The goal of this paper is to study fractional differential equations involving instantaneous and non-instantaneous impulses with Sturm-Liouville boundary conditions. By using critical point theory and variational approach, infinitely many solutions are obtained. The interesting point is that the potential has an oscillating asymptotic behavior. Also one example is presented to illustrate the main result.

Concomitant presence of acute type A dissection and coactation of aorta is rare (1). Levoatriocardinal vein has shown to be associated with left sided hypoplastic lesions as well as with normal hearts (2, 3 ). However, concurrent presence of levoatriocardinal vein with acute type A dissection, severe aortic regurgitation and Coarctation of aortic isthmus was not described. We here described a case of 20 year male presented to emergency department with acute chest pain radiating to back. On evaluation, he was found to have acute type A dissection with dilated aortic root, severe aortic regurgitation, normal mitral valve, severe coarctation of aorta and levoatriocardinal vein. Patient was managed successfully with composite valve conduit replacement of ascending aorta with ascending aortic to descending aortic graft (16mm graft) with levoatriocardinal vein ligation.

Let $\mathcal{S}$ be the Sierpi\’nski gasket in $\mathbb{R}^2$ and $\mathcal{S}_{0}$ denote the boundary of $\mathcal{S}$. In this paper, we study the following non-homogeneous $p$-Laplacian equation \begin{align*} -\Delta_p u &= \lambda |u|^{q-2} u + f \text{~in}\; \mathcal{S}\setminus\mathcal{S}_0\\ u &= 0\;\mbox{~on}\; \mathcal{S}_0, \end{align*} where $p$, $q$, $\lambda$ are real numbers such that $\lambda >0$, $1

ABSTRACT: Background: Cauda equina syndrome secondary (CES) to primary sacral diffuse large B cell lymphoma (DLBCL) is an uncommon condition, and few cases have been reported in the medical literature. After an extensive literature review related to these topics, we did not find a reported case like our patient.

Many publications on COVID-anosmia and asymptomatic COVID-stroke have been released, and plenty of studies on novel therapeutic approach have been published. Here we report an atypical case, our findings from review the medical literature, and comment on the treatment modalities

Neurosarcoidosis and thyroid abnormalities are reversible causes of dementia in the elderly. We present a case of a patient with rapidly progressive dementia due to neurosarcoidosis and sarcoid involvement of the thyroid improved by corticosteroids and Methimazole.

This clinical case is showing a potential synergistic neuroprotective interaction of Cerebrolysin and high doses of aspirin. The case describes the significant recovery of neurological deficits in a patient with moderate ischemic stroke caused by right posterior cerebral artery thrombosis after treatment with Cerebrolysin in combination with aspirin

A child with a A350V IQSEC2 missense mutation resulting in drug resistant epilepsy stops having seizures when he has a fever. We demonstrate that raising the body temperature of the child using a commercial Jacuzzi dramatically reduces his seizures and appears to improve his social behavioral interactions.

Hybrid repairs for pseudoaneurysms after previous surgical coarctation repair are becoming a well-accepted and widespread method especially in patients with complex aortic disease. We report two cases that performed two different hybrid repair methods for pseudoaneurysm associated with previous aortic coarctation.

One of the first lines in controlling diseases and malnutrition is diet therapy and currently, due to tool limitations, for designing the patients’ diet plan, the food groups and the list of food substitutes are being used while suitable databases of foods composition are available. Methods of designing individuals’ diet and total of 8791 foods are reviewed to calculate the nutrients of mixed foods and design a suitable method of diet therapy with more freedom for the patients in the future. Food groups because of their simplicity are suitable for public health educations but have limitations that could be better covered using nutrient balances. The main cause of developing the list of food substitutes was the limitations in calculating nutrients in a designed diet that currently could be run using applications. Patients also by using self-management nutrition applications that based on the nutrient balancing method shown they are ready to accept this method. A well-designed application can make using nutrient balancing method which is the future of diets possible. However, the main limitation is still the needs for a big, validated, and accurate foods composition database that needs to be developed.Keywords : Diet, Food Groups, Nutrients, Diet therapy, Nutrition

