No abstract as per guidelines. Key Points instead. Key points • The Roland Dizziness Questionnaire (RDQ) helped clinicians make a diagnosis in patients with dizziness during a telephone consultations • Use of the RDQ reduced the need for additional investigations and telephone follow-up • Use of the RDQ does not significantly reduce the need for face-to-face appointments • Both patients and clinicians found the RDQ a useful addition to the assessment

Lentil crop is highly sensitive to abrupt increase in temperature during mid to late reproductive stage leading to severe reduction of biomass and seed yield. Therefore, in the present investigation, RNAseq analysis was carried out between IG4258 (heat tolerant) and IG3973 (heat sensitive) lentil genotypes at reproductive stage under both normal and heat stress conditions in the field. It resulted in a total of 2,09,549 assembled transcripts and among these 1,61,809 transcripts had coding regions of which 94,437 transcripts were annotated. The differential gene expression analysis showed up-regulation of 678 transcripts and down regulation of 680 transcripts between tolerant and susceptible genotypes at early reproductive stage. While 76 transcripts were up-regulated and 47 transcripts were down-regulated at late reproductive stage under heat stress conditions. The validation of 12 up- or down transcripts through RT-PCR corresponded well with expression analysis data of RNAseq with a correlation of R2=0.89. KEGG pathways enrichment analysis identified transcripts associated with genes encoding proteins/regulating factors related to different metabolic pathways including signal transduction, fatty acid biosynthesis, rRNA processing, ribosome biogenesis, gibberellin (GA) biosynthesis and riboflavin biosynthesis. This analysis also identified 21,487 genic-SSRs that can be used in molecular mapping of heat tolerant genes in lentil.

This paper introduces advances in the use of Bessel functions (cylinder functions) in achieving optimal sharpness of shapes delineated by collections of holes (dark valley regions) and bright regions in different areas of a video frame. An image hole is an island of low voxel intensities surrounded by varying voxel intensity peaks. The basic approach is to identify dominant collections of lights (high voxel intensity peaks) and darks (low voxel intensity clusters) in video frames. A main finding in this paper is that surface objects (recorded in images) are sharper wherever there are preponderant contrasting differences between image lights and darks. These contrasting differences lead to the highly accurate detection of shape holes (dark valleys) that delineate surface shapes recorded in sequences of video frames). With the use of cylindrical Bessel functions, contrasting differences between peaks and valleys can be measured in terms of voxel intensities and voxel indices.

In this article, we discuss the controllability and stability of Hilfer fractional evolution equations in Banach space. We derive these results by first proving the existence and uniqueness of mild solutions for proposed system of equations. Existence and uniqueness results are obtained with the help of theory of propagation family, techniques of measure of non-compactness and fixed point theorem. An example is also given for the demonstration of obtained results.

In this paper, we prove the existence and multiplicity of solutions for the following Robin problem \begin{equation*} \left\{ \begin{array}{cc} -\text{div}\left( a(x)\left\vert \nabla u\right\vert ^{p(x)-2}\nabla u\right) =\lambda b(x)\left\vert u\right\vert ^{q(x)-2}, & x\in \Omega \\ a(x)\left\vert \nabla u\right\vert ^{p(x)-2}\frac{\partial u}{\partial \upsilon }+\beta (x)\left\vert u\right\vert ^{p(x)-2}u=0, & x\in \partial \Omega ,% \end{array}% \right. \end{equation*}% under some appropriate conditions in double weighted variable exponent Sobolev space by applying Mountain Pass Lemma, Ekeland’s variational principle and Fountain Theorem.

The objective of the present article is to analyze the magnetohydrodynamic hybrid nanofluid flow and heat transfer in a porous medium with the nanoparticles shape effect. The effect of thermal conductivity variation, slip condition and heat generation is also considered. The Sphere (spherical) and Lamina (non-spherical) shapes of Al2O3 and Cu nanoparticle are suspended in pure water to form hybrid nanofluid. The partial differential equations (PDEs) of motion are converted into ordinary differential equation (ODEs) by well-known similarity transformation. The resultant ordinary differential equation (ODEs) are solved analytically with the help of Homotopy analysis method (HAM). Furthermore, the coeffects of physical parameters on velocity profiles, temperature profiles and Nusselt number are also taken into consideration. It is found that the performance of the Lamina (non-spherical) shapes nanoparticles on temperature disturbance and heat transfer is better than Sphere (spherical) shape nanoparticles Keywords: Nanoparticle shape,Nanofluid, Magnetic field, Homotopy analysis method.

