We report a three month old infant who developed a persistent junctional reciprocating tachycardia induced cardiomyopathy that was successfully treated with radiofrequency ablation. To our knowledge this is the youngest reported patient with a successful epicardial lesion placed in a diverticulum off of the coronary sinus. We use this case to highlight how low power lesions in the coronary sinus in the youngest of patients can achieve results safely. Delineation of coronary anatomy is crucial prior to lesion deliverance.

Clinical ImageSimultaneous hot and cold thyroid nodules: Which is malignant?Yuki Otsuka, M.D.1, Yasuhiro Nakano, M.D.1, Daisuke Omura, M.D., Ph.D.1, Takayuki Iwamoto, M.D., Ph.D.2, Ruiko Hayashi, M.D.3 and Fumio Otsuka, M.D., Ph.D.11Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan

The granular coefficient of restitution (CoR) is an empirical data of simulations using two-fluid model with kinetic theory of granular flow (KTGF). The CoR relates with binary inelastic collisions of discrete particles. In present study, an approach of coupled KTGF for Euler granular phase and discrete element method (DEM) for discrete particles is proposed. The granular CoR is computed from the binary collisions of discrete particles using DEM. The momentum transfer between the Euler gas phase and the discrete particles is calculated from the momentum transfer coefficient between the Euler gas phase and Euler granular phase. The viscous force of discrete particles of DEM is computed from the turbulent model of Euler gas phase. A correlation of granular CoR is proposed as a function of granular volume fractions. The simulated axial velocities of Euler granular phase and discrete particles are in agreement with experiments in a spout fluidized bed.

In this study, effect of swirling addition on the liquid mixing behavior of multi-orifice-impinging transverse jet mixer has been investigated by planar laser induced fluorescence as well as large eddy simulation (LES). In the case of swirling addition into the jet flow, there exists an optimized swirling jet angle or optimized jet-to-cross velocity ratio for the fixed mixer configuration. A larger swirling jet angle will make the flow dominated by the swirling, resulting in a slower mixing process. Interaction of swirling crossflow with no-swirling injected streams, or with swirling injected streams in the opposite direction is beneficial for the mixing. LES predictions show that many small vortices are produced homogenously due to intensified impingement in the case of opposite swirling directions, leading to a relative fast mixing process in several milliseconds. Whereas the mixing is restrained when the swirling directions of two flows are the same.

This paper presents a study on the relationship between transport properties and geometric free volume for dense hard sphere (HS) systems. Firstly, a generic free volume distribution function is proposed based on recent molecular dynamic (MD) simulations for the HS geometric free volume1,2. Combining the new distribution function with a local particle transportation model, we obtain a power law for the HS transport properties. Then a relation between the geometric free volume and thermodynamic free volume is established, which makes it possible to obtain the expressions of the geometric free volume. The new models are tested with MD results for HS viscosity, diffusivity, respectively and the results are very satisfactory. Using the power law we are able to reproduce equations obtained from different approaches, such as the entropy scaling laws3, mode coupling theory4 or empirical correlations5. In particular, A long-standing controversy regarding the Cohen-Turnbull-Doolittle free volume model6,7 is resolved.

Covalent organic frameworks (COFs) are a family of promising membrane materials because of their intrinsic pores with uniform size, tunable functionalities, and high stability. Especially, two-dimensional (2D) COFs can be exfoliated into single- or few-layered nanosheets and restacked into molecular sieving membranes through controlling restacking modes and thickness. However, the traditional methods mainly rely on increasing the thickness (vertical restacking control) to achieve high separation selectivity but with limited permeance. Herein, the fabrication of ultrathin COF membranes through a horizontal restacking control with the aid of introducing thermal perturbation is reported, i.e., a heating vacuum filtration method to optimize the relative displacement of nanosheets in horizontal direction without sacrificing thickness control. The obtained membrane exhibits high H2 permeance (655.6 GPU) and H2/CO2 selectivity (43.2) for CO2 pre-combustion capture. Furthermore, this method also displayed its universality to control the restacking microstructures of other COF nanosheets and the resulted properties of membranes.

We report a multi-objective stochastic mixed-integer non-linear programming (MINLP) framework for sustainable retrofit and capability expansion of traditional energy systems in petrochemical complexes. Multiple uncertainties including energy demands, solar radiations and wind speeds are considered in the optimization framework, which are characterized by normal distributions of historical data or normal distributions pre-defined with assumed mean values and standard variations. A stochastic reduced order model sampling technique is introduced to describe the uncertainties by a small number of scenarios and their individual probabilities. The optimization framework further accounts for system configuration selection and sizing of the candidate energy conversion equipment, such as thermal storage units, gas turbines, boilers, steam turbines, as well as their operating capacities in each time period. A case study is investigated to demonstrate the performance of the proposed strategy and the optimization results under three modes (deterministic, stochastic and semi-stochastic programs) are compared.