The denatured state of several proteins has been shown to display transient structures that are relevant for folding, stability and aggregation. To detect them by nuclear magnetic resonance (NMR) spectroscopy, the denatured state must be stabilized by chemical agents or changes in temperature. This makes the environment different from that experienced in biologically relevant processes. Using high-resolution heteronuclear NMR spectroscopy, we have characterized several denatured states of a monomeric variant of HIV-1 protease induced by different concentrations of urea, guanidinium chloride and acetic acid. We have extrapolated the chemical shifts and the relaxation parameters to the denaturant-free denatured state at native conditions, showing that they converge to the same values. Subsequently, we characterized the conformational properties of this biologically relevant denatured state under native conditions by advanced molecular dynamics simulations and validated the results by comparison to experimental data. We show that the denatured state of HIV-1 protease under native conditions displays rich patterns of transient native and non-native structures, which could be of relevance to its guidance through a complex folding process.

This study aimed to compare the infection dynamics of three genotype II African swine fever viruses (ASFV) circulating in Europe. Eighteen domestic pigs divided into three groups were infected intramuscularly or by direct contact with two haemadsorbent ASFVs (HAD) from Poland (Pol16/DP/ OUT21) and Estonia (Est16/WB/Viru8), and with the Latvian non-HAD ASFV (Lv17/WB/Rie1). Parameters such as symptoms, pathogenicity, and distribution of the virus in tissues, humoral immune response, and dissemination of the virus by blood, oropharyngeal and rectal routes were investigated. The Polish ASFV caused a case of rapidly developing fatal acute disease, while the Estonian ASFV caused acute to subacute infections in the presence of surviving animals. In contrast, animals infected with the ASFV from Latvia developed a more subtle, mild, or even subclinical disease. Oral excretion was sporadic or even absent in the attenuated group, whereas in animals that developed an acute or subacute form of ASF, oral excretion began at the same time as in the blood, or even 3 days earlier, and persisted up to 22 days. Regardless of virulence, blood was the main route of transmission of ASFV and infectious virus was isolated from persistently infected animals for at least 19 days in the attenuated group and up to 44 days in the group of moderate virulence. Rectal excretion was limited to the acute phase of infection. In terms of diagnostics, the ASFV genome was detected in contact pigs from oropharyngeal samples earlier than in blood, independently of virulence and, together with blood, both samples could cover a longer range to detect ASFV infection. The results presented here provide quantitative data on the spread and excretion of ASFV strains of different virulence among domestic pigs that can help to better focus surveillance activities and thus increase the ability to detect ASF introductions earlier.

Conjugated open ended cones in which the configured pentagons are consistent, lies in the circle of Fries Kekule structure [8]. This non-adjacent tightest configuration of pentagons as shown in the Fig. 1 is consistent with a Fries Kekule structure and thus provides the most stable cone. In the study, various topological indices of the same structure in regard of physico-concoction resources and bioactivity of substance mixtures are studied which further helps to study the behavior of chemical compounds. In this regard, Zagreb indices M_1^* (G) and M_2^* (G) of a molecular graph G are used to evaluate the complexity in chemical systems and biological organisms. In this manuscript, we consider two complex families of stable carbon nanocones and compute their ECI, TEI and eccentricity-based Zagreb indices.

We located ‘hidden’ S-character chirality in formally achiral glycine using a vector-based interpretation of the total electronic charge density distribution. We induced the formation of stereoisomers in glycine by the application of an electric field. Control of chirality was indicated from the proportionate response to a non-structurally distorting electric field. The bond-flexing was determined to be a measure of bond strain, which could be a factor of three lower or higher, depending on the direction of the electric field, than in the absence of the electric field. The bond-anharmonicity was found to be approximately independent of the electric field. We also compared the formally achiral glycine with the chiral molecules alanine and lactic acid, quantifying the preferences for the S and R stereoisomers. The proportional response of the chiral discrimination to the magnitude and direction of the applied electric field indicated use of the chirality discrimination as a molecular similarity measure.