The problem of entropy generation and mixed convection in a nanofluid trapezoidal cavity with an internal solid cylinder is studied numerically using the finite difference method. The bottom wall is thermally insulated while the upper wall slides with uniform velocity from left to right and cooled isothermally. Remainder of these walls are kept adiabatic. Water-based nanofluids with \Al2O3 nanoparticles are chosen for the investigation. The Boussinesq approximation is applicable. The influence of Reynolds number, Richardson number, dimensionless radius of the solid cylinder, location of the solid cylinder and nanoparticles of volume fraction on streamlines, isotherms, isentropic as well as the local and average Nusselt number were investigated. It was found that the location and size of the solid cylinder are important control parameters for optimizing heat transfer and Bejan number within the partially heated trapezoid cavity.

Substantial evidence suggests plants and herbivores are limited by multiple resources but their role in driving plant-herbivore interactions is still poorly understood. Here we model multiple resource limitation of plants and herbivores and derive analytical solutions for steady-state plant biomass, herbivore biomass and herbivore impact. The model predicts “apparent” limitation of herbivore biomass by resources that otherwise do not limit herbivore growth. Consequently, higher supply of plant-growth limiting resources allows herbivores to persist at lower supplies of herbivore growth-limiting resources. Likewise, increased supply of these non-limiting resources to herbivores can dramatically increase herbivore impacts on plants. Additionally, the outcomes of herbivore exclusion experiments should differ along different resource gradients, depending on herbivore response to plant resource concentrations. Analysis of existing and new data from marine, freshwater and terrestrial systems supports several of these predictions. Our analysis expands ecologists’ understanding of plant-herbivore dynamics to accommodate multiple limiting resources.

Relatives are expected to cooperate more and compete less. In symbiotic partnerships, hosts may benefit from interacting with highly-related symbionts because there is less conflict. This has been difficult to test empirically. We used the arbuscular mycorrhizal symbiosis to study the effects of fungal relatedness on host and fungal benefits, creating fungal networks varying in relatedness (self vs. non-self) between two host plants, in both soil and in-vitro systems. To determine how fungal relatedness affected overall transfer of nutrients to host roots, we fluorescently tagged phosphorus and quantified resource distribution. We imaged fungal networks, and related fractal dimension to fungal growth strategies. We found that decreased relatedness was associated with increased fungal growth and complexity, lower transport of nutrients across the fungal network, and lower plant benefit, likely an outcome of increased fungal competition. More generally, we demonstrate how relatedness among symbionts can mediate the overall benefits of symbiotic partnerships.

Endoglucanases are necessary to improve high-solids enzymatic hydrolysis of lignocellulosic biomass by promoting liquefaction and decreasing the medium viscosity, alleviating one of the processes’ major hindrances. In this study, endoglucanases produced by a particular strain of Aspergillus awamori were evaluated to speed up biomass liquefaction in reactions with 30% solids. Firstly, A. awamori crude supernatant (Aa) was assessed as a supplement to commercial enzymes, decreasing the media viscosity in 10-fold and improving glucose release by 20% after 24 h. Afterward, Aa was fractionated by size-exclusion chromatography and an endoglucanases-rich fraction was identified by liquid chromatography-mass spectrometry. This fraction was then supplemented to the most efficient commercial enzyme and its performance compared with the unfractionated Aa, resulting in the same improvement on medium viscosity and glucose release in 6 h. These data indicate that A. awamori endoglucanases have a powerful effect on the viscosity decrease during high-solids enzymatic hydrolysis.

