After reviewing the current literature and our systematically evaluated experience gained in daily practice, we propose a simplified action algorithm in case of nevi and other melanocytic skin lesions. Our approach is less stressful for the patients and, according to our conclusions, more economical, efficient and, above all, much safer than the recommendations currently in effect.

In this paper, a theoretical analysis model and two simulation methods are applied to characterize the quasi-static and fatigue delamination of composite laminate with uneven thicknesses. The test data of partially reinforced double-cantilever beam (DCB) were used as benchmark to verify the analysis model and simulation, and cohesive zone models (CZMs) and virtual crack closure technique (VCCT) are used in simulation. It’s shown that the partially reinforced DCB has a unique double-peak load-displacement relationship, and produces instability development during the delamination. By comparing the results of simulation and experiment, it is found that the simulation based on the exponential CZM can simulate the delamination process of partially reinforced DCB under both quasi-static and fatigue loading; while VCCT method will generate a straight delamination front edge in the area of reinforcement, and lost the micro-damage of the previous loading step between load steps, and result in an incorrect delamination behavior.

Introduction Atrial fibrillation (AF) is frequent after any cardiac surgery, but evidence suggests it may have no significant impact on survival if sinus rhythm (SR) is effectively restored early after the onset of the arrhythmia. In contrast, management of preoperative AF is often overlooked during or after cardiac surgery despite several proposed protocols. This study sought to evaluate the impact of preoperative AF on mortality in patients undergoing isolated surgical aortic valve replacement (AVR). Methods We performed a retrospective, single-centre study involving 2,628 consecutive patients undergoing elective, primary isolated surgical AVR from 2008 to 2018. A total of 268/ 2,628 patients (10.1%) exhibited AF before surgery. The effect of preoperative AF on mortality was evaluated with univariate and multivariate analyses. Results Short-term mortality was 0.8% and was not different between preoperative AF and SR cohorts. Preoperative AF was highly predictive of long-term mortality (median follow-up of 4 years [Q1-Q3 2-7]; HR: 2.24, 95% CI: 1.79-2.79, P<0.001), and remained strongly and independently predictive after adjustment for other risk factors (HR: 1.54, 95% CI: 1.21-1.96, P<0.001) compared with preoperative SR. In propensity score-matched analysis, the adjusted mortality risk was higher in the AF cohort (OR: 1.47, 95% CI: 1.04-1.99, P=0.03) compared with the SR cohort. Conclusions Preoperative AF was independently predictive of long-term mortality in patients undergoing isolated surgical AVR. It remains to be seen whether concomitant surgery or other preoperative measures to correct AF may impact long-term survival.

Translocation of metabolites between different plant species provides important hints in understanding the fate of bioactive root exudates. In the present study, targeted and untargeted mass spectrometry-based metabolomics was applied to elucidate the transfer of bioactive compounds between rye and several crops and weed species. Our results demonstrated that benzoxinoids (BXs) synthesized by rye were taken up by roots of neighboring plant species and translocated into their shoots. Furthermore, we showed roots of the rye plant took up compounds originating from neighboring plants. Among the compounds taken up by rye roots, wogonin was detected in the rye shoot, which indicates the root-to-shoot translocation of this compound. Elucidating the transfer of bioactive compounds between plants is essential for understanding plant-plant interactions, developing natural pesticides and understanding their modes of action.

On the basis of the multiaxial fatigue limit equation by Liu and Yan, a fracture equation of mixed mode crack is proposed in this note. By means of the test data on the mixed crack fracture reported in literature, the fracture equation has been verified to be not only simple in computation but also high in accuracy.

