Objectives To evaluate the benefits imparted by concurrent chemoradiotherapy (CCRT) and chemotherapy of any form to elderly head and neck cancer (HNC) patients in Ireland. Secondary outcomes included comparison of these benefits to the adult population and subgroup analysis by site. Design, setting, and participants A retrospective cohort study was conducted using 20 years of cancer registry data provided by the National Cancer Registry of Ireland. All HNC diagnosed from 1994-2014 were included. Cox multivariate regression analysis was applied to test for the benefits of CCRT and chemotherapy of any form in HNC. The primary outcome measures were cancer-specific and all-cause survival in months. Results Survival analysis showed an overall benefit to the use of CCRT in patients with advanced disease over 65 years, particularly when used for hypopharyngeal, oral cavity, oropharyngeal, and laryngeal malignancy, though the latter did not achieve statistical significance. Chemotherapy of any form conferred a survival benefit in elderly patients with hypopharyngeal, laryngeal, nasopharyngeal, and oropharyngeal cancer. Conclusion CCRT and chemotherapy of any form confer significant survival benefits to appropriately selected elderly HNC patients and should therefore not be withheld solely on the basis of age.

This paper deals with a homogeneous Dirichlet initial-boundary problem of parabolic equations with different space-time coefficients, $$u_t =\Delta u + t^{\sigma_1} u^{\alpha} + \langle x\rangle^{n} v^{p},\quad v_t =\Delta v + \langle x\rangle^{m} u^{q} + t^{\sigma_2} v^{\beta},$$ where the eight exponents are nonnegative constants and $\langle x\rangle$ is the Japanese brackets. We obtain the Fujita exponents of solutions, which are determined by the eight exponents and the dimension of the space domain. Moreover, simultaneous or non-simultaneous blow-up of the two components of blow-up solutions is discussed with or without conditions on the initial data.

Background. To analyze the clinical features of children with plastic bronchitis (PB) and identify the risk factors of multiple flexible fiberoptic bronchoscopy (FOB) therapy. Methods. Retrospective analysis was performed on 269 PB children from 2016 to 2019, 144 cases were in single FOB group, 125 cases were in the multiple FOB group. The clinical manifestations, laboratory datas, imaging findings and management were investigated. The different features were compared between the single FOB group and multiple FOB group. Results. A total of 269 PB children were collected with a mean age of 6.7 ± 2.8 years. 257 (95.5%) cases were diagnosed as Mycoplasma pneumonia (MP) infection. The mean duration of fever was 10.6 ± 3.7 days. All the patients presented with fever, and 62 (23.0%) suffered from hypoxemia, 144 (53.5%) had extrapulmonary complications. Higher levels of ESR, CRP, PCT, IL-6, LA, LDH, FER and D-dimer were observed. The proportion of pulmonary consolidation, segmental or lobar atelectasis, pleural effusion and pleural thickening were 97.4%, 46.5%, 47.9% and 63.2%, respectively. Furthermore, multivariate logistic regression analysis showed that N% >75.5%, LDH >598.5U/L, and D-dimmer>0.45mg/L were independent isk factors for multiple FOB therapy. Conclusions. MP is a significant pathogen of PB in children. Patients with PB are more likely to suffer from persistent fever, excessive inflammation and severe radiological findings. N% >75.5%, LDH >598.5U/L and D-dimmer > 0.45mg/L may be predictors of multiple FOB treatment.

This Supporting Information includes:in-depth information on the setup and implementationadditional figures, tables  and equations relevant to the articleinteractive code examples building on the shared data Corresponding author Email:  Roderick.Murray-Smith@glasgow.ac.uk

Pulmonary cryptococcosis presents as various radiological manifestations depending on the immunological status of the host. The most common chest radiographic findings include single or multiple nodules. Herein, we present a rare case of pulmonary cryptococcosis in a patient with rheumatoid arthritis presenting as multiple cystic lesions that enlarged after treatment.

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In this paper, a modified weak Galerkin finite element method on Shishkin mesh has been developed and analyzed for the singularly perturbed convection-diffusion-reaction problems. The proposed method is based on the idea of replacing the standard gradient (derivative) and convection derivative by modified weak gradient (derivative) and modified weak convection derivative, respectively, over piecewise polynomials of degree $k\geq1$. The present method is parameter-free and has less degree of freedom compared to the weak Galerkin finite element method. Stability and convergence rate of $\mathcal {O}((N^{-1}\ln N)^k)$ in the energy norm are proved. The method is uniformly convergent, i.e., the results hold uniformly regardless of the value of the perturbation parameter. Numerical experiments confirm these theoretical findings on Shishkin meshes. The numerical examples are also carried out on B-S meshes to confirm the theoretical results. Moreover, the proposed method has the optimal order error estimates of $\mathcal {O}(N^{-(k+1)})$ in a discrete $L^2-$ norm and converges at superconvergence order of $\mathcal {O}((N^{-1}\ln N)^{2k})$ in the discrete $L_\infty-$ norm.

