its contents.

Mask Up America!!! - Stop This Deceptive Self-Destructive COVID-19 CHARADE!!!: The rantings of a perplexed US Nephrologist!!!Macaulay Amechi Chukwukadibia Onuigbo MD MSc FWACP FASN MBA1,2The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT.College of Business, University of Wisconsin MBA Consortium, Eau Claire, WI.

Great concerns over the influence of corona virus disease 2019 (COVID-19) on the nervous system have been growing since the first reported case of neurological affection in China. Neurologic presentations of COVID-19 are variable and may occur prior to the diagnosis. These can present variably in the disease course and were found to have more severe disease courses. We report two case of COVID-19 with different neurological presentations. The burden of COVID-19 and its neurological manifestations necessitate the urgent recognition of these neurological conditions for treating such patients.

A document by Steven Smith. Click on the document to view its contents.

Situs viscerum inversus always poses clinical and diagnostic challenge. We report the case of an unexpected and late discover of dextrocardia requiring aortic valve replacement.

Objective To describe the prevalence of overall and asymptomatic SARS-CoV-2 infection in pregnant women admitted for delivery at 3 maternity units in North Wales. Design A prospective multicentre cohort study of universal testing for SARS-CoV-2 infection offered to all pregnant women admitted for delivery. Setting 475 women admitted for delivery in 3 maternity units in North Wales at Bangor, Bodelwyddan and Wrexham between 3rd June and 2nd July 2020. Population 95.8% (n=475) of all women admitted for delivery. Methods Testing performed by reverse transcription-polymerase chain reaction of nasopharyngeal swabs with concurrent universal screening for signs and symptoms of COVID-19 infection. Main Outcome Measures Overall and asymptomatic prevalence of SARS-CoV-2 infection in pregnant women admitted for delivery. Results The overall prevalence of SARS-CoV-2 infection in pregnant women in North Wales was 2.74% with an asymptomatic prevalence of 1.89%. 69% of women infected with SARS-CoV-2 at delivery were asymptomatic. Conclusions Pregnant women with SARS-CoV-2 infection are not reliably identified using symptom and temperature screening as most infected women are asymptomatic on admission. The prevalence of maternal infection and asymptomatic carrier rates vary based on geographic differences in disease prevalence. It is suggested that a trial period of universal testing may help determine whether such an approach is appropriate for an individual maternity unit. Funding – None Key words Universal testing, SARS-CoV-2, COVID-19, pregnant women, delivery

Lymphoblastic Lymphoma and Chronic Myeloid leukemia are two distinct neoplasms with different pathogenesis and clinical presentation. We hereby share a challenging case of a child presenting with fever, leucocytosis, generalized lymphadenopathy and massive splenomegaly. He was diagnosed as having novel association of concurrent T-Lymphoblastic Lymphoma diagnosed on cervical lymph node biopsy with BCR-ABL Negative Chronic Myeloid leukemia on bone marrow aspirate. Study of more such cases is needed for optimal patient management.

Objective To study the clinical efficiency of laparoscopic sacroopexy and vaginal sacrospinous ligament fixation in the treatment of pelvic organ prolapse. Design Retrospective analysis of clinical cases Setting China Population or sample A total of 115 patients admitted to the Second Affiliated Hospital of Anhui Medical University from April 2015 to October 2019. Methods According to different surgical methods, they were divided into two groups. Statistical analysis was performed on the general condition, intraoperative condition, postoperative follow-up subjective recovery and postoperative complications of the enrolled patients. Main outcome measures Clinical efficacy of two different surgical methods in the treatment of pelvic organ prolapse. Results The general information (age,pregnancy history, delivery history, the time of menopause, BMI) and clinical POP-Q stage of the patients were compared, and the results showed that there are no statistically significant difference (P > 0.05). Compared with the LSC group, SSLF group showed significant statistical differences in operation time, intraoperative blood loss, postoperative retention time of urinary catheter, and total cost of hospitalization (P <0.05). The difference of hemoglobin between the SSLF group and the LSC group was statistically significant (P <0.001). In postoperative follow-up, the subjective total cure rate of SSLF and LSC was 95.89% and 86.11% respectively. There was no statistical difference in the subjective cure rate between the two surgical methods (x2 =3.390, P=0.066). Conclusion During the intraoperative and postoperative follow-up, there were statistical differences in multiple factors, indicating that there are differences between the two surgical methods in clinical treatment.