Cancer is a disease of somatic mutations. These cellular mutations compete to dominate their microenvironment and dictate the disease outcome. While a therapeutic approach to target specific driver mutations helps to manage the disease, subsequent molecular evolution of tumor cells threatens to overtake therapeutic progress. There is need for rapid, high-throughput, unbiased in-vitro discovery screening platforms that capture the native complexities of the tumor and rapidly identifiy mutations that confer chemotherapeutic drug resistance.Taking the example of CDK4/6 inhibitor (CDK4/6i) class of drugs, we show that the pooled in-vitro CRISPR screening platform enables rapid discovery of drug resistance mutations in a 3D setting. Gene edited cancer cell clones assembled into an organotypic multicellular tumor spheroid (MCTS), exposed to CDK4/6i caused selection and enrichment of the most drug resistant phenotype in a 3D setting, detectable by next gen sequencing after a span of 28 days. The platform was sufficiently sensitive to enrich for even a single drug resistant cell within a large, 2500-cell, drug-responsive complex 3D tumor spheroid. The genome-wide 3D CRISPR-mediated knockout screen (>18,000 genes) identified several genes whose disruptions conferred resistance to CDK4/6i. Further, multiple novel candidate genes were identified as top hits only in the microphysiological 3D enrichment assay platform and not the conventional 2D assays. Taken together, these findings suggest that including phenotypic 3D resistance profiling in decision trees could improve discovery and reconfirmation of drug resistance mechanisms and afford a platform for exploring non-cell autonomous interactions, selection pressures, and clonal competition.

A document by Hikmet Koyunbakan. Click on the document to view its contents.

The Pigeon circovirus (PiCV) which contains a circular single stranded DNA (approximately 2 kb) belongs to the genus Circovirus and the family Circoviridae. PiCV infections in pigeons (Columba livia) have been reported worldwide. Nowadays, pigeon racing is becoming increasingly popular and considered to be a national sport in China, and even, the greatest competitions of racing pigeons are stake place in China. However, there is no epidemiologic data on PiCV infections among racing pigeons in China. To trace the prevalence, genetic variation and evolution of PiCV in sick and healthy racing pigeons, 622 samples were collected from 11 provinces or municipalities of China from 2016 to 2019. Samples were tested by polymerase chain reaction. The results showed that the positive rate of PiCV was 19.3% (120/622) at the sample level; 59.0% (23/39) at the club level, suggesting that the virus was prevalent in Chinese racing pigeons. A sequence analysis revealed that the cap genes of the PiCV strains identified in our study display high genetic diversity and shared nucleotide homologies of 71.9%–100% and amino acid homologies of 71.7%–100%. 28 and 37 unique amino acid substitutions were observed among the cap proteins and rep proteins of our PiCV strains, respectively. Furthermore, two initiation codons (GTG and ATT) of cap gene were newly found. A cap-gene-based phylogenetic analysis showed that the strains in this study could be further divided into six groups (A, B, C, E, G, H and I) and some of our strains are closely related to worldwide strains from different types of pigeons. A large number of recombination events (31 events) were also detected in the PiCV genomes from Chinese racing pigeons. These findings suggest that PiCV strains circulating in China exhibits higher genetic diversity.

Avian pathogenic E. coli (APEC) are generally considered to be the reservoir for human extraintestinal pathogenic E. coli (ExPEC): they share similar genetic characteristics and pathogenicity with no or minimal host specificity. In this study, we successfully isolated and identified an E. coli strain as the culprit responsible for serious colibacillosis outbreaks in intensive chicken farms in China in 2016. We investigated its phylogenetic classification (A, B1, B2, C, D, E, and F) by PCR analysis; its virulence and host range using challenge experiments with different animals; and its virulence factors, drug resistance genes, sequence type (ST), and related biological information through high-throughput sequencing. This isolate was found to belong to ST95, group B2, and serotype O18. The E. coli strain shows strong virulence in chickens with a minimum lethal dose (MLD) of 3 × 103 CFU/chicken and a strong virulence in mice with an MLD of 3 × 102 CFU/mouse and in rabbits with an MLD of 3 × 103 CFU/rabbit. Whole-genome sequencing showed that it consists of six types of prevalent resistance genes, 33 antibiotic efflux genes, and nine recognized virulent factors. The detailed data are available from GenBank (SRR13005645) for further study.