Background The origin distribution of right-ventricular-outflow-tract (RVOT) ventricular arrhythmias (VAs) remains unclear. There is limited data on the ablation effectiveness of the reversed U-curve method compared with the antegrade method. Objectives To investigate the origin distribution of RVOT-type VAs and compare the ablation effectiveness of the two methods. Method Consecutive patients who had idiopathic RVOT-type VAs were prospectively enrolled. After activation mapping, patients were randomly assigned to supravalvular strategy using the reversed U-curve or subvalvular strategy using the antegrade method. The primary outcome was initial ablation (IA) success, defining as the successful ablation within the first three attempts. Results 61 patients were enrolled from November 2018 to June 2020. Activation mapping revealed 34/61 (55.7%) of the earliest ventricular activating (EVA) sites were above the pulmonary valves (PVs). The IA success rate was 25/33(75.8%) in the patients assigned to supravalvular strategy as compared with 16/28(57.1%) in those assigned to subvalvular strategy (P=0.172). Logistic regression revealed a substantial and qualitative interaction between the EVA sites and IA strategies (Pinteraction<0.001). For multiple-comparison, either strategy had a remarkably higher IA success rate in treating its ipsilateral EVA sites than contralateral ones (P<0.0083). Conclusion Of the idiopathic RVOT-type VA origins, half were located above the PV. The two strategies did not differ in the primary outcomes. However, they complement locating the EVA sites and facilitate ipsilateral ablation, which produces a significantly higher IA success rate. (Chinese Clinical Trial Registry number, ChiCTR2000029331)

Climate change is considered as one of the biggest threats to coral reefs in the next 100 years. The most significant impact of climate change would be the rise in global seawater temperature. A critical turning point which determines the fate of coral reefs depends on how corals and their associated algae respond to the rise in seawater temperature. Symbiotic plasticity may help corals to survive such environmental threats. The zooxanthella Symbiodinium is classified into nine clades (A – I), six of which are known to be coral symbionts. As reaction to thermal stress, symbionts are lost to the host by several mechanisms. Physiological models on the importance of nitrogen fixing bacteria, i.e., diazotrophs, for bleached corals indicate that diazotrophically derived nitrogen either allows corals to better withstand bleaching, or increases bleaching by generating unbalanced nutrient requirements that lead to phosphorous starvation of the Symbiodinium. Reactive oxygen species (ROS) triggered by symbiosis operation of the damaged photosynthetic machinery causes leaks in the host cell, where they overpower cellular antioxidant mechanisms and potentially damage the host tissue. Both symbiotic partners, however, have significant adaptations for managing ROS to mitigate against cell damage as illustrated herein. Such extensive compile of literature in this review suggest that physiological host plasticity and/or symbiotic components clearly plays a significant role in response to thermal stress that may also vary between different species of corals, as many corals may contain specific ecotypes or clades of zooxanthellae which may vary in their ability to withstand thermal stress.

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With regard to acquired melanosis of the conjunctiva, there is still neither a worldwide uniform nomenclature nor reliable data on how frequent this type of pigment disorder is. This is even more true for the estimation of the risk of progression into cancer as well as the clinical management of this entity. This short paper presents the current, partly contradictory scientific knowledge which is available.

Objective: Arterial stiffness refers to arterial wall rigidity, particularly in central vessels, and is an independent predictor of cardiovascular disease. 25-Hydroxy (OH) vitamin D has beneficial effects on blood pressure, vascular endothelial function, and arterial stiffness. Therefore, we aimed to elucidate the role of 25-OH vitamin D deficiency in arterial stiffness development and its relationship with arterial stiffness in healthy children. Methods: This study included 80 patients with low levels of 25-OH vitamin D and 40 healthy control. The study participants were then divided into three groups: group 1 consisted of patients with a deficient 25-OH D level of < 19.9 ng/mL, group 2 with an insufficient 25-OH D level between 20-29.9 ng/mL; group 3 were considered control group with a sufficient serum 25-OH vitamin D level of ≥30 ng/mL. Aortic strain, distensibility, stiffness index, and standard left ventricular measurements were calculated using M-mode echocardiographic data. Results: Left ventricular mass index (LVMI) and interventricular septal diastolic thickness (IVSTd) appeared to increase in group 1 compared to groups 2 and 3. Aortic strain and distensibility were significantly decreased in group 1, whereas aortic stiffness index and elastic modulus were significantly increased. The aortic stiffness index was negatively correlated with serum 25-OH vitamin D levels; however, aortic strain, aortic distensibility, and LVMI were positively correlated. Conclusions: Our study results revealed a significant relationship between 25-OH vitamin D levels indicative of a deficiency and aortic stiffness. We suggest that arterial stiffness may also occur in healthy children with a 25-OH vitamin D deficiency.