Microalgal cultivation has received considerable attention because of increasing prominent energy depletion and environmental issues worldwide. However, most microalgae isolated from moderate environments currently cannot adapt well to the changing environmental conditions when cultivated at large scales. Therefore, microalgal diversity of biocrust from the extreme Tengger desert was investigated in this study, using high-throughput sequencing, for further exploring their abilities of lipid and biodiesel production. To identify the best management practices for cultivating biocrust microalgae on large scale, the light dependent growth kinetics and the corresponding lipid-producing properties were evaluated under different cultivation scales. The results of microalgal diversity decreasing with biocrust succession imply a large potential microalgal resource bank in the early developmental biocrusts. Through evaluating the light dependent growth kinetics of two screened microalgae Chlorella sp. BSC-24 and Monoraphidium dybowskii BSC-81, we verify that the screened biocrust microalgae could adapt well to the large cultivation scale with an increased light requirement. Furthermore, our results show that the variations of lipid productivity could be successfully interpreted by microalgal biomass accumulation (P<0.05), instead of lipid content (P>0.05). In particular, a quite good lipid productivity (18.36-18.78 mg·L-1·d-1) and fatty acid methyl ester compositions through microalgal lipid extraction and transesterification were achieved, via cultivating the screened biocrust microalgae in a 1000 L desert open raceway pond. Altogether, our results suggest screening and cultivating lipid-producing microalgae from biocrusts is a promising path to produce high quality of biodiesel for further industrial application in desert regions.

In this paper we consider the Timoshenko-Ehrenfest beam models (2019, {\it Who developed the so-called Timoshenko beam theory? Mathematics and Mechanics of Solids)} and we stablished exponential decay results based on influence of the second spectrum of frequency and it’s damaging consequences for wave propagation speeds. For the classical case, having two wave speeds governing the stress waves and shear waves, we prove that the corresponding semigroup associated to the system decays exponentially under equal wave speeds assumption. On the contrary, there is a lack of exponential stability and we prove it’s optimality based on Borichev-Tomilov approach. For the truncated case, we assure the well-posedness by using the Faedo-Galerkin method and we prove that the total energy decays exponentially regardless any relationship between coefficients of the system by using the energy method.

Abstract The concept of 0 dimension,1 dimension ,2 dimension,and 3 dimension,the more high dimension,until infinite dimension ,namely the concept of gradually increasings of dimension is non-existence.Instead,there is only a concept of infinitely great that is an one quantitative continuum. The space we see is just the defference of 1 dimension finite quantities and infinitely great quantities that is open space and is implied by change of direction .The accurate description of this one quantitative continuum is that its parts are connected each other as a unity at the infinite distance（infinitely great）relative to any orientation (all orientations)of our existence.it is unity in which its random parts is this infinitely great quantities and thus we call this unity as infinite quantities of infinite dimensions.

In this paper, we introduce the concept of fuzzy ideal supra compactness and fuzzy ideal supra connectednessen in fuzzy supra topological spaces and study some of the properties and characterizations of fuzzy ideal supra compactness and fuzzy ideal supra connectednessen.

Trees form the bases of terrestrial ecosystems; however, the origin of the diversity of trees within these systems is a major question in evolutionary biology and ecology. Mycorrhizal type, pollination, and seed dispersal mode are key drivers of tree diversity. However, because they are usually studied in isolation, their evolutionary relationships are poorly understood. Here, we show the evolutionary relationships among mycorrhizal type, seed dispersal mode, and pollination mode in 821 tree species. We found evidence of the joint evolution of all three features. Most arbuscular mycorrhizal-associated trees had endozoochorous seed dispersal and biotic pollination, whereas most ectomycorrhizal-associated trees had anemochorous seed dispersal and wind pollination. Overall, mycorrhizal type, seed dispersal mode, and pollination mode were linked, emphasising the importance of the joint study of these traits to understand tree diversity. Plants have lived closely with AM fungi for over 400 million years, and later evolved mutualistic interactions that promote plant diversification. This raises a novel question over how mycorrhizal symbiosis drives the evolution of seed and pollination mutualism, and how it contributes to plant diversification. Here, we provide a comprehensive reliable scaffold for understanding not only tree evolution but also the evolution and mechanisms of forest ecosystems.

1 Background and Objective Coronavirus disease-2019 (COVID-19) or its complications in children with cancer were not increased as compared to normal children in earlier reports. However, continuing intensive treatment during ongoing COVID-19 infection has not been studied systematically. We report a single tertiary center experience on COVID-19 in children with cancer and continuation of cancer-directed therapy in them. 2 Methods Children ≤15years on active cancer treatment detected with COVID-19 until September 15th, 2020 were prospectively followed-up. Patients were managed in accordance to well-laid guidelines. Treatment was continued for children with COVID-19 infection who were clinically stable and on intensive treatment for various childhood cancers as far as practicable. 3 Results One hundred twenty-two children (median age 8years; range 1-15years, male: female 1.7:1) with cancer were diagnosed with COVID-19. All-cause mortality rate was 7.4%(n=9) and COVID-19 related mortality rate was 4.9%(n=6). Of 118 children, 99 (83.9%), 60 (50.8%), 43 (36.4%), 26 (22.0%) and 6 (5.1%) had RT-PCR positivity at 14, 21, 28, 35 and 60 days from diagnosis of COVID-19 respectively. Scheduled risk-directed intravenous chemotherapy was delivered in 70 (90.9%) of 77 children on active systemic treatment with a median delay of 14days (range, 0-48days) and no increased toxicities. 4 Conclusions COVID-19 was not a major deterrent for the continuation of active cancer treatment despite persistent RT-PCR positivity. The long-term assessment of treatment adaptations requires further prospective follow up and real time addressal.