1) Food web models explain and predict the trophic interactions in a food web, and they can infer missing interactions among the organisms. The allometric diet breadth model (ADBM) is a food web model based on the foraging theory. In the ADBM the foraging parameters are allometrically scaled to body sizes of predators and prey. In Petchey et al. (2008), the parameterisation of the ADBM had two limitations: (a) the model parameters were point estimates, and (b) food web connectance was not estimated. 2) The novelty of our current approach is: (a) we consider multiple predictions from the ADBM by parameterising it with approximate Bayesian computation, to estimate parameter distributions and not point estimates. (b) Connectance emerges from the parameterisation, by measuring model fit using the true skill statistic, which takes into account prediction of both the presences and absences of links. 3) We fit the ADBM using approximate Bayesian computation to 16 observed food webs from a wide variety of ecosystems. Connectance was consistently overestimated in the new parameterisation method. In some of the food webs, considerable variation in estimated parameter distributions occurred, and resulted in considerable variation (i.e. uncertainty) in predicted food web structure. 4) We conclude that the observed food web data is likely missing some trophic links that do actually occur, and that the ADBM likely predicts some links that do not exist. The latter could be addressed by accounting in the ADBM for additional traits other than body size. Further work could also address the significance of uncertainty in parameter estimates for predicted food web responses to environmental change.

K Upasana, Neha Rastogi, Dhwanee Thakkar, Anjali Yadav, Sunisha Arora, Satya Prakash YadavPediatric Hematology Oncology and Bone Marrow Transplant Unit, Cancer Institute, Medanta The Medicity Hospital, Gurgaon, Haryana, India.Correspondence : Dr Satya P Yadav, Pediatric Hematology Oncology & BMT Unit, Cancer Institute, Medanta -The Medicity, Gurgaon, Haryana, India 122001.Email:satya_1026@hotmail.com, Fax: +91 1244962222Total Pages - 7Abstract (word count) – N/ATable - 0Figure - 0Text (word count) – 480Running title – Mucormycosis post covid19Key words – Mucormycosis; Covid-19; India

Infections and pandemics will condition us in an increasingly predominant way regarding diagnostic, medical and surgical activities in all specialist areas; and this particularly in cardiovascular one. Nevertheless in the future the need to cohabit with pandemic events and to be able to continue an elective and not only emergency cardiac surgery program represents an imperative.

Multiple sclerosis (MS) is a progressive inflammatory disease of the central nervous system that normally leads to impairment and persistent disability at a rather early age. The observation that physical stress can lead to the onset of reversible neurological symptoms has in the past led to patients being discouraged from doing sports. We investigated the current status of research and conclude that this advice may be as incorrect for a majority of MS patients as recent recommendation which encourage individuals with MS to engage in all kinds of physical activity. 

Butyl acetate has shown wide attention in food, cosmetics, medicine and biofuel sectors. These short chain fatty acid esters can be produced by either chemical or biological synthetic process with corresponding alcohols and acids. Currently, biosynthesis of short chain fatty acid esters, such as butyl butyrate through microbial fermentation systems has been achieved; however, few studies regarding biosynthesis of butyl acetate were reported. In this study, three proof-of-principle strategies for the one-pot butyl acetate production from glucose by microbial fermentation was designed and evaluated. (1) 7.3 g/L of butyl acetate was synthesized by butanol producing Clostridium acetobutylicum NJ4 with the supplementation of exogenous acetic acid; (2) With the addition of butanol, 5.76 g/L of butyl acetate can be synthesized by acetate producing Actinobacillus succinogenes130z (ΔpflA) with the supplementation of exogenous butanol; (3) Microbial co-culture of C. acetobutylicum NJ4 and A. succinogenes130z (ΔpflA) can directly produce 2.2 g/L of butyl acetate from glucose, representing the first study in terms of butyl acetate production by using microbial co-culture system. Through the immobilization of A. succinogenes130z (ΔpflA), butyl acetate production was further improved to 2.86 g/L. These strategies may be extended to the biosynthesis of a wide range of esters, especially to some longer chain ones.