Objectives Possibility of reinfection with SARS-CoV-2 changes our view on herd immunity and vaccination, and can impact worldwide quarantine policies. We performed RT-PCR follow-up studies on recovered patients to assess possible development of reinfections and re-positivity. Method During a 6-month period, 202 PCR-confirmed recovering COVID-19 patients entered this study. Follow-up RT-PCR tests and symptoms assessment were performed one month after the initial Positive results. patients who tested negative were tested again one and three months later. The Serum IgG and IgM levels were measured in the last follow-up session. Results In the first two follow-up sessions, 82 patients continued their participation, of which four patients tasted positive. In the second follow-up 44 patients participated, three of whom tested positive. None of the patients who tested positive in the first and second follow-up session were symptomatic. In the last session, 32 patients were tested and four patients were positive, three of them were mildly symptomatic and all of them were positive for IgG. Conclusion A positive RT-PCR in a recovering patient may represent reinfection. While we did not have the resources to prove reinfection by genetic sequencing of the infective viruses, we believe presence of mild symptoms in the three patients who tested positive over 100 days after becoming asymptomatic, can be diagnosed as reinfection. The IgG may have abated the symptoms of the reinfection, without providing complete protection.

Since the start of the SARS-CoV-2 pandemic, it has been difficult to differentiate between SARS-CoV-2 re-infection and prolonged RNA shedding. In this report, we identified patients with positive rtPCR results for SARS-CoV-2 ≥70 days apart. Clinical and laboratory data were collected and criteria were applied to discern whether the presentation was consistent with SARS-CoV-2 re-infection or prolonged viral RNA shedding. Eleven individuals met the initial testing criteria, of which, seven met at least one criteria for re-infection and four were consistent with prolonged RNA shedding. These data demonstrate the need for criteria to differentiate SARS-CoV-2 re-infection from prolonged RNA shedding.

Objective To assess the effects body mass index (BMI) on live birth rates in patients undergoing in vitro fertilization (IVF) with trophectoderm biopsy and preimplantation genetic testing for aneuploidies (PGT-A) when transferring a single euploid blastocyst. Design Retrospective cohort study. Setting Public fertility center in China. Population 821 women who underwent first cycle of frozen-thawed single euploid blastocyst transfer between 2012 and 2020. Methods Patients were grouped by World Health Organization (WHO) BMI class: underweight (<18.5, n=80), normal weight (18.5-24.9, n=602), overweight (25-30, n=112), and obese (≥30, n=27). A logistic regression model was used to assess the association between BMI and live birth while adjusting for potential confounders. Main outcome measures Live-birth rate was primary outcome. Results There was no difference in the birth weight, miscarriage, preterm birth, pregnancy complication, type of delivery and fetal gender by BMI category. The clinical pregnancy rate was higher in the overweight and obese groups. In multivariate logistic regression analysis, we fail to demonstrate a statistically significant relationship between BMI and live birth in underweight (adjusted odds ratio [AOR] 0.80; 95% confidence interval [CI], 0.47-1.35, p=0.402), overweight (AOR 0.85; 95% CI, 0.54-1.35, p=0.491) or obese (AOR 1.07; 95% CI, 0.48-2.38, p=0.864) patients compared with the normal weight reference group. Conclusion No statistically significant relationship was identified between BMI and live birth in patients undergoing IVF with PGT-A, suggesting that the negative impact of obesity on IVF and clinical outcomes may be related to aneuploidy.