Background: Epicardial adipose tissue (EAT) mimics visceral fat which is associated with metabolic derangements and coronary artery disease (CAD). EAT volume (EAT-V) measured by CT scan had shown good correlation with CAD. QRISK3 score is a validated risk predictor of future cardiovascular events but has limitations. We assessed whether EAT thickness (EAT-T) measured by echocardiography, a simple and widely available tool, correlated with EAT-V, and whether EAT-T is a predictor of CAD independently of QRISK3 scores. Methods: We enrolled 97 patients who underwent CTA for evaluation of chest pain. EAT-T was measured by 2D-echocardiography in parasternal long axis (PLAX) and parasternal short axis (PSAX) views. We evaluated association of EAT-T with EAT-V and CAD (≥50% stenosis on CTA); and independent predictive value of EAT-T for CAD after adjusting for QRISK 3 scores. Results: EAT-T was significantly more in patients with CAD (PLAX: 4.82 ± 1.31 mm vs. 4.06 ± 1.25 mm, p=0.005). EAT-T correlated strongly with EAT-V (r=0.75, p<0.001). On receiver operating characteristic curve analysis, EAT-T (PLAX) ≥3.9 mm (area-under-curve: 0.68; 95% CI: 0.58-0.79, sensitivity 84%, specificity 55%) predicted the presence of CAD. On multivariate analysis after adjusting for QRISK 3 scores, EAT-T showed significant association with CAD with highest odds ratio for indexed EAT-T (EAT-T/body surface area) (PLAX) ≥2.2 mm/m2 (OR 5.40; 95% CI: 2.17-13.55.; p<0.001). Conclusion: EAT-T is a predictor of CAD independent of QRISK3 scores. An increased EAT-T detected CAD with >80% sensitivity. These findings need to be validated in larger prospective cohort studies.

Background Palonosetron is a serotonin-3 (5-HT3) receptor antagonist indicated in the prevention of chemotherapy-induced nausea and vomiting (CINV) in pediatric and adult patients. Traditional dosing for palonosetron in the pediatric population has been 20 mcg/kg with a maximum dose of 1500 mcg. This study aimed to evaluate the impact of an institutional dose cap of 750 mcg on pediatric CINV. Procedure This is a retrospective chart review of admitted patients given palonosetron intended for prevention of CINV at a pediatric medical center between July 1, 2018 and June 30, 2020. Patients 1 month up to 17 years of age who received at least one dose of palonosetron prior to chemotherapy (not preceding stem cell transplant) were included. Information regarding chemotherapy, antiemetic premedication, emesis, and breakthrough antiemetic agents were recorded to quantify the instances of CINV. Results Seven hundred and seventy-one patient encounters met inclusion criteria (n=485 traditional dose, n=286 dose capped). There was no statistical difference in the instances of emesis (p=0.98) or breakthrough agents administered (p=0.65) between the two groups. Dose capping patients at 750 mcg reduced cost by approximately 34.9% compared to traditional dosing. Conclusions The use of a dose cap of palonosetron at 750 mcg maintains efficacy for prevention of CINV while reducing cost in pediatric patients receiving chemotherapy.

Background Iron deficiency anemia (IDA) is detrimental to growth and neurodevelopmental outcomes in young children. IDA is primarily managed in the outpatient setting, though children with severe anemia may require admission. No prior studies of children with severe IDA admitted to US children’s hospitals exist. The objective is to describe characteristics of children requiring admission for IDA. Procedure Using the Pediatric Health Information system database, we identified children age 0-5 years admitted from 2004-2018 with a primary diagnosis of IDA. Patient characteristics were compared by chi-square test or t-test of means. Univariate logistic regression was used to identify factors associated with readmission. We also performed a retrospective review of primary care records. Results A total of 4963 unique patients were identified, with 5202 unique hospitalizations. The mean age at admission at index hospitalization was 1.5 years with no gender difference. A trend towards an increasing number of admissions was noted in recent years. The majority of the patients received blood transfusions (87.3%) and oral iron (61.4%), whereas only 4.9% of patients received intravenous iron. Overall, 13.1% of patients required ICU admission, which was more common in female patients and children of Black or Asian race. Factors associated with decreased odds of readmission included blood product transfusion and use of oral iron during the index hospitalization. Conclusions IDA is a preventable condition, with potential for detrimental long-term outcomes. Trends in the number of admissions over time are concerning in light of the substantial use of hospital resources.

von Willebrand disease is a hereditary disease associated with a tendency to bleed and it is important to reduce the possibility of bleeding in a procedure. This case describes the use of a hemostatic factor, Factor VIII concentrate (Confact F®), during a dental procedure involving teeth extraction and implant placement.

