In this paper, we prove an optimal three-ball inequality for bi-Laplace equation in some open, connected set. The derivation of such estimate relies on a delicate Carleman estimate for the bi-Laplace equation and some Caccioppoli inequalities to estimate the lower-ters. Based on three -ball inequality, we then derive the vanishing order of solutions, which is a quantitative version of the strong unique continuation property.

The paper formulates the nonlinear problem of steady-state heat conduction at the constant electric potential difference on the surfaces of a plane dielectric layer with the temperature-dependent heat conduction coefficient and electrical resistivity. A fixed temperature value is set on one of the layer surfaces, and the convective heat exchange with the ambient medium occurs on the opposite surface. The formulation of the problem is transformed into integral ratios, which allows the calculation of the temperature distribution over the layer thickness, governed both by the monotonic and nonmonotonic function. The quantitative assay of the temperature state of a layer of a polymer dielectric made of amorphous polycarbonate is given as an example, as well as the analysis of nonuniformity of the absolute value of electric field intensity over the thickness of this layer.

This paper concerns the generalized hyperbolic mean curvature flow for spacelike curves in Minkowski $R^{1,1}$. Base on the derived quasilinear hyperbolic system, we investigate the formation of singularities in the motion of these curves. In particular, under the generalized hyperbolic mean curvature flow, we prove that the motion of periodic spacelike curves with small variation on one period and small initial velocity blows up in finite time. Some blowup results have been obtained and the estimates on the life-span of the solutions are given.

Background: In Bogotá, Colombia, oxygen-dependent (OD) preterm infants are home discharged in Kangaroo Position, to a Kangaroo Mother Care program (KMCP) with ambulatory oxygen, strict follow-up and oxygen weaning protocols. Objectives: 1) to describe growth and morbimortality up to 6 months of an OD preterm infants’ cohort. 2) to explore the association between oxygen requirement, perinatal history, Hb levels, transfusions, feeding patterns and growth. Methods: Prospective cohort study. Descriptive and multivariate analysis. Results: 445 patients were recruited with 33 weeks median gestational age (GA). 21% of mothers had preeclampsia, 50% infections and 77% received antenatal corticosteroids. Upon KMCP admission, median GA, chronological age and hospital stay were 36 weeks, 19 and 17 days, respectively; 55.6% of patients had neonatal sepsis and 66.6% were admitted to Neonatal Intensive Care Unit. Patients had on average 52 days with oxygen, a median of 3200g and 42 weeks GA at oxygen weaning. Median follow-up oxygen saturation was 94% with 0.016-0.5 l/min of oxygen. One-year mortality was 0.2% and attrition 20%. At 6 months, all patients had appropriate growth and 66% were breastfeeding. Multiple regression analysis showed that higher GA, Hb levels, weight gain, and exclusive breastfeeding decreased oxygen requirement whilst invasive ventilation and transfusions had the opposite effect (R2=0.48). Conclusions: In OD preterm infants, there is a close relationship between days of oxygen requirement and GA, mechanical ventilation, Hb levels at discharge, transfusions, exclusive breastfeeding and weight gain. Strict monitoring with established protocols in an ambulatory KMCP allows adequate growth and safe oxygen weaning.

Objectives: To follow-up pediatric CF patients—in terms of health status and nutritional status—via Telehealth services during the COVID-19 pandemic. Additional aims were to measure the level of anxiety in the patients and their parents, and to determine the COVID-19 transmission status in the CF patients. Materials and Methods: The CF team supported the patients via remote contact, including dedicated telephone lines. During Telehealth Services interviews, in addition to obtaining information about the patients’ anthropometric measurements, health status, and CF-related complaints, the State-Trait Anxiety Inventory (STAI) was administered to the patients and the Hospital Anxiety and Depression Scale (HAD) was administered to their parents. Results: The study included 144 pediatric CF patients (74 male and 70 female). Mean age of the patients was 8.9 years. In all, 42 (29.2%) of the patients were tested for COVID-19, of which 4 were positive. The mean STAI score was significantly lower in the patient group than in the control group (P < 0.001). The mean HAD anxiety score was significantly higher in the parents of the CF patients, as compared to the parents of the controls (P = 0.005). The mean HAD depression score was also statistically higher in the parents of the CF patients (P < 0.001). Conclusion: Telehealth is an innovative method for providing healthcare services while maintaining social distancing, avoiding the risk of exposure and spread of COVID-19. Telehealth services reduce patients’ and parents’ anxiety, and increases their confidence in managing CF-related complications.