Although the regulation in Pi homeostasis of miR399 have been studied in various plants, its molecular mechanisms in response to freezing stress are still elusive. In this work, we found that the expression of tae-miR399 and its target gene TaUBC24 in tillering nodes of strong cold resistance winter wheat cultivar Dongnongdongmai1 (Dn1) was significantly altered subjected to severe winter. tae-miR399 and its target gene TaUBC24 were also responsive to short-term freezing stress in tillering nodes of Dn1 seedlings. TaUBC24 physically interacted with TaICE1. Ehanced freezing tolerance was observed in overexpressing tae-miR399 Arabidopsis lines. Under freezing stress, overexpressing tae-miR399 decreased the expression of AtUBC24 to increase the expression of genes in CBF signaling pathway, Pi translocation pathway and starch metablism, including AtCBFs, AtCOR47, AtCOR413IM, AtPHT1;4, AtAPLs and AtBAMs, inhibit the degradation of AtICE1 and AtPHO1, and promote the activities of SOD, POD and CAT. These findings indicated that the increased freezing tolerance was dependent upon elevating CBF signaling pathway, phosphorus utilization efficiency, starch degradation, accumulation of soluble sugar and ability of ROS scavenge. These results will aid our understanding of molecular mechanism of how miR399-UBC24 module plays a cardinal role in regulating plant freezing stress tolerance through mediating the downstream pathways.

Illicit drugs are marketed both via dark web platforms and social media, but there are also research reports buying these drugs online. This study is intended to analyse the risk factors for the purchase of online illicit drugs. We assumed that social interactions, low levels of self-control, and impaired mental health would be correlated with online opioid sales following criminological and addiction analysis research. Moreover, online drug sales are expected to be related to low self-control and daily drug consumption. Participants in this nationwide study were aged 15 to 25 years and lived in Germany (N=1,732) and France (N=1,732). Measures of impulsivity, ability sensitivity, social association, psychological tension, and repetitive activity (drinking, gambling, and Internet use) predicted online drug use. 4% of German and French respondents reported buying drugs online of which, 63% did so via social media services. Online opioid purchases were associated with lower self-control, elevated social anxiety, heavy gambling, and Internet use, as shown by multinomial logistic regression and binary intervention regression models. It was not a risk factor to have online friends, but close social links with offline friends served as a security factor. The results indicate that more attention should be paid to mainstream social media services as a source for buying drugs as there are many psychological and self-control issues among online drug consumers.

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Management of acute bronchiolitis remains controversial due to lack of strong evidence-based data. Nebulized epinephrine and hypertonic saline have been studied in infants with bronchiolitis, with conflicting results. This systematic review and meta-analysis aimed to evaluate the efficacy on length of stay (LOS), clinical severity scores (CSS), oxygen saturation (SaO2) and safety profile of nebulized epinephrine plus hypertonic saline (HS) in infants with acute bronchiolitis. Outcomes were represented by mean differences (MD) or standard mean differences (SMD) and 95% confidence intervals (CIs) were utilized. 18 trials were systematically selected and 16 of them contributed for the meta-analysis (1,756 patients). Overall, a modest but significant positive impact was observed of the combination therapy on LOS (MD of – 0.35 days, 95% CI -0.62 to -0.08, p = 0.01, I2 = 91%). Stratification by time of CSS assessment unveiled positive results in favor of the combination therapy in CSS assessed 48 hours and 72 hours after the admission (SMD of -0.35, 95% CI -0.62 to -0.09, p = 0.008, I2 = 41% and SMD of -0.27, 95% CI -0.50 to -0.04, p = 0.02, I2 = 0%, respectively). No difference in SaO2 was observed. Additional data showed a consistent safety profile, with a low rate of adverse events (1%), most of them mild and transient. In conclusion, nebulized epinephrine plus HS may be considered as a safe, cheap and efficient alternative for decreasing LOS and CSS in infants with acute bronchiolitis, especially on those who require more than 48 hours of hospitalization.

A 62-year-old man with rare blood type exhibited severe respiratory failure due to novel coronavirus. Extracorporeal membrane oxygenation was inapplicable, which requires numerous blood products with the same blood type. We thoroughly restricted fluid volumes by sacrificing renal function. He was discharged with complete recovery of respiratory and renal functions.