In this article, we aimed to elaborate a universal clinical multidisciplinary protocol in order to facilitate the management of the peg-shaped maxillary lateral incisors, via a case of two upper lateral incisors affected by microdontia. A meticulous clinical analysis, wax up and mock up are crucial to ensure optimal rehabilitation.

Evaluating the spatial and temporal model performance of distributed hydrological models is necessary to ensure that the simulated spatial and temporal patterns are meaningful. In recent years, spatial and temporal remote sensing data have been increasingly used for model performance evaluation. Previous studies, however, have focused on either the temporal or spatial model performance evaluation. In addition, temporal (or spatial) model performance evaluation is often done in a spatially (or temporally) lumped approach. Here, we evaluated (1) the temporal model performance evaluation in a spatially distributed approach (spatiotemporal) and (2) the spatial model performance in a temporally distributed approach (temporospatial) model performance evaluation. This study demonstrated that both spatiotemporal and temporospatial model performance evaluations are necessary since they provide different aspects of the model performance. For example, spatiotemporal model performance evaluation helps in detecting the areas with an issue in the simulated temporal patterns. However, temporospatial model performance evaluation helps in detecting the time with an issue in the simulated spatial patterns. The results also show that an increase in the spatiotemporal model performance will not necessarily lead to an increase in the temporospatial model performance and vice versa, depending on the evaluation statistics. Overall, this study has highlighted the necessity of a joint spatiotemporal and temporospatial model performance evaluation to understand/improve spatial and temporal model behavior/performance.

BACKGROUND: This study aims to determine nicotine dependence levels in pre and during pandemic and its correlations with COVID-19 phobia among healthy men during controlled social life: a sample of primary care population. METHODS: This cross-sectional study was conducted with 472 healthy men in Çorum, Black Sea Region, Turkey between February 2019 and October 2020. An online questionnaire was used to collect data including demographic profile, smoking behavior, intention to quit, Fagerström Nicotine Dependence test (FTND) pre and during COVID-19 pandemic and COVID-19 phobia scale. RESULTS: In this study, a percentage change of +6.2, +0.8, +1.9, -2.7, -5.1 was found in very low, low, medium, high and very high dependence categories respectively between pre-pandemic and during controlled social life in pandemic. A percentage change of +2.8 was seen in terms of intention to quit smoking. The mean score for COVID-19 phobia was 65.9 ± 15.8 and almost two-thirds of the participants (62%) had medium and high COVID-19 phobia. Men with high/very high dependence had significantly more COVID-19 phobia than the other two groups. There was a significant correlation between FTND scores and COVID-19 phobia. CONCLUSIONS: There were considerable changes in dependence levels and COVID-19 phobia was more common in high/very high dependence group. Controlled social life should be considered a golden opportunity for predicting levels of nicotine dependence and will bring benefit for lower smoking prevalence. COVID-19, Nicotine dependence, Phobia, men, Primary health care.

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Within this study, four thermal ring-opening reactions, Reactions (1-4), were selected in order to investigate the phenomenon of torquoselectivity as well as predicting non-competitive or competitive reactions in QTAIM and stress tensor frameworks rather than using conventional methods. The theoretical analysis for these reactions exhibits differently for non-competitive and competitive reactions as well as for the conrotatory preferences either TSOC or TSIC directions by presenting degeneracy or non-degeneracy in their results. The concordant results of stress tensor and QTAIM scalar and vectors with experimental results provide a better understanding of all reactions mechanism. Examination the (rb), ε, H(rb), ℙσ, 3, BPL, and H indicate that Reaction 1 is a competitive and Reactions (2-4) are non-competitive reactions with TSOC, TSOC, and TSIC preference directions respectively.

In the case of a suspicious mole on the skin, the question always arises as to whether it is benign or malignant. Is it a harmless mole, a capillary malformation or a basal cell carcinoma, squamous cell carcinoma or even a melanoma? Often the nevus can be assessed just by a close examination of the lesion and a few questions about its origin. However, every dermatologist knows all too well the problem that very different lesions can look extremely similar to the naked eye and even on dermatoscopy. Therefore, the question arises: how should dermatology deal with and communicate in such cases? This article identifies ways forward in this difficult situation, which occurs tens of thousands of times a day around the globe.