Background and Aim: We aimed to investigate the effects of anxiety or social support on sleep quality in patients with COVID-19 who were older than 65 years of age and undergoing quarantine process. Material and Method: The study included the patients ≥65 years of age who had a quarantine process for 14 days during the COVID-19 outbreak. The sociodemographic features and comorbidities were recorded in all patients. Geriatric Anxiety Scale (GAS), Multidimensional Perceived Social Support Scale (SS), and Pittsburgh Sleep Quality Index (PSQI) questionnaires were applied. Results: Totally 198 patients (123 male and 75 female) were included in the study. Among patients, 115 (58.1%) patients were living in a nursing home. All GAS scores and the total PSQI were significantly higher and all SS scores were significantly lower in PCR positive patients compared with the negative ones (p:0.001). Moreover, All GAS scores and the total PSQI were significantly higher and all SS scores were significantly lower in patients living in nursing homes compared with the others (p:0.001). Conclusion: In elderly patients faced with the COVID-19, social support was negatively associated with the sleep disturbances. We suggest that, increasing social support is important in elderly patients in the clash against COVID-19.

Background Few therapies are available for treating patients with B acute lymphoblastic leukemia (B-ALL) who relapse after umbilical cord blood transplant (UCBT). Chimeric antigen receptor (CAR)-modified T cell therapy targeting CD19 is novel and effective for treating refractory/relapsed (R/R) hematological malignancies. Method We report the response rate, toxicity, and survival of CD19-targeted CAR modified T cells administered to 10 patients with B-ALL who relapsed after UCBT from April 2018 to September 2019. Patients ≥14 years of age were subsequently recruited in the clinical trial (NCT02851589) conducted at the First Affiliated Hospital of USTC, Hefei, China. Results Patients (n = 11) were infused with peripheral blood T cells transduced with CD19-directed CAR lentiviral vectors (0.42 × 106 –3.91 × 106 cells/kg body weight). Among 10 patients who were successfully infused, 9 achieved minimal residual disease-negative complete remission (MRD-neg CR). As of July 30, 2020, 6 of 10 patients experienced a relapse (median follow-up for CR was 13.2 months, range 5.8–31.7 months). The 6-month rates of progression-free survival (PFS) and overall survival (OS) were 44.4% and 77.8%, respectively. Toxicities were reversible, including severe cytokine release syndrome (CRS) (≥ grade 3) and neurotoxicity in 10% (1/10) and 10% (1/10) of patients, respectively, and no patient experienced graft-versus-host disease (GVHD). Conclusion CD19-targeted CAR-modified T cell therapy may therefore serve as a safe and effective approach for treating patients with relapsed B-ALL after UCBT. A multicenter clinical trial including more subjects is required to confirm safety and efficacy.

Background: In response to coronavirus disease 2019 (COVID-19), the psychological distress of health care workers (HCWs) is overwhelming, irrespective of the extent of exposure to infected patients. Infection control and prevention (ICP) measures for mobile children and youths are indispensable to contemplate sustainable public health management, but it is difficult to define the clear trade-offs between ensuring virus-containing strategy and resuming ordinary childcare. Aim: To analyze the occupational distress and dilemma of HCWs working on the pediatric cancer ward as a representative model to conceptualize the core of anxiety at the childcare frontline. Methods: Qualitative and quantitative studies using an empirical phenomenological approach and questionnaire survey from 20 th April to 5 th May 2020. Results: High confidence in the institutional ICP measures is fundamental to maintain a strong social responsibility and resilience of HCWs against the crisis, but they are still under overwhelming anxiety within themselves, particularly about being infected to become an asymptomatic carrier who might pass the virus to patients. Both nursing staff and HCWs with less than 5 years of working experience perceived more intense psychological distress in comparison with physicians. Conclusion: We would like to suggest that target approaches, such as activating interpersonal communication and facilitating ICP adherence, are indispensable to maintain the safety climate among HCWs. Recognizing the psychological distress of childcare HCWs is important to mitigate their occupational distress, but also development of future public health strategy in the era of COVID-19.

A document by Rufus Cartwright. Click on the document to view its contents.