How variations in carbon supply affect wood formation remains poorly understood in particular in mature forest trees. To elucidate how carbon supply affects carbon allocation and wood formation, we attempted to manipulate carbon supply to the cambial region by phloem girdling and compression during the mid- and late-growing season and measured effects on structural development, CO2 efflux, and nonstructural carbon reserves in stems of mature white pines. Wood formation and stem CO2 efflux varied with location relative to treatment (i.e., above or below the restriction). We observed up to twice as many tracheids formed above versus below the treatment after the phloem transport manipulation, whereas cell-wall area decreased only slightly below the treatments, and cell size did not change relative to the control. Nonstructural carbon reserves in the xylem, needles, and roots were largely unaffected by the treatments. Our results suggest that low and high carbon supply affects wood formation, primarily through a strong effect on cell proliferation, and respiration, but local nonstructural carbon concentrations appear to be maintained homeostatically. This contrasts with reports of a decoupling of source activity and wood formation at the whole-tree or ecosystem level, highlighting the need to better understand organ-specific responses, within-tree feedbacks, as well as phenological and ontological effects on sink-source dynamics.

Aim: With the widespread use of SGLT2i, various adverse events (AEs) have been reported. This study aimed to describe the distribution of SGLT2i-related AEs in different systems, quantify the association of important medical events (IMEs) and SGLT2i regimens, and build a signal profile of SGLT2i- induced IMEs. Methods: Data from 2015 Q1 to 2020 Q4 in the FDA Adverse Event Reporting System database (FAERS) were selected to conduct disproportionality analysis. Two signal indicators, the reported odds ratio (ROR) and information component (IC), were used to evaluate the correlation between SGLT2i and IMEs. The lower end of the 95% confidence interval of IC (IC025) exceeding zero was deemed a signal. For ROR, it was defined a signal if ROR025 over one, with at least 3 cases. Results: A total of 45,771,436 records were involved, including 111,564 records related to SGLT2i, with 38,366 records of SGLT2i-induced IMEs. Overall, SGLT2i was significantly associated with IMEs (IC=0.36, 95% CI: 0.35-0.38; ROR=1.44, 95% CI: 1.42-1.46). Most SGLT2i-related adverse events occurred in monotherapy (92.93%). Diabetic ketoacidosis was the most IMEs. Specifically, acute osteomyelitis has the strongest signal of all SGLT2i (IC025=7.83), and it was unique to canagliflozin. Diabetic ketoacidosis, acute kidney injury, ketoacidosis, Fournier’s gangrene, and euglycemic diabetic ketoacidosis were common to the four FDA-approved SGLT2i. Conclusion: Our study demonstrated that different SGLT2i regimens lead to different important adverse events, but there are overlapping events. Early identification and management of SGLT2i-associated IMEs are essential for clinical practice.

Background: Titration of inspired oxygen is a challenge in preterm infants with hypoxemic respiratory failure (HRF). Monitoring of brain oxygen by near infrared spectroscopy (NIRS) has been proven to minimize the burden of hyperoxia and hypoxemia, with better understanding of cerebral autoregulation (CAR). integrating NIRS and pulse oximetry (SpO2) for titrating inspired oxygen is a novel approach. Methods: We aimed to study the impact of integrated monitoring of oxygen saturation by SpO2 and cerebral regional tissue oxygen (crRTO) by NIRS during oxygen reduction test (ORT) on reducing oxygen requirement in preterm infants with HRF. The correlation between SpO2 with crRTO, and fractional oxygen extraction (FOE) was assessed, concordance levels (r>0.5) were determined during the assessment period, and was considered as a sign of impaired autoregulation. The primary outcome was the achievement of significantly lower FiO2 at 72 hours after start of the integrated monitoring. Results: Total of 38 preterm infants were included, 27 had normal cerebral autoregulation (CAR), (group 1) in whom SpO2 was poorly correlating with cerebral regional tissue oxygen (crRTO) with (r<0.5) and had significantly greater percentage of reduction below baseline in FiO2 (Mean:34%). Eleven infants had impaired CAR (group 2) with SpO2 significantly correlating with crRTO (r>0.5) and had a linear trend of FOE inverse to SpO2 and crRTO; this was considered as an arterial saturation dependent oxygen delivery (SadDO2). Conclusion: Integrated monitoring of preterm infants by SpO2 and crRTO was associated with easier weaning of oxygen with less burden of both hyperoxia and hypoxemia.

This work discusses the results from tests conducted to investigate the uniaxial compression and creep behavior of red sandstone. The original untreated sample and the 800 ℃ treated sample have been selected to carry out the experiments. It has been found that high temperature has obvious influence on the mechanical properties of red sandstone. The relationship between creep strain and instantaneous strain, as well as instantaneous deformation modulus and creep viscosity coefficient have been analyzed. It has been found that high temperature reduces the ability of red sandstone to resist instantaneous deformation and creep deformation. Acoustic emission (AE) technology has been also used in the loading process of uniaxial compression and creep tests, providing a powerful means for damage evolution analysis of red sandstone.