Metabarcoding of environmental DNA (eDNA) is an attractive complement to morphological methods for characterizing marine sediment benthic communities. However, incomplete sampling is a major concern when inferring community composition, and metabarcoding results are heavily dependent on methodology. Using 18S V1-V2 and COI markers, we investigated the effect on observed alpha- and beta diversity of (A) homogenization intensity during sediment DNA extraction, (B) extraction replicates vs larger sediment extraction volume, and (C) pre- and post-PCR extract pooling. We show that an intermediate Precellys homogenizer program for DNA extraction can significantly improve sediment metabarcoding results in terms of captured diversity and inter-replicate homogeneity compared to vortexing only. This effect was stronger than that of increased sediment extract volume. Pre-PCR pooling of DNA extraction replicates increased observed rarefied richness compared to single extract medians, but not to the extent of amplifying or sequencing extraction replicates individually before pooling, i.e. post-PCR, or in silico pooling, respectively. We argue that this discrepancy was due to both an increased number of PCR artifacts and reduced PCR drift. Inter-sample heterogeneity was considerably higher for the COI metazoan dataset, compared to the total eukaryotic 18S dataset, likely due to a combination of metazoan eDNA distribution, stochastic effects due to less conserved primer sites, and a high degree of COI non-target amplification. Based on our results, extraction replicates of smaller sediment volumes, in combination with firm but intermediate homogenization and pre-PCR pooling, is a cost-effective way of maximizing sediment eDNA metabarcoding sample coverage, compared to increased extraction volume.

    82 yıl evvel aramızdan yalnızca bedenen ayrılan Ulu Önder Mustafa Kemal Atatürk'ün matematik alanında yaptığı yeniliklere, Türkçeye kazandırdığı matematik terimlerine değindik. Eserlerine, hem eğitim hem de günlük hayatımızda pek çok yerde tanıklık ettiğimiz Başöğretmenimiz’i saygıyla anıyoruz.

Background: Traditional radiotherapy is difficult to carry out definite treatment without damaging the adjacent brain parenchyma. Many studies have shown that the physical properties of carbocation radiation therapy allow treatment to reduce damage to critical structures and thus improve patient survival. Purpose: The purpose of this systematic review and meta-analysis is to evaluate the efficacy and safety of Carbon ion or Carbon ion combination radiation therapy in improving meningioma. Materials and Methods: The related studies published from January 1, 1951 to August 1, 2020 were searched comprehensively on PubMed, Cochrane Library, China Biomedical Literature Database, Web of Science, EMBASE. The extracted data included studies focused on rates and types of adverse events were sorted and classified by excel, and the overall survival and local control rates data were further analyzed with R software, Results: In eight included studies and 506 individuals, the three-year survival rate and annual local control rate of benign meningiomas were 100%. The one-year, two-year and 5-year survival rates of patients with atypical meningioma were 100%, 95% and 50%. The one-year and two-year survival rates of patients with recurrent intracranial meningiomas were 90% and 71% respectively. The one-year and two-year local control rates of non-benign meningiomas were 53% and 33% respectively. Headache, sensory impairment, cognitive impairment, and hearing impairment were the most common toxic reactions, with incidences of 19.4%, 23.7%, 9.1% and 9.1%, respectively.

In this era of evidence-based practice, scholarly work such as peer-reviewed scientific publications play a vital role in policy and decision-making at an individual, organization, and country-level. Alongside being considered an essential means of communicating scholarly work, scientific publications also investigate the specific domains that lack well-established literature and thereby inform scientists and researchers to thrive for the betterment of the publics' well-being. Thus, the main purpose of articulating the scientific, scholarly work should be to make it understandable and accessible to everyone, including the lay audience. However, oftentimes, researchers overlook the lay summaries while publishing the research findings.

Hemophilia A (HA) consists of a genetic X-linked blood disorder. It is caused by a diversity of F8 gene mutations, with missense type being the most prevalent. Amino acid substitutions may impact physicochemical properties of the protein, providing an abundant scenario for investigation. This work evaluates 71 substitutions contributing to distinct patients’ phenotypes (mild, moderate, and severe), in terms of physicochemical alterations (PA - electrostatic potential, hydrophobicity, surface solvent-accessible/excluded areas, disulfide disruptions, and substitutions indexes), through an in silico strategy. PA information extracted from models fuels a hierarchical clustering analysis (HCA - independently and in combination) in an attempt to connect mutations and patients’ phenotypes. The combined use of PA over the analysis of single features seems to better reflect the impact of substitutions in severity degree, apparently in a domain-dependent way. Besides, a principal component analysis (PCA) identified prominent properties impacting clustering results for each domain. Electrostatic potential has a greater contribution to A3 than C1 domain clustering, probably by A3 involvement in FVIII activation, for example. The conjugated use of HCA and PCA is a powerful tool to assess if and what kind of structural features are involved in FVIII protein functionality impact and HA disease severity.

