In this paper, we prove two identities involving quantum derivatives, quantum integrals, and certain parameters. Using the newly proved identities, we prove new inequalities of Simpson's and Newton's type for quantum differentiable convex functions under certain assumptions. Moreover, we discuss the special cases of our main results and obtain some new and existing Simpson's type inequalities, Newton's type inequalities, midpoint type inequalities and trapezoidal type inequalities.

Objective: To test the hypothesis that compared to single layer continuous uterine suture (SLCUS), a double layered purse string uterine suture (PSUS) significantly reduces cesarean scar defect (CSD) rates, without increasing the perioperative maternal morbidity. Design : Interventional prospective, randomized study . Setting: University obstetric units in Tunisia. Population: 100 pregnant women with an indication of a planned Caesarean. Methods: Patients were enrolled in 2 groups according to the uterine suture technique: SLCUS or PSUS. A Saline infusion hysterosonography was performed by the same senior obstetrician blinded to the uterine suture technique 6 months after surgery . Main Outcome measures: Operative time and Calculated blood loss (CBL) were used for the short time analysis . Uterine and CSD measurements were used for the mid time analysis . Results : Despite a few minutes longer operative time in SUS group (7.17 ± 2.31 min Vs. 6.31 ± 3.04 min, p = 0.028 in SLCUS group; p <10‾³); there was no significant difference in terms of CBL (520 ± 58 in SUS group vs. 536 ± 50 ml in SLCUS group, p = 0.724). The medium-term analysis showed a significant decrease in the rate of CSD with the PSUS: 6.66% vs.40% with SLUCS; p = 0.002. Moreover, SLUCS was the leading risk factor for CSD : adjusted OR=6 ;95% CI [0- 1],p < 10‾³) . Conclusion : Compared to single layer continuous suture, purse string uterine suture significantly reduces cesarean scar defect rates, without increasing the perioperative maternal morbidity. NCT03930134. https://clinicaltrials.gov/ct2/show/NCT03930134

Background: The current emergency medicine literature on cardioversion for atrial fibrillation (AF), describes its performance on those who are hemodynamically unstable, present within 48 hours of the onset of the arrhythmia, or are on long term anticoagulants. This article describes a clinical pathway comparing patients presenting to the emergency department (ED) with atrial fibrillation (AF) of more than 48 hours who underwent a transesophageal echocardiogram (TEE) and subsequent cardioversion in the ED. The objective of this study is to evaluate such a pathway looking at the time to cardioversion, length of hospital stay, rate of successful cardioversion, and the rate of complications compared to the traditional pathway of admitting patients directly to the cardiology department for evaluation and treatment. Methods: This was a retrospective observational study of patients who presented to the ED with AF for more than 48 hours, underwent a transesophageal echocardiogram, and then were electrically cardioverted either in the emergency department versus the cardiology ward. Results: Electrical cardioversion was performed in the ED on 92 patients (61%) and the cardiology department on 59 (39%). Over 90% of cardioversions were successful in both groups. Time to cardioversion was significantly less in the ED group versus the cardiology group (1.03 ± 0.8 days versus 4.17 ± 1.9; p<0.001). Similarly, the mean length of hospital stay was less for the ED group (1.5± 1.5 days versus 7.2 ± 3.5; p<0.001). Conclusion: Patients who present in atrial fibrillation for more than 48 hours and then have a TEE, undergo electrical cardioversion faster in the ED compared to the cardiology ward. This clinical pathway also results in a shorter length of hospital stay without having more side effects.