Study Objective: This study compared the efficacy and safety of a combination of uterine artery embolization or methotrexate before hysteroscopy in the treatment of cesarean scar pregnancy. Methods: We divided 276 cesarean scar pregnancy patients into three groups. Group A underwent direct hysteroscopy; Group B received uterine artery embolization plus hysteroscopy; Group C received the systemic administration of methotrexate prior to hysteroscopy. Results: The patients in Group A lost significantly more blood than those in Groups B (P ＜ 0.05). There were no significant differences between the three groups with regards to massive hemorrhage and transfusion (P ＞ 0.05). None of the patients required hysterectomy. Group A was also associated with a significantly shorter period of hospitalization, reduced medical costs, and fewer adverse events than either Group B or C (P ＜ 0.05). Moreover, among women of advanced age (≥35y), the levels of serum anti-Mullerian hormone in Group B were significantly lower than those of the baseline group (P＜0.05), which were significantly lower than those in Group A after surgery (4.22 ± 2.35 vs 2.78± 1.89 ng/ml, P ＜ 0.05). Conclusion: Direct hysteroscopy is a reliable treatment option for most early type I cesarean scar pregnancy patients with a gestational sac. A combination of methotrexate and uterine artery embolization before hysteroscopy in these patients has limited remedial effects. uterine artery embolization may reduce ovarian reserve in patients aged ≥35y.

Nesta seção, introduziremos o conceito de estados físicos de um sistema em mecânica clássica.

Objective: The purpose of this research was to establish prediction model of fetal distress risk and admission to neonatal intensive care unit(NICU) risk of patients with fetal growth restriction(FGR). Design: Case-control study, a retrospective analysis. Setting: Women’s Hospital, School of Medicine, Zhejiang University in China. Population: 930 patients who were diagnosed with FGR were selected, and using fetal distress and admission to NICU as outcome.. Methods: Using lasso regression and multivariable logistic regression analysis established the nomogram prediction model of fetal distress risk and admission to NICU risk. Discrimination, calibration and clinical usability of the predicting model were respectively adopted. Internal validation was assessed using the bootstrapping validation. Main Outcome Measures: Nomograms were established for Predicting fetal distress and admission to neonatal intensive care unit in patients with FGR. Results: We found that six identified factors associated with fetal distress of patients with FGR. Four independent predictors were selected for admission to NICU of patients with FGR. The delivery method of cesarean section increased the above risks. Two nomograms were developed and verified accordingly. The two models had good discrimination and good calibration respectively. The decision curve analysis performed that the clinical usability and benefits of the nomograms were the range of 3%-75% and 17%-95%. Conclusion: Two nomograms were the first to predict fetal distress and admission to NICU of patients with FGR. Establishing effective predictive models based on independent predictors could help early diagnosis and evaluation of fetal distress and admission to NICU in patients with FGR.

A document by Melissa Kapulu. Click on the document to view its contents.

Backgroud: Surgical results of functional single ventricle (FSV) patients with totally anomalous pulmonary venous connection (TAPVC), have a poor outcome. We retrospectively analyzed our 10-year surgical clinical experience and risk factors of mortality of these patients. Methods: Between March 2008 and August 2018, 43 consecutive patients with FSV and TAPVC underwent initial surgical palliation and TAPVC repair or not. The median body weight and age were 12 (range 5-44) kg and 32 (range 2-256) months, respectively. Among these cases, there are 19 cases of supracardiac TAPVC, 22 of intracardiac type, and 2 of mixed type. 12 patients need to perform TAPVC repair during initial surgical palliation (supracardiac in 10 and mixed type in 2). Results: Overall survival at 1 and 5 years were 89.5% and 83.3%, respectively. In TAPVC repair group and non-TAPVC repair group, overall survival after the initial surgical palliation were 58.3 and 87.1% at 1 year, 40.0% and 87.1% at 3 years, respectively. Cox univariate analysis detected that preoperative pulmonary vein obstruction (PVO) (p=0.047) and concomitant TAPVC repair (p=0.007) were risk factors for mortality, and multivariable analysis indicated concomitant TAPVC repair as the only factor (p=0.033). Conclusions: The mid-term results of surgical results of FSV associated with TAPVC, especially for patients who need to concomitant TAPVC repair, remain poor. Preoperative PVO is identified as risk factor that increases mortality of these patients.

Anomalous origin of a single coronary artery arising from the innominate artery associated with coronary artery fistula and truncus arteriosus is an extremely rare anomaly. A 16-month-old girl received Rastelli procedure during in the surgical treatment of truncus arteriosus. We found the coronary artery anomaly in the operation. The operation went well, and the patient is doing well without any respiratory symptoms or active intolerance 28 months postoperatively.There may have a connection between a single coronary artery arising from the innominate artery and truncus arteriosus according to the literature reports. The three defects described above are rarely found together, indeed, such a case as ours may be the first reported in the literature.