Mitral valve replacement may be indicated for delayed MitraClip failure. Although it would be best to preserve the chordal apparatus during mitral valve replacement, this has not been reported for delayed MitraClip failure. The reason is probably because there is almost always impressive inflammation around the MitraClip which has likely precluded previous attempts at chordal preservation. We report successful chordal preservation mitral valve replacement for delayed MitraClip failure.

Newborn screening (NBS) of cystic fibrosis (CF) is not available currently in Hungary. Pediatricians should be able to recognize the illness based on the symptoms alone. Lack of NBS causes differential diagnostic challenges for physicians and delayed diagnosis of CF. We present a case of a two-year-old girl who was transferred to our hospital as a suspected Covid-19 patient with one week history of fever and coughing in March 2020. As Covid-19 was excluded, the severity of the clinical picture pointed towards an acute exacerbation of an underlying chronic condition. Her symptoms such as tachypnea, wheezing, lung crackles, hepatomegaly and clubbing of the fingers were all consistent with undiagnosed CF. In the end, sweat chloride level and genetic test verified the diagnosis. This case emphasizes the need of NBS in Hungary.

A document by Kim Pepin. Click on the document to view its contents.

Serum MRGPRX2 as a long-time available biomarker for drug-induced anaphylaxisTo the Editor,The diagnosis of anaphylaxis is based on clinical symptoms after exposure to a trigger factor1. Serum tryptase is useful for an accurate diagnosis of anaphylaxis. However, one of its limitations is short half-life, hence the need for blood samples to be obtained at the onset of anaphylaxis2,3. Mas-related G protein-coupled receptor-X2 (MRGPRX2), expressed in mast cells, is related to degranulation of mast cells in the IgE-independent pathway for anaphylaxis4-6. We aimed to evaluate serum MRGPRX2 levels in patients with drug-induced anaphylaxis (DIA) and to determine usefulness as a potential marker of anaphylaxis by maintaining its concentrations longer.We included 68 patients who consulted at allergy clinic for a history of anaphylaxis after causal drug administration between January 2010 and December 2017. Diagnosis of DIA and causal drugs were determined by an allergist. Patients were excluded if 1) causal drugs were ambiguous, or 2) other relevant causes were combined. Each patient underwent serum MRGPRX2 level measurement randomly at least once from the onset of anaphylaxis. MRGPRX2 levels were determined using an ELISA kit from MyBioSource. We also measured MRGPRX2 levels of 74 controls.We classified DIA patients according to causal drugs to investigate the difference in MRGPRX2 levels between drugs. In addition, we analyzed the MRGPRX2 levels according to the time interval from the anaphylactic event to verify maintenance of MRGPRX2 levels over a longer period of time. The time interval for each patient was defined as the gap between the measurement time of MRGPRX2 levels and the anaphylactic event. This study was approved by the institutional review board of Asan Medical Center (2018-1252), and subjects provided written informed consent.This study included 74 controls and 68 patients with DIA. The mean MRGPRX2 level in the DIA group was significantly higher than that of the control group (57.4±42.8 vs. 17.5±12.7, p <.001) (Figure 1A). Patients were classified into 5 subgroups according to their causal drugs, including antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), histamine-2 receptor blockers (H2- blockers), radiocontrast media (RCM), and others. The others included clopidogrel, proton pump inhibitors, diltiazem, carboplatin, rifampicin, and ethambutol. The most common causal drug was antibiotics (49%), followed by NSAIDs (19%), and H2 blockers (10%). The mean MRGPRX2 levels in patients with DIA caused by antibiotics were higher than in those with other subgroups, but there was no significant difference between the 5 causal drugs (p = 0.964) (Table 1).MRGPRX2 levels of patients with 4–5week time interval were higher (97.4±39.7) than those with 0–1 week (51.9±45.2), 1–2 weeks (54.0±42.1), 2–3 weeks (66.9±39.7), and 3–4 weeks (47.2±27.6) but with no significant difference (p = 0.099) (Table 1). Overall, mean MRGPRX2 levels in each time interval were higher than those in the controls (Figure 1B). There was no significant difference among the frequencies of the causal drugs in each time interval (Table S1).This study demonstrated that serum MRGPRX2 was a potential long-time biomarker for DIA, maintaining high concentration for more than a month from the onset of anaphylaxis. Patients with DIA had higher mean MRGPRX2 levels than controls in all time intervals from the anaphylaxis onset. Thus, MRGPRX2 may be a promising biomarker for supporting a diagnosis of DIA over a longer period than tryptase.This study has limitations in that there was no data of serial changes in MRGPRX2 concentration according to the time interval in the same patient and no direct comparison between MRGPRX2 and tryptase levels. However, this is a pilot study. The performance of MRGPRX2 as a useful biomarker of DIA needs to be further studied using a larger population and in a longer time.