Worldwide, wild birds are frequently suspected to be involved in the occurrence of outbreaks in captive-bred birds although proofs are lacking and most of the dedicated studies are insufficiently conclusive to confirm or characterize the roles of wild birds in such outbreaks. The aim of this study was to assess and compare, for the most prevalent peridomestic wild birds, the different exposure routes for Avian Influenza and Newcastle disease viruses in conservation breeding sites of Houbara bustards in the United Arab Emirates. To do so, we considered all of the potential pathways by which captive bustards could be exposed to Avian Influenza and Newcastle disease viruses by wild birds, and ran a comparative study of the likelihood of exposure via each of the pathways considered. We merged data from an ecological study dedicated to local wild bird communities with an analysis of the contacts between wild birds and captive bustards and with a prevalence survey of AIV and NDV in wild bird populations. We also extracted data from an extensive review of the scientific literature and by the elicitation of expert opinion. Overall, this analysis highlighted that captive bustards had a high risk of being exposed to pathogens by wild birds. This risk was higher for Newcastle disease virus than Avian influenza virus, and House sparrows represented the riskiest species for the transmission of both viruses through indirect exposure from consumption of water contaminated from the faeces of an infectious bird that got inside the aviary. Thus, this analysis reveals that wild peridomestic birds may play a role in the transmission of avian pathogens to captive bred birds. These results also reaffirm the need to implement sanitary measures to limit contacts between wild and captive birds and highlight priority targets for a thoughtful and efficient sanitary management strategy.

A document by Jeroen Buters. Click on the document to view its contents.

Background and aim of the study: Elderly patients are more likely to have adverse complications after coronary artery bypass grafting (CABG). There are few studies on the risk factors for acute kidney injury (AKI) after surgery in elderly patients, especially in the Asian population. This study retrospectively analysed the risk factors for AKI in Chinese elderly patients after CABG and established a risk prediction model to detect these risk factors early and take active intervention measures. Methods: A total of 432 patients were included in this study from 2018 to 2019. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. The patients were divided into an AKI group and a non-AKI group. Multivariate logistic regression analysis was used to screen out the factors with p < 0.05. Results: Out of 432 patients in the study, 119 (27.5%) developed AKI. The estimated glomerular filtration rate (eGFR), ≥3 coronary anastomoses, preoperative intra-aortic balloon pump (IABP) implantation and prolonged ventilation time were independent risk factors for AKI. The area under the ROC curve was 0.702 (95% confidence interval (CI) [0.643-0.761], p < 0.001). Conclusions: The eGFR, ≥3 coronary anastomoses, preoperative IABP implantation and prolonged ventilation time are independent risk factors for AKI in elderly patients undergoing coronary artery bypass grafting. Early discovery of these risk factors and the implementation of appropriate intervention measures are useful to reduce the occurrence of AKI after CABG and improve the prognosis of patients.

Despite biological invasions are one of the main environmental problems of the twenty-first century, there is still no theoretical or empirical agreement on whether a high phylogenetic relatedness between exotic and native species positively or negatively affect invasion success. To resolve this conundrum, it has been proposed that the effect might be scale-dependent, being negative at smaller spatial scales and positive at larger scales. Here we show that this scale-dependent pattern may be a sampling artefact associated with species-area effects and a non-random pattern of species introductions. We support this conclusion with simulations and empirical data on invaded and non-invaded avian communities in regions from five continents. We further show that at smaller-scales ---where these artifacts are negligible--- invasion success generally increases with the presence of closely-related species, but that predictive accuracy largely depends on considering the influence of human-related disturbances in facilitating invasions.

ABSTRACT Objective: In this study we aimed to determine the coexistence of overactive bladder in patients with gastroenterological disorders including hepatitis, cirrhosis and IBD. Materials and Methods: we prospectively collected the data of patients who admitted to the outpatient clinic of department of gastroenterology at xxx hospital between May 2017 and February 2019. All patients with chronic gastroenterological disorders such as hepatitis and irritable bowel syndrome willing to participate the study after the verbal consent were included the study Results: A total of 289 female patients were included the study. The mean age of the patients was 49.9 ±13 years. The mean BMI value was 27.9± 4.5 kg/m2. Among 289 patients, 135 (46.7%) had Hepatitis B, 53 (18.3%) had ulcerative colitis, 35 (12.1%) had Crohn’s disease, 22 (7.6%) had autoimmune hepatitis, 19 (6.6%) had primer biliary cirrhosis, 13 (4.5%) had Hepatitis C and 12(4.2%) had celiac disease. The mean age of patients was similar between patients having OAB-v8 higher and lower than 8 (p=0.46). However, patients having OAB score>8 had higher BMI compared to patients who had OAB score <8, 29.1 ±5 vs. 27.2 ±4.1 kg/m2, p=0.001. In multivariate regression analysis, BMI was the sole indicator of OAB (p=0.001) whereas age (p=0.46), menopause status (p=0.33), smoking status (p=0.97) were not. Conclusion: The incidence of OAB in our patient cohort was higher than the reported incidence which might suggest evaluation patients with gastrointestinal disorders in terms of overactive bladder on routine follow-up.