The coalescence of an impinging droplet colliding with a sessile droplet at an angle(θi) is investigated by numerical simulation. The range of θi is 0° - 60° and the surface wettability are set as hydrophilic or hydrophobic, and both of them can affect the droplet mergence behavior. By using a modified mixing function, the dimensionless total mixing time τm can be calculated. The results show that there is no clear effect of θi on τm on a hydrophobic surface, while τm increases as θi increases on the hydrophilic surface. With the Weber number(We) ranging from 5.65 to 22.7 and the Ohnesorge number(Oh) ranging from 0.136 to 0.214, we find τm hardly changes with We and Oh. By dividing the mergence and mixing process in a convection and a diffusion stage, we find that the diffusion is much larger than the convection time.

1. Stable isotopes represent a unique approach to provide insights into the ecology of organisms. δ13C and δ15N have specifically be used to obtain information on the trophic ecology and food web interactions. Trophic discrimination factors (TDF, Δ13C and Δ15N) describe the isotopic fractionation occurring from diet to consumer tissue and these factors are critical for obtaining precise estimates within any application of δ13C and δ15N values. It is widely acknowledged that metabolism influences TDF, being responsible for different TDF between tissues of variable metabolic activity (e.g. liver vs. muscle tissue) or species body size (small vs. large). However, the connection between the variation of metabolism occurring within a single species during its ontogeny and TDF has rarely been considered. 2. Here, we conducted a 9-month feeding experiment to report Δ13C and Δ15N of muscle and liver tissue for several weight classes of Eurasian perch (Perca fluviatilis), a widespread teleost often studied using stable isotopes, but without established TDF for feeding on a natural diet. In addition, we assessed the relationship between the standard metabolic rate (SMR) and TDF by measuring their oxygen consumption of the individuals. 3. Our results showed a significant negative relationship of SMR with Δ13C, and a significant positive relationship of SMR with Δ15N of muscle tissue, but not with TDF of liver tissue. SMR varies inversely with size, which translated into a significantly different TDF of muscle tissue between size classes. 4. In summary, our results emphasize the role of metabolism in shaping specific TDF (i.e. Δ13C and Δ15N of muscle tissue), and especially highlight the substantial differences between individuals of different ontogenetic stages within a species. Our findings thus have direct implications for the use of stable isotope data and the applications of stable isotopes in food web studies.

Recent field experiments showed that predators influence the prey population not only by direct consumption but also by stimulating various defensive strategies. The cost of these defensive strategies can include energetic investment in defensive structures, reduced energy income, lower mating success, and emigration which ultimately reduces the reproduction of prey. To explore the effect of these defensive strategies (anti-predator behaviors), a modified Leslie-Gower predator-prey model with the cost of fear has been considered. Gestation delay is also incorporated in the system for a more realistic formulation. Boundedness, equilibria and stability analysis of the temporal model are studied. By considering gestation delay as a bifurcation parameter, the existence of Hopf-bifurcation around the interior equilibrium point is discussed together with the direction, stability and period of bifurcating solutions arising through Hopf-bifurcation. The spatial extension of the proposed model incorporating density-dependent cross-diffusion is also investigated and the conditions for diffusion-driven instability are obtained. To illustrate the analytical findings, detailed numerical simulations are performed. Biologically realistic Turing patterns as hexagonal spots, spots and stripes mixture, and labyrinthine type patterns are identified. It is found that the fear level has a stabilizing impact on delay induced destabilization and both stabilizing and destabilizing effects on Turing instability.