Since 2014, highly pathogenic avian influenza H5N6 viruses have been responsible for outbreaks in poultry. In this study, four H5N6 virus strains were isolated from fecal samples of sick white ducks and dead chickens in Shandong in 2019. These H5N6 viruses were triple-reassortant viruses that have not been previously characterized. Their HA genes were derived from the H5 viruses and were closely related to the vaccine strain Re-11. Their NA genes all fell into the N6-like lineage and the internal gene were derived from H5N1 and H9N2 viruses. They all showed high pathogenicity in mice and caused lethal infection with high rates of transmission in chickens. Moreover, the SPF chickens inoculated with the current used vaccine in China were completely protected from these four H5N6 viruses. Our study indicated the necessity of continued surveillance for H5 IAV and the importance of timely update of vaccine strains in poultry industry.

I agree with their implications on the weakness of the US healthcare systeml,2. As of Oct. 30 in 2020 using the last 200 days open data3, the number of daily deaths due to the COVID-19 in the US can be predicted by the state-of-the-art curve fitting with the 6th degree polynomial:Nov. 6 daily deaths 959,Nov. 13 daily deaths 1017, andNov. 20 daily deaths 1002.Fig. 1 shows the predicted three red points on the number of deaths on Nov. 6, Nov. 13 and Nov. 21 respectively. The graph was created by the curve-fitting Python program: usdaily.py4. If the US does not change the current policy against the COVID-19 pandemic, the number of daily deaths will not be alleviated in the next three weeks.

Abstract: Rationale, aims, and objectives: Chinese patients with advanced chronic kidney disease (CKD), especially rural patients possibly occur self-referral behavior and then treatment decisions followed. It is unclear the relationship between self-referral and treatment decision-making. Thus, the aim of this study was to explore the perceptions and views of self-referral and treatment decision making among patients with advanced chronic kidney disease. Methods: We conducted semi-structured interviews with 26 patients with advanced kidney disease and 12 nephrologists. Interviews were conducted and analyzed thematically until reaching thematic saturation. Results: We identified three themes reflected: 1) self-referral decision making (self-referral motive, barrier to self-referral, seeking for self-referral information); 2) the views and experience of self-referral care (facilitating shared decision making, imposing psychological pressure, feeling about self-referral communication, challenge to staff-patient relationship); 3) treatment decision making (decisional awareness and roles, cost-benefit trade-off and redicision). Conclusions: Our study identified that organizational and demographic factors, self-referral motives worked together at the self-referral decision-making and treatment decision-making when advanced CKD patients facing with healthcare facilities and treatment options. Those findings suggest stakeholders should accelerate the popularization of peritoneal dialysis technology and establish the CKD screening and management systems. For self-referral patients with advanced CKD, our results suggest specialized dialysis transition care to improve quality of communication and soothe patients’ negative emotion.