BACKGROUND: Exercise-induced respiratory symptoms are frequently reported by asthmatics and exercise-induced bronchospasm (EIB) is a frequent cause that requires objective testing for diagnosis. Eucapnic voluntary hyperventilation (EVH) is recommended as an exercise surrogate stimulus for this purpose, but its short-term reproducibility is not yet established in young asthmatics. OBJECTIVE: To evaluate the short-term test-retest agreement and reproducibility of FEV1 changes after EVH in young asthmatics. METHODS: Asthmatics aged between 10 and 20 years underwent EVH for EIB diagnosis on two occasions 2-4 days apart at a specialized university clinic. FEV1 was measured 5, 15 and 30 minutes after EVH with a target ventilation rate 21 times baseline FEV1. EIB was diagnosed as a decrease >10% in FEV1 from baseline. RESULTS: Twenty-six of 62 recruited individuals tested positive for EIB on both visits (positive group) and 17 on one visit only (divergent group); and 19 tested negative on both visits (negative group). The overall agreement was 72.5% (95%CI 61.6%, 83.6%) and positive and negative agreement was 41.9% and 30.6% respectively. Despite overall low bias in FEV1 response between test days (0.87%), the limits of agreement were wide (+20.72%). There were no differences in pre-challenge FEV1 or achieved ventilation rate, between visits either between groups (p=0.097 and p=0.461) or within groups, (p=0.828 and p=0.780). No test was interrupted by symptoms and there were no safety issues. CONCLUSIONS: More than one EVH test should be performed in young asthmatics with a negative test to exclude EIB and minimize misdiagnosis and mistreatment.

The occupancy and relative abundance of species are temporally varying. Estimating these, given incomplete and biased sampling is challenging, not least for fossilized organisms, where preservation is an additional issue. Here, we describe a relative abundance-focused multi-species occupancy model (TRAMPOline) in a hierarchical Bayesian framework. We designed our model on the basis of the need to understand the dynamics of several focal species over 2.3 million years, by drawing on additional information provided by non-focal species observed in the same fossilized community. We expanded our model by adding random effects of species and time intervals (geological formations) and explored potential explanatory factors (paleoenvironmental proxies) and temporal autocorrelation that could provide extra information on unsampled geological time intervals. Our new model, set in an occupancy modeling framework widely used in ecology but little applied in paleoecology, is applicable across a wide range of questions on species-level dynamics in contemporary and palaeoecological community settings.

Hemicrania continua (HC)-tic syndrome is a rare disorder characterized by the overlap of HC and trigeminal neuralgia (TN) or TN-like paroxysms. We describe a case of secondary HC-tic syndrome related to fungal sphenoiditis. Less common causes including sphenoiditis should be considered when headache presents with a refractory and complicated form.

Abstract Objective: Pregnant women may develop disseminated intravascular coagulation (DIC), possibly resulting in massive maternal haemorrhage and perinatal death. The Japan guideline recommends use of antithrombin Ⅲ (ATⅢ) for DIC in obstetrics; however, its effect remains uncertain. The present study therefore aimed to investigate the effect of ATⅢ for DIC patients in obstetrics, using a national inpatient database in Japan. Design: Nationwide observational study Setting: Japan Population: We used the Diagnosis Procedure Combination inpatient database to identify patients who delivered at hospital and were diagnosed with DIC from July 2010 to March 2018. Methods: Propensity score matching analyses were performed to compare in-hospital maternal mortality and hysterectomy during hospitalization between users and non-users of ATⅢ on the day of delivery. Main Outcome Measures: In-hospital mortality, hysterectomy Results: A total of 9,920 patients were enrolled, including 4,329 patients (44%) who used ATⅢ and 5,511 patients (56%) who did not use ATⅢ. One-to-one propensity score matching created 3290 pairs. In-hospital maternal mortality did not differ significantly between the propensity-matched groups (0.3% in the ATⅢ group vs. 0.5% in the control group; odds ratio, 0.73; 95% confidence interval, 0.35–1.54). Patients in the ATⅢ group, compared with those in the control group, had a significantly lower proportion of receiving hysterectomy during hospitalization (5.3% vs. 8.7%; difference, -2.9%; 95% confidence interval, -4.2 to -1.6%). Conclusions: The present study did not show mortality-reducing effect of ATIII for patients with DIC in obstetrics. ATⅢ may have clinical benefit in terms of reduction in receiving hysterectomy.