Abstract Objectives: There are several different definitions of complete revascularization on coronary surgery across the literature. Despite the importance of this definition there is no agreement on which one has the most impact. The aim of this study was to evaluate which definition of complete surgical revascularization correlates with early and late outcomes. Methods: All consecutive patients submitted to isolated CABG from 2012 to 2016 with previous myocardial scintigraphy were evaluated. Exclusion criteria: emergent procedures and previous cardiac surgery procedures. Population of 162 patients, follow-up complete in 100% patients; median 5,5 IQR 4,4-6,9 years. Each and all of the 162 patients were classified as complying or not with the four different definitions: Numerical, Functional, Anatomical Conditional and Anatomical unconditional. Univariable and multivariable analyses were developed to detect if any definition was a predictor of perioperative and long-term outcomes. Results: Complete functional revascularization was a predictor of increased survival (HR 0.47 CI95: 0,226-0,969; p=0.041). No other definitions showed effect on follow-up mortality. Age and cardiac dysfunction increased long-term mortality. The definition of complete revascularization did not have an impact on MACCE or need for revascularization Conclusions: An uniformly accepted definition of complete coronary revascularization is lacking. This research raises awareness about the importance of viability guidance for CABG.

Soil erosion features and ideal tillage practices are not very clear at the crop seedling stage in Chinese Mollisols. Simulated rainfall experiments were conducted at the rainfall intensities of 50 and 100 mm h-1 to investigate the differences in soil erosion of a 5° hillslope during the maize seedling stage between conservation and conventional tillage measures, including cornstalk mulching (Cm), horizontal ridging (Hr), horizontal ridging + mulching (Hr+Cm), vertical ridging + mulching (Vr+Cm), flat-tillage (CK), and vertical ridging (Vr). The results demonstrated that crops could remit soil erosion at the seedling stage by reducing the kinetic energy and changing the distribution of raindrops. The conservation tillage measures significantly alleviated total runoff (11.7%–100%) and sediment yield (71.1%–100%), postponed runoff-yielding time (85 s–26.1 min), decreased runoff velocity (71.5%–96.7%), and reduced runoff and soil loss rate, compared to the conventional tillage measures. Practices with mulching showed better performance than Hr. Mulching reduced sediment concentration by decreasing runoff velocity and soil particle filtration in a manner similar to buffer strips. The contour ridge ruptured earlier at 100 mm h-1 than at 50 mm h-1 and changed the characteristics of the soil erosion by providing a larger sediment source to the surface flow. Runoff strength, rather than soil erodibility, was the key factor affecting soil erosion. Decreasing runoff velocity was more important than controlling runoff amount. The Hr + Cm treatment exhibited the lowest soil erosion and is, thus, recommended at the corn seedling stage.

Background: Acute appendicitis (AA) is a common cause for abdominal pain encountering unnecessary surgeries in emergency departments. The present meta-analysis aims to assess the accuracy of abdominal ultrasound in suspected acute appendicitis cases in terms of sensitivity, specificity, and post-test odds for positive and negative results. Materials and Methods: An extensive and systematic search was conducted in Medline (via PubMed), Cinahl (via Ebsco), Scopus, and Web of Sciences from 2010 till the end of March 2021. Two authors analyzed studies for inclusion, collected results, and conducted analyses separately. The histopathological study on tissue collected during appendectomy served as the gold standard for determining the final diagnosis. The accuracy was determined by evaluating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic odds ratio. Results: Out of 3193 references, a total of 18 studies were selected. Overall sensitivity of 77.2% (95 % CI – 75.4 – 78.9%) and specificity of 60% (95 % CI – 58% – 62%) were observed. The diagnostic odds ratio of 6.88(95 % CI 1.99 – 23.82) was obtained. Conclusion: Abdominal ultrasound shows significant accuracy of diagnosis in patients with suspected acute appendicitis.