African horse sickness (AHS) is a transboundary and non-contagious arboviral infectious disease of equids. Infected Culicoides biting midges can spread the African horse sickness virus, and Culicoides imicola (C.imicola) is one of the important transmission vectors. The disease has spread without any warning from the sub-Saharan Africa towards the Southeast Asian countries. Therefore, it is imperative to predict the distribution of the AHS infection risk along the Sino–Southeast Asian borders. The reported AHS outbreaks were extracted from the archive of the Food and Agriculture Organization from December 22, 2005 to September 1, 2020. The occurrence records of C.imicola were mainly obtained from published literature. Subsequently, the maximum entropy algorithm was used to model AHS and C.imicola separately and to research the relationship among bioclimate variables, land cover characterization, horse distribution density, and the prevalence of AHS infection. Finally, we combined the AHS risk prediction with the suitability map of C.imicola to model the risk areas for AHS occurrence in Mainland China. The models showed the mean area under the curve (AUC) as 0.935 and 0.910 for AHS and C.imicola, respectively. Using jackknife analysis, we determined the important factors affecting the AHS outbreak as horse distribution density, mean temperature of the wettest quarter, and precipitation of the coldest quarter. The mean temperature of coldest quarter contributed most to the occurrence of C.imicola, followed by precipitation of coldest quarter and global land cover characterization. The overlay of the AHS and C.imicola prediction map shows that the areas southwest of Hainan and southeast of Fujian are at high risk of AHS occurrence under current conditions. Furthermore, the border sectors of Yunnan and Guangxi also presented relatively high risk.

Aim. Polypharmacy may increase the prevalence of potential multidrug interactions (pMDIs), where one drug interacts with two or more other drugs, possibly amplifying the risk of a potential adverse drug event (pADE). The major goal of this study was to estimate the prevalence of amplifying pMDIs in an ambulatory cohort of older patients. Methods. Current medication lists of 22033 randomly chosen outpatients ≥50 years old were extracted from the New York Presbyterian Hospital (NYP) data warehouse. Network analysis identified patients prescribed three or more interacting drugs from their current medication lists. Potentially harmful interactions were identified from the NYP drug-drug interaction alerting system. pMDIs were considered amplifying if the interactions increased the probability of a pADE through pharmacokinetic, pharmacodynamic or conditional mechanisms. Results. pMDIs were identified in 5.1% of the medication lists; 3.4% were three-drug and 1.1% were four-drug pMDIs. The most common drugs involved were psychotropic, comprising 23.3% of the total drugs. The most common pADEs associated with the interactions were serotonin syndrome (17.2%), seizures (14.4%), prolonged QT interval (15.8%) and bleeding (14.4%). pADE amplification risk was identified in 71.8% of three-drug pMDIs when one drug interacted with two others, 97.8% when all three interacted with each other, and 93% for four-drug pMDIs. Conclusion. Our data suggest that approximately 5% of elderly ambulatory patients may be exposed to pMDIs which amplify the probability of associated adverse drug events. The recent and persistent rise in polypharmacy will likely increase the prevalence of pMDIs and potential exposure to serious adverse events.

Second-generation H1-antihistamines are generally considered to be safe. Here we describe a healthy boy who developed left-arm convulsions after repeated exposure to a dry suspension of desloratadine combined with Huatengzi granules. The boy had no family or disease history of epilepsy, convulsions, or any other drug therapy. The Naranjo Adverse Drug Reaction Probability Scale was used to determine that the convulsions were probably related to desloratadine. Our findings suggest that desloratadine (a second-generation H1-antihistamine) can cause epileptic convulsions in healthy children, and so clinicians should be vigilant of the possibility of central side effects.

With the changes of the times and the growth of public demand for medical services, the service objects, service contents and service approaches of hospital pharmacists are also changing and increasing. By summarizing the changes of hospital pharmacists' practice in hospitals and their contributions to the improvement of hospital service quality in the practice of hospital pharmaceutical care, this paper hopes that more doctors, nurses and patients can have a more in-depth understanding of the specific work of pharmacists, which, at the same time, will also provide some reference for pharmacists at home and abroad to optimize the level of pharmaceutical care. Compared with doctors and nurses, hospital pharmacists have a much more systematic and professional drug knowledge system and service concept, which can guarantee that they can undertake the responsibilities of rational use of drugs, control of medical expenditure, guarantee of efficacy, reduction of medical risks, reduction of doctors' workload, improvement of national health and so on. After years of practice and research, pharmacists have gradually realized their own value and established professional needs through hospital pharmaceutical care.