A document by Hüseyin Aygün . Click on the document to view its contents.

Purpose: Successful resuscitation and early defibrillation are critical in survival after in- or out-of-hospital cardiopulmonary arrest. This study aimed to determine the knowledge, skills, and attitudes of the pediatric healthcare professionals about the defibrillator use and to offer solutions if there was room for improvement. Procedures: This was a multicenter survey study. Findings: The study included 716 healthcare professionals with an average age of 30.1 ± 5.8 years; 50% (n=358) were pediatric residents and 41.3% (n=296) had less than three years of professional experience. Self-declared level of knowledge about defibrillation/cardioversion was low-to-medium for 66.5% (n=476); 60.8% (n=435) had never practiced these procedures and 22.2% (n=159) had never received any training about defibrillator use. There was a significant relationship between professional experience and the proportion of participants who correctly responded to the first-shock dose for defibrillation but not for cardioversion. Conclusion: Professional experience is crucial in the correct defibrillator use. However, the defibrillation/cardioversion procedures are prone to errors since they are not commonly applied in day to day practice. An ideal approach to improve the experience of personnel could be to use practical training with case-based simulations and to educate the personnel about the features of the defibrillators available in their clinics.

Objectives: To accurately assess the vertical transmission rate of Methicillin-resistant Staphylococcus aureus (MRSA) and its clinical impacts on pregnant mothers and neonates. Design: A prospective observational cohort study. Setting: Japan. Population: 898 pregnant women and their 905 neonates delivered in gestation week > 32+0 at Toyooka Hospital from August 2016 to December 2017. Methods: MRSA was cultured from the nasal and vaginal samples taken from mothers at enrollment and the nasal and umbilical samples taken from neonates immediately after their birth. We examined the vertical transmission rate of MRSA in mother-neonate pairs. We used multivariable logistic regression to identify maternal/neonatal adverse outcomes associated with maternal MRSA colonization. Main outcome measures: The frequency of maternal/neonatal MRSA colonization and adverse outcomes. Results: The prevalence of maternal MRSA colonization was 6.1% (55/898), and that of neonates was 0.8% (8/905). The prevalence of neonatal MRSA was 12.7% (7/55 mother-neonate pairs) in the MRSA-positive mothers, whereas it was only 0.12% (1/843 pairs) in the MRSA-negative mothers (OR: 121, 95% CI: 14.6-1000). When the maternal vaginal-MRSA was positive, the vertical transmission rate was 44.4% (4/9). Skin and soft tissue infections (SSTIs) developed significantly more frequently in neonates born to the MRSA-positive mothers (OR: 7.47, 95% CI: 2.50-22.3). Conclusions: The prevalence of MRSA in pregnant women was approximately 6%. The vertical transmission rate of vaginal MRSA was as high as 44.4%. Maternal MRSA colonization is associated with increased development of neonatal SSTIs via vertical transmission.

Appendiceal cancers may be difficult to diagnose even after comprehensive investigation. This report of locally advanced perforated appendiceal adenocarcinoma attached to the terminal ileum, cecum, and rectosigmoid illustrates the management challenges that require comprehensive knowledge of pathologic variations and range from simple appendectomy to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

The anal sphincters may be divided by direct anal trauma or by severe pelvic injuries. The preoperative clinical assessment may correlate well with intra-operative assessment. As long as about half the sphincter ring remains active there is a good chance of restoring satisfactory faecal continence following a sphincteroplasty.

Anal fistula and pilonidal disease may coexist in the same patient and may even be connected as in this case with an anal carcinoma- in situ (Bowen’s disease) in an immunodepressed patient. It is difficult to tell if the malignancy arose from the chronic pilonidal disease or vice-versa.