After allogeneic peripheral blood stem cell transplantation (PBSCT), children are at high risk of hepatitis B virus (HBV) infection because of the potential loss of HBV immunity. The factors which can affect it are not fully understand. This study aimed to assess the probability of hepatitis B surface antibody (HBsAb) disappearance after PBSCT and to evaluate the impact of donor and recipient immunity on HBsAb disappearance. A total of 110 patients who underwent PBSCT between January 2016 and December 2018 and their paired donors were retrospectively enrolled in this study. Before transplantation, 87 (79.1%) patients were HBsAb seropositive, and 23 (20.9%) were HBsAb seronegative. Fifty-five (63.2%) patients with protective HBsAb titers before PBSCT lost their HBV immunity within one year after transplantation. Univariate analysis showed that the low recipient pretransplant HBsAb titer, antithymocyte globulin (ATG) administration, corticosteroid administration and graft-versus-host disease (GVHD) were significant risk factors for HBsAb disappearance (P<0.05). Multivariate analysis showed that only recipient pretransplant HBsAb titers lower than 207.5 IU/L (P=0.022, hazard ratio (HR): 1.925, 95% confidence interval (CI): 1.101-3.367) and the presence of GVHD (P=0.033, HR=1.921, 95% CI: 1.056-3.495) were risk factors for HBsAb disappearance one year after HSCT. In conclusion, most recipients lost previously acquired immunity to HBV after PBSCT. A high titer of HBsAb in the recipient before transplantation had a protective effect against posttransplant HBsAb disappearance, but the presence of donor immunity did not significantly influence the maintenance of recipient immunity to HBV.

Introduction: The prevalence of carbapenem-resistant Klebsiella strains and their related mortality are increasing worldwide. These pandemics impose optimizing antibiotic consumption through the application of the antibiotic stewardship programs. We aimed to evaluate the impact of applying antibiotic stewardship programs on carbapenem consumption and the klebsiella resistance pattern in critically ill patients of a large Egyptian hospital. Method: We retrospectively evaluated critically ill patients with isolated Klebsiella species from the ICU of Elaraby hospital, Egypt during the period from April 2017 to January 2019. We collected data related to carbapenem consumption (expressed as defined daily dose /1000 patient-days) and Klebsiella clinical isolates and their antimicrobial susceptibility pattern. Based on Klebsiella sensitivity, as sensitive to ceftriaxone and cefotaxime, resistant to ceftriaxone/cefotaxime, or resistance to meropenem/imipenem, Klebsiella isolates were classified as grades 1, 2, or 3, respectively. Our primary outcome was the change in carbapenem consumption after implementing the program, while the secondary outcomes were the change in the incidence of carbapenem-resistant Klebsiella. Results: The study included 205 patients with isolated Klebsiella species during the study period. The antibiotic stewardship program started in March 2018. Out of the 205 patients, 61 patients (29.8%) represented the pre-intervention sample, and 144 patients (70.2%) represented the post-intervention sample. Applying the antibiotic stewardship program was associated with a significant decrease in the carbapenem consumption from 38.9 to 26.6 defined daily dose /1000 patient-days (P=0.02). The incidence of carbapenem-resistant Klebsiella was decreased from 85.25% of total Klebsiella isolates to 48.6% (P<0.001). Klebsiella species were more likely to be in a lower category of resistance after applying the program with an odds ratio (OR) = 6.3 (2.88-13.73) using ordinal logistic regression. Conclusion: Applying the antibiotic stewardship program could reduce the unnecessary carbapenems use in the ICU with a subsequent decrease in the emergence of the Klebsiella resistant strains.

Objective Analyze the potentially inappropriate medications (PIMs) use in 372 old adult inpatients in our hospital. Methods According to the Criteria for Potentially Inappropriate Medications use for the old adults in China (2017 Edition, a retrospective analysis of the medications in 372 old adult inpatients aged 65 years and above was performed to evaluate the occurrence of their PIMs use. Results The average age of the 372 inpatients was (74.67±6.95) years old, the average Inpatient days was (11.96±8.5) days, and the average number of illnesses per person was (4.92±2.55). Of 372 inpatients, 62.63% (233) inpatients had PIMs in the China-PIM list for the old adults , and 17.20% (64) inpatients had PIMs related to their diseases. Conclusion The proportion of PIMs among old adult inpatients in our hospital is relatively high. The hospital should pay attention to it and actively take measures to reduce the risk of PIMs for the old adults and ensure rational drug use in clinical medicine.

Photosynthesis is an important biochemical reaction that provides food and oxygen to maintain aerobic life on earth. Recently, increasing photosynthesis has been revisited as an approach for reducing crop yield losses caused by global warming. Here, we argue that respiration, rather than photosynthesis, may be the primary contributor to yield losses in a warming climate. Moderate high temperature stress causes little damage to photosynthesis but significantly increases respiration rate. In this case, energy production efficiency is enhanced by high temperature, but most of this energy is allocated to maintenance respiration, resulting in an overall decrease in energy utilization efficiency. Engineering crops with low respiration and high energy utilization efficiency could therefore effectively solve the world food crisis as global warming increases.