Metagenomics and metatranscriptomics are powerful tools to uncover key microbes and processes driving biogeochemical cycling in natural ecosystems. Currently available databases depicting metabolic functions from metagenomic/metatranscriptomic data are not dedicated to biogeochemical cycles. There are no databases encompass genes involved in the cycling of dimethylsulfoniopropionate (DMSP), an abundant organosulfur compound. Additionally, a recognized normalization mode to estimate and compare the relative abundance and environmental importance of pathways from metagenomic and metatranscriptomic data has not been available. These limitations impact the ability to accurately relate key microbial driven biogeochemical processes to differences in environmental conditions. Thus, an easy to use specialized tool that infers and visually compares the potential for biogeochemical processes, including DMSP cycling, is urgently required. To solve these issues, we developed DiTing, a tool wrapper to infer and compare biogeochemical pathways among a set of given metagenomic or metatranscriptomic reads in one step, based on the KEGG (Kyoto Encyclopedia of Genes and Genomes) and a manually created DMSP cycling gene database. Accurate and specific formulas for over 100 pathways were developed to calculate their relative abundance. Output reports detail the relative abundance of biogeochemically-relevant pathways in both text and graphical format. We applied DiTing to metagenomes from simulated data, hydrothermal vents and the Tara Ocean project. The DiTing outputs were consistent with genetic feature of genomes used in simulated benchmark data, and also demonstrated that the predicted functional profiles correlated strongly with changes in environmental conditions. DiTing can now be confidently applied to wider metagenomic and metatranscriptomic datasets.

Hydatid disease is a zoonosis caused by Echinococcus granulosus. It is seen most frequently in the liver and lungs in adults. The mediastinal location of this disease is rare. Herein, we report the case of a 38-year-old male with signs of heart failure related to a rupture of a mediastinal hydatid cyst with pericardial tamponade. The diagnosis was confirmed by echocardiography, computed tomography, and hydatic serology, and the patient was operated and put on albendazole for 3 months with favorable clinical course.

Objective: To demonstrate that a double balloon catheter combined with oxytocin decreases time between induction of labour and delivery (TID) as compared to a vaginal dinoprostone insert in cases of PROM at term. Design: Prospective, randomized, controlled trial. Setting: French university hospital Population: Patients undergoing labour induction for PROM at term with unfavorable cervix. Methods: We compared the double balloon catheter over a period of 12 hours with adjunction of oxytocin 6 hours after catheter insertion, versus dinoprostone vaginal insert. After device ablation, cervical ripening continued only with oxytocin. Main outcome measures: The primary outcome was TID. Secondary outcomes concerned delivery mode, maternal and fetal outcome and were adjusted for parity. Results: 40 patients per group were randomized. Each group had similar baseline characteristics. The study failed to demonstrate reduced TID (16.2 vs 20.2 hours, ES = 0.16 (-0.27 to 0.60), p=0.12) in catheter group versus dinoprostone except in nulliparous women (17.0 vs 26.5 hours, ES = 0.62 (0.10 to 1.14), p=0.006). The rate of vaginal delivery <24h significantly increased with combined induction (88.5% vs 66.6%, p=0.03). No statistical difference was observed concerning caesarean rate (12.5% vs 17.5%, p>0.05), chorioamnionitis (0% vs 2.5%, p=1), postpartum endometritis, maternal or neonatal outcomes. Procedure-related pain and tolerance to devices were found to be similar for the two methods. Conclusion: The double balloon catheter combined with oxytocin is an alternative for cervical ripening in case of PROM at term, and may reduce TID in nulliparous women.

FAD3 play important roles in modulating membrane fluidity in response to various abiotic stresses. However, a comprehensive analysis of FAD3 in drought, salinity and heat stress tolerance is lacking in soybean. The present study assessed the functional role of fatty acid desaturase 3 to abiotic stress responses in soybean. We used Bean Pod Mottle Virus -based vector to alter expression of Glycine max omega-3 fatty acid desaturase . Higher levels of recombinant BPMV-GmFAD3 transcripts were detected in overexpressing soybean plants. Overexpression of GmFAD3 in soybean resulted in increased levels of jasmonic acid and higher expression of GmWRKY54 as compared to mock-inoculated, vector-infected and FAD3-silenced soybean plants under drought and salinity stress conditions. FAD3 overexpressing plants showed higher levels of chlorophyll content, leaf SPAD value, relative water content, chlorophyll fluorescence, transpiration rate, carbon assimilation rate, proline content and also cooler canopy under drought and salinity stress conditions as compared to mock-inoculated, vector-infected and FAD3-silenced soybean plants. Results from current study revealed that GmFAD3 overexpressing soybean plants exhibited drought and salinity stress tolerance although tolerance to heat stress was reduced. On the other hand, soybean plants silenced for GmFAD3 exhibited tolerance to heat stress, but were vulnerable to drought and salinity stress