In many farming landscapes, aquatic features such as wetlands, creeks and dams provide water needed for stock and irrigation, while also acting as habitat for a range of plants and animals. Indeed, some species threatened by land use change may otherwise be considerably rarer – or even extinct – in the absence of these habitats. Therefore, a critical issue for the maintenance of biodiversity in agricultural landscapes is the extent to which the management of aquatic systems can help promote the integration of agricultural production and biodiversity conservation. We completed a snapshot cross-sectional study in southern New South Wales (south-eastern Australia) to quantify the efficacy of simple management practices – partial revegetation and stock reduction via fencing – for improving vegetation structure, water quality, and macroinvertebrate assemblages. We found that even short-term livestock exclusion resulted in increased vegetation cover. Relative to dams that were unfenced, those that had been partially or completely fenced for many years were characterized by reduced turbidity and nutrient levels and contained fewer thermotolerant (faecal) coliforms. They also supported increased richness and abundance of macroinvertebrates. In contrast, control (unfenced) dams tended to have high abundance of a few macroinvertebrate taxa. Notably, differences remained between the macroinvertebrate assemblages of fenced dams and nearby ‘natural’ waterbodies. Our results show how management interventions can improve water quality in farm dams and provide a valuable reference and baseline for longer term studies of farm dam improvement.

Cheating in microbial communities is often regarded as a precursor to a “tragedy of the commons”, ultimately leading to over-exploitation by a few species, and destabilisation of the community. However, this view does not explain the ubiquity of cheaters in nature. Indeed, existing evidence suggests that cheaters are not only evolutionarily and ecologically inevitable, but also play important roles in communities, like promoting cooperative behaviour. We developed a chemostat model with two microbial species and a single, complex nutrient substrate. One of the organisms, an enzyme producer, degrades the substrate, releasing an essential and limiting resource that it can use both to grow and produce more enzymes, but at a cost. The second organism, a cheater, does not produce the enzyme but benefits from the diffused resource produced by the other species, allowing it to benefit from the public good, without contributing to it. We investigated evolutionarily stable states of coexistence between the two organisms and described how enzyme production rates and resource diffusion influence organism abundances. We found that, in the long-term evolutionary scale, monocultures of the producer drive themselves extinct because selection always favours mutant invaders that invest less in enzyme production. However, the presence of a cheater buffers this runaway selection process, preventing extinction of the producer and allowing coexistence. Resource diffusion rate controls cheater growth, preventing it from outcompeting the producer. These results show that competition from cheaters can force producers to maintain adequate enzyme production to sustain both itself and the cheater. This is known in evolutionary game theory as a “snowdrift game” – a metaphor describing a snow shoveler and a cheater following in their clean tracks. We move further to show that cheating can stabilise communities and possibly be a precursor to cooperation, rather than extinction.

Background: Cervical cerclage has been used for decades to decrease rates of preterm birth. The Shirodkar and McDonald cerclage are the two most commonly used cerclage techniques with no current consensus on the preferred technique. Objective: To compare the efficacy of the two techniques. Search strategy: Studies were sourced from six electronic databases and reference lists. Selection criteria: Studies including women with a singleton pregnancy, requiring a cervical cerclage, using either the Shirodkar or McDonald technique that ran comparative analyses between the two techniques. Data collection and analysis: The primary outcome was preterm birth before 37 weeks, with sub analyses at 28, 32, 34 and 35 weeks. Secondary data was also collected on neonatal, maternal and obstetric outcomes. Main results: Seventeen papers were included - analysis showed the Shirodkar group had significantly less chance of preterm birth before 37 weeks (RR 0.91, 95% CI 0.85-0.98). This finding is reinforced by statistically significant reduction in rates of preterm birth before 37, 35, 34 and 32 weeks, PPROM (RR 0.87 ,95% CI 0.77 – 0.99), difference in cervical length (mean difference 5.25, 95% CI 4.68–5.83), cerclage to delivery interval (mean difference 10.79, 95% CI 8.20-13.38), and an increase in birthweight (mean difference 348 grams, 95% CI 291–406) in the Shirodkar group. Conclusion: Shirodkar cerclage leads to a significant reduction in preterm birth and delivers better maternal and neonatal outcomes when compared to McDonald cerclage. Funding: No funding was required for this review. Keywords: Cervical, Stitch, Cerclage, McDonald, Shirodkar, Preterm birth