Background: Cigarette smoking has recently been associated with several gastrointestinal symptoms, and smoking cessation has been recommended as a life style change strategy for irritable bowel syndrome (IBS). This study assessed the prevalence of IBS in cigarette smokers based on the Rome IV criteria, the severity of nicotine dependence, and the effect of smoking cessation in IBS(+) smokers. Method: This prospective study included 371 smokers who attended for smoking cessation treatment at family medicine clinics in a tertiary hospital between January and April 2019. Data on demographic characteristics, IBS status according to the Rome IV criteria, and Fagerstrom Test for Nicotine Dependence (FTND) scores were collected during face-to-face interviews. Results: The mean patient age was 40.7 ± 11.96 years, 29.4% were heavy smokers, and 18.1% had IBS. There was no relationship between the presence of IBS and the nicotine dependence level; however, there was a significant difference in age (P=0.03), duration of smoking (P=0.05), FTND score (P=0.02), and sex (P<0.001) between those with and without IBS. Logistic regression analyses identified female sex to be a predictor of IBS in smokers (adjusted odds ratio 1.78, 95% confidence interval 1.18–2.69; P=0.006). At the one-year follow-up, IBS(+) smokers who had quit smoking showed a decrease in gastrointestinal symptoms (P=0.035). Conclusions: There was no association between severity of nicotine dependence and IBS, although the FTND score was higher in IBS(+) smokers than in IBS(-) smokers. Smoking cessation ameliorated gastrointestinal symptoms but had no effect on IBS status. Key words: irritable bowel syndrome, nicotine dependence, Rome IV criteria, smoking

Background: Pediatric Emergency Care Applied Research Network (PECARN) is a useful Clinical Decision Support Tool (CDST) to identify traumatic brain injuries and reduce the use of head CT scans among pediatric patients. The present Meta-analysis aims to evaluate the diagnostic accuracy of the PECARN rule from 2009 to 2020 in children with a very low risk of blunt head trauma. Methods: A detailed search was conducted from the databases of Medline (via PubMed), Cinahl (via Ebsco), Scopus, Web of Sciences, from 2009 till the end of December 2020 using the keywords like decrease use of CT scan, blunt head trauma (BHT) combined with accuracy, Pediatric Emergency Care Applied Research Network (PECARN) OR Clinical Decision Support Tool (CDST). Studies showing the diagnostic accuracy of the PECARN rule in children younger than 18 years of age with minor BHT were included. Results: 13 studies were included in the present analysis. Pooled sensitivity of 0.08, (95% confidence interval of 0.074 - 0.087), pooled specificity of 0.20 ( 95% CI of 0.196 - 0.213) and diagnostic odds ratio of 0.004 (95% CI of 0.000-0.1666) was in <2 years of age. The overall sensitivity of 0.07, specificity of 0.66, and diagnostic odds ratio of 0.54 (95% CI of 0.10 -2.78) was seen in ≥2 years of age. Overall sensitivity of 0.13 (95% CI 0.12-0.14), specificity of 0.81 (95% CI 0.80-0.82) and diagnostic odds ratio of 0.79 (95% CI of 0.08 -7.71) was in 0-18 years of age. Conclusion: The present analysis indicates the PECARN decision tool as an accurate CDST in low-risk minor blunt head trauma cases in children below two years of age and can become a useful tool in reducing Head CT’s scan overuse in pediatric emergency departments.

Telomeres are protective, nucleoprotein structures at the end of chromosomes that have been associated with lifespan across taxa. However, the extent to which these associations can be attributed to absolute length versus the rate of telomere shortening prior to sampling remains unresolved. In a longitudinal study, we examined the relationship between lifespan, telomere length and the rate of telomere shortening in wild, purple-crowned fairy-wrens (Malurus coronatus coronatus). To this end, we measured telomere length using qPCR in the blood of 59 individuals sampled as nestling and 4-14 months thereafter, and in 150 individuals sampled on average three times across adulthood. We applied within-subject centering analyses to simultaneously test for associations between lifespan and average telomere length and telomere shortening. We reveal that the rate of telomere shortening in the first year of life predicted lifespan, with individuals with faster shortening rates living less long. We also report a trend for an effect of telomere length in the first year of life on lifespan, independent of telomere shortening. In contrast, in adulthood neither telomere shortening, nor telomere length predicted lifespan, despite a considerably larger data set. Our results suggest that telomere length measured very early in life (during development) and longitudinal assessments of telomere shortening during the first year of life constitute more useful biomarkers of total life expectancy than either telomere length measured after development, or telomere shortening later in adulthood.