Groundwater age is often used to estimate groundwater recharge through a simplified analytical approach. This estimated recharge is thought to be representative of the mean recharge between the point of entry and the sampling point. However, given the complexity in actual recharge, whether the mean recharge is reasonable is still unclear. This study examined the validity of the method to estimate long-term average groundwater recharge and the possibility of obtaining reasonable spatial recharge pattern. We first validated our model in producing reasonable age distributions using a constant flux boundary condition. We then generated different flow fields and age patterns by using various spatially-varying flux boundary conditions with different magnitudes and wavelengths. Groundwater recharge was estimated and analyzed afterwards using the method at the spatial scale. We illustrated the main findings with a field example in the end. Our results suggest that we can estimate long-term average groundwater recharge with 10% error in many parts of an aquifer. The size of these areas decreases with the increase in both the amplitude and the wavelength. The chance of obtaining a reasonable groundwater recharge is higher if an age sample is collected from the middle of an aquifer and at downstream areas. Our study also indicates that the method can also be used to estimate local groundwater recharge if age samples are collected close to the water table. However, care must be taken to determine groundwater age regardless of conditions.

Coronavirus family has a single-stranded RNA genome encoding 25-30 proteins in different viruses by the mechanism of positive-sense strategy. Extended open reading translation frames (genes) were found to locate under a negative-sense polarity in all coronaviruses genomes. These negative-sense genes varies in the range of 150-450 nt to encode negative genes polypeptides (NGP) with mol. wt. 5-30 kDa. It implies that coronaviruses besides positive genome strategy may have "a dark side of the Moon" expressing genes and virions through the negative strategy. It is noteworthy, that positive- and negative-sense genes colocolized in the same RNA regions of coronavirus genome, so called stacking genes.  Ambisense stacking of genes in coronavirus genomes significantly increases virus diversity, genetic potential and extend virus-host adaptation pathway possibilities.

Non-structural carbohydrate (NSC) storage may be under strong selection in woody plant species that occur across strong environmental gradients. We therefore investigated carbon allocation strategies in a widely distributed, introduced woody plant. We predicted genotypes from cold climates with exposure to episodic freeze events, would have elevated NSC concentrations with the tradeoff of reduced growth and reproduction relative to warm-adapted genotypes. We established an experimental common garden using genotypes of Tamarix spp., sourced across a large thermal gradient within their introduced range. We measured seasonal NSC storage in coarse roots and stems, above-ground growth and flower production. Autumn NSC concentrations were 50% higher in genotypes from sites with spring freeze events compared to genotypes from warmer sites. Cold-adapted genotypes also had a 2.3-fold higher starch to soluble sugar ratio than warm-adapted genotypes. Across all genotypes and seasons, NSC storage was inversely correlated with growth and reproduction. Results suggest that Tamarix from colder locations cope with freeze events by maintaining large storage pools to support tissue regrowth, but with the tradeoff of reduced growth and reproduction. Results provide evidence of selection in carbon allocation strategies in response to climate in introduced woody species.

Objectives: With new dental materials constantly being launched on the market, the number of researches on the properties of dental materials have increased substantially in the past few years. However different results about physical properties of the same material are frequently found in the literature. In an endeavor to elucidate the cause(s) of these disparate results, a review of the literature published in the last five years was conducted, to investigate whether these differences are due to the testing machines - also called chewing simulators – used in the studies. Data: We searched for data of indicators of test accuracy, maintenance of test parameters during all experiments, reproducibility of test and standards in the articles, or in the manufacturers’ sites. Sources: The database searched was CAPES PORTAL (http://www-periodicos-capes-gov-br.ez27.periodicos.capes.gov.br) Study Selection: In the search, the following keywords were used: “bite force” AND “simulator”, “chewing simulator” and “mastication simulator”, and the publication filter date of “January 1, 2016”. As a result, 100 articles were selected and recovered in order of appearance by using the filter “relevance”. Conclusion: based on the data obtained in this review, the disparate results of experiments with dental materials appeared to be more related to the test conditions rather than with the testing machines.