ABSTRACT Objective To evaluate the diagnostic accuracy of the 68Gallium (68Ga) - prostate specific membrane antigen (PSMA) positron emission tomography/magnetic resonance imaging (PET/MRI) and multiparametric MRI (mpMRI) by region-based comparison of index tumour localisations using histopathological tumour maps of patients who underwent radical prostatectomy due to clinically significant prostate cancer. Patients and Methods The study included 64 patients who underwent radical prostatectomy after primary staging with mpMRI and 68Ga-PSMA PET/MRI. Diagnostic analysis was performed by dividing the prostate into four anatomic regions as left/right anterior and left/right posterior. The extension of the lesions in mpMRI and the pathological uptake in 68Ga-PSMA PET/MRI were matched separately for each region with the extension of the index tumour into each region. Results The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and the accuracy of mpMRI and 68Ga-PSMA PET/MRI are shown as 55.7%, 91.8%, 80.6%, 77.2%, 78.1% and 60.8%, 94.3%, 86.8% 79.8%, 83.5%, respectively. 68Ga-PSMA PET/MRI has higher sensitivity and specificity compared with mpMRI. However, no statistically significant difference was found (p = 0.464). Combined imaging had significantly higher diagnostic accuracy compared with mpMRI and 68Ga-PSMA PET/MRI (change in AUC: 0.084 and 0.046, p < 0.001 and p = 0.028, respectively), while no statistically significant difference was found between mpMRI and 68Ga-PSMA PET/MRI (change in AUC: 0.038, p = 0.246). Conclusion 68Ga-PSMA PET/MRI had higher clinical diagnostic accuracy in prostate cancer compared with mpMRI. Diagnostic accuracy was significantly increased in the combined use of both imaging modalities.

Lung cancer is the most common cancer and a leading cause of death from cancer in men and women in the world. Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are considered as the first-line treatment of EGFR mutated NSCLC. However, almost all patients eventually develop acquired resistance to EGFR-TKIs, with a median PFS of 9-14 months. With the development of immunotherapy, people realize that the interaction between tumor immune microenvironment (TIME) and tumor cells can also affect EGFR-TKIs treatment. TIME contains a variety of elements and previous researches of TIME in EGFR-TKIs therapy on NSCLC are decentralized. Here, we review the characteristics of TIME in NSCLC from EGFR-TKIs therapy and its role in TKIs resistance.

Fungal pathogens cause extensive plant diseases that damage crop production in the agricultural industry, resulting in annual crop loss, diminished food security, and historically significant epidemics. Though effective fungicides are available, their risks to the environment and animal health have increased the demand for more sustainable methods to control fungal pathogens. In plants, polygalacturonic-inhibiting proteins (PGIPs) play critical roles for resistance to fungal disease by inhibiting the pectin-depolymerizing activity of endopolygalacturonases (PGs), one type of enzyme secreted by pathogens that compromise plant cell walls and leave the plant susceptible to disease. Here, the interactions between PGIPs from Phaseolus vulgaris (PvPGIP1 and PvPGIP2) and PGs from Aspergillus niger (AnPG2), Botrytis cinerea (BcPG1, BcPG2), and Fusarium moniliforme (FmPG3) were reconstituted through a yeast two hybrid (Y2H) system to investigate the inhibition efficiency of various PvPGIP1 and 2 truncations and mutants. We found that tPvPGIP2_5-8, which contains LRR5 to LRR8 and is of only one-third the size of the full-length peptide, exhibits the same level of interactions with AnPG and BcPGs as the full length PvPGIP2 via Y2H. The inhibitory activities of tPvPGIP2_5-8 on the growth of A. niger were then examined and confirmed on pectin agar. Application of both full length PvPGIP2 and tPvPGIP2_5-8 clearly slows down the growth of A. niger and B. cinerea in the presence of pectin. The investigation on the sequence-function correlation of PvPGIP2 suggests that LRR5 could have the most essential structural feature for the inhibitory activities, and may be a possible target for the future engineering of PGIP with enhanced activity. This work highlights the potential of using plant-derived PGIPs as an exogenously applied fungal control agent both to plants and postharvest crops while minimally impacting the environment and human health.