Quantifying an individual’s state as fitness proxy has proven challenging, but accumulating evidence suggests that telomere length and attrition may indicate individual somatic state and success at self-maintenance, respectively. Sexual ornamentation is also thought to signal phenotypic quality, but links between telomeres and sexual ornamentation have been little explored. To address this issue, we examined whether telomere length and dynamics are predicted by the expression of a sexually selected ornament, the length of outermost tail feathers (streamers), using longitudinal data from a population of European barn swallows (Hirundo rustica). We further assessed associations of telomere length with age, sex, breeding status and survival. Telomere length showed high individual repeatability (R = 0.97) across years while shortening with age in both sexes. Telomere length and dynamics were not significantly associated with survival to the next year, remaining lifespan or reproduction status (comparing breeding and non-breeding yearlings). Tail streamer length was negatively associated with telomere length, independent of sex. Thus, telomere length may reflect the costs of carrying an elaborated sexual ornament, although ornament size did not significantly predict telomere shortening. In conclusion, telomere length in adult barn swallows is a highly consistent trait and shows a negative relationship with sexual ornamentation, suggesting a trade-off between sexual ornamentation and telomere length.

In this paper, we construct the Riemann-Liouville fractional integral and differential operator of bicomplex order and illustrate some examples to calculate the fractional integration and differentiation of bicomplex order of some elementary functions. Also, we discuss some properties of these operators by proving analogues of the Leibniz and chain rules for these operators.

The approximate analytical solution of the point source problem in 2D heterogeneous media is provided in this article. It is based on the analytical solution of 2D quasi-Laplace equation, which can be expressed as a combination of piecewise power series. Each power series is expanded at a singular point with a group of intrinsic non-integer power exponents, and then they are sewn together to obtain the solution for the whole region. To permit the power series to be used in the region containing point sources, the point source is approximately treated as a closed inner boundary, on which Neumann boundary condition is imposed. By this means, the approximate analytical solution of the point source problem, which is actually the Green's function for 2D Poisson equation, is obtained.

Chest pain immediately after atrial fibrillation ablation is seen essentially with every case, and we counsel the patients that it is expected. On the other hand, delayed chest pain is not always expected and usually points towards a procedure complication, as shown in this case.

Aim: The main objective of this study was to determine the prevalence of real DDIs between immunosuppressants and other drugs in transplant patients. Methods: We conducted a prospective, observational 1-year study at a tertiary hospital, including all transplanted patients. We evaluated data from monitoring blood concentrations of immunosuppressive drugs and adverse drug events (ADEs) caused by DDIs. The DDIs were classified as C, D, or X according to their Lexi-Interact rating (C = monitor therapy, D = consider therapy modification, X = avoid combination). The clinical importance of real DDIs was expressed in terms of patient outcomes. The data were analyzed using Statistical Package for Social Sciences (SPSS) package v. 25.0 (IBM Corp., Armonk, NY, USA). Results: A total of 309 transplant patients were included. Their mean age was 52.0 ± 14.7 years (18–79) and 69.9% were male. The prevalence of real DDIs was 21.7%. Immunosuppressive drugs administered with anti-fungal azoles and tacrolimus (TAC) with nifedipine have a great clinical impact. Real DDIs caused ADEs in 22 patients. The most common clinical outcome was nephrotoxicity (1.6%; n=5), followed by hypertension (1.3%; n=4). Suggestions for avoiding category D and X DDIs included: changing the immunosuppressant dosage, using paracetamol instead of non-steroidal anti-inflammatory drugs, and interrupting atorvastatin. The number of drugs prescribed and having been prescribed TAC was associated with an increased risk of real DDIs. Conclusion: There are many potential DDIs described in the literature but only a small percentage proved to be real DDIs, based on the patients´ outcomes.