Aims: To evaluate the effectiveness of an interactive teaching intervention on medical students’ knowledge and attitudes about stem cell research and therapy. Methods: A quasi-experimental, one group pre-posttest study design was employed. A six-session interactive teaching course (intervention) was conducted for a duration of 6 weeks. Pre and post intervention surveys were used. Differences in students’ knowledge and attitude mean scores were examined using paired t-test, while gender differences were examined using independent t-test. Results: Seventy one sixth year medical students were invited to participate in this study. A pre-intervention survey was distributed to 58 students who agreed to participate (81.6%). Out of 58 students, only 48 (82.7%) completed the entire course. Total knowledge scores and attitude score significantly increased post intervention. Significant gender differences in knowledge and attitude scores were not detected post intervention. Conclusions: Integrating stem cell science into medical curricula coupled with interactive learning approach were effective in increasing students’ knowledge about recent advances in stem cell research and therapy, and in improving attitudes toward stem cells research and applications.

Canine morbillivirus, also known as canine distemper virus (CDV) is one of the most important infectious diseases threat to the health and conservation of free ranging and captive wild carnivores. CDV vaccination using recombinant vaccines has been recommended for maned wolf (Chrisosyon brachyurus) after the failure of modified live vaccines that induced disease in vaccinated animals. However, there has been a lack of systematic evaluation about the response of this preventive protocol in zoo carnivores due to ethical reasons that do not approve vaccination trials with challenge in that species. Here we report a CDV outbreak in a captive population of maned wolf with an index case that was previously vaccinated with a recombinant vaccine. Five juveniles and one adult from a group of seven maned wolves housed in an outdoor exhibit died in April-May 2013 in a zoo in the Metropolitan Region, Chile. Clinical signs ranged from lethargy to digestive and respiratory signs. Diagnosis of CDV was confirmed by histopathology, antibody assays and viral molecular detection and characterization. The phylogenetic analyses of the nucleotide sequence of H gene of the CDV genome identified in the two positive samples suggest a close relation with the lineage Europe 1, commonly found South America and Chile. CDV infections in maned wolf have not been previously characterized. To the authors best knowledge is the first report of the clinical presentation of CDV in a canine species previously inmmunized with a recombinant vaccine. Further research will be necessary to understand the impact of CDV in wild maned wolf populations and new protocols (with boosters) that could improve the effectiveness of the recombinant vaccine against CDV in wild carnivores.

A benchmark of anisotropic polarizabilities has been carried out for 14 (hetero)-aromatic molecules using the methods: RPA, RPA(D), HRPA, HRPA(D), SOPPA, SOPPA(CC2), SOPPA(CCSD), CC2, CCSD and CC3. While this benchmark, to a large extend, shows similar tendencies as found for isotropic polarizabilities, it also reveals some differences between isotropic and anisotropic polarizabilities. CCSD is found to be the method performing closest to CC3 as it also was for isotropic polarizabilities. For static anisotropic polarizabilities SOPPA(CCSD) performs incredibly close to CCSD, however, the less demanding HRPA(D) follows shortly after in precision. For dynamic anisotropic polarizabilities SOPPA(CCSD) is again the method least deviating from CC3, beside CCSD, but its standard deviation is worse than for RPA, which gives results only slightly more deviating from the CC3 results than SOPPA(CCSD). While the HRPA model is seen to perform incomparably worse than any of the other methods, the simpler RPA is on the other hand thus performing notably well. The finding of this good performance of the relatively simpler and cheaper methods, RPA and HRPA(D), permits calculation of much larger systems without sacrificing the quality of the calculation.

Background: Primary cardiac sarcomas are the most commonly encountered primary cardiac malignancies with a marked tendency of recurrence. In the complex and heterogeneous field of cardiac masses a proper differential diagnosis based on multimodality imaging approach is extremely useful in order to plan the most appropriate treatment. Case Summary: We report the case of a 69-year-old woman presenting with worsening dyspnoea and syncope due to cardiac pleomorphic sarcoma, emphasizing the critical aspects of differential diagnosis and management. Discussion: A stepwise diagnostic strategy through multimodality imaging evaluation is the cornerstone for an appropriate prompt intervention, even if histopathological characterization remains the diagnostic gold standard for histotype definition, to guide the treatment and define the prognosis.

Infective endocarditis was a cause that can not be ignored in patients with clinical fever, which was often missed and misdiagnosed because of the diversity of clinical manifestations. This paper reported a case of infective endocarditis diagnosed by echocardiography and PET-CT due to recurrent fever. The patient was an elderly woman with a history of 20 years of type 2 diabetes and 5 years of hypertension. The first symptom was recurrent fever. After admission, the relevant examination did not determine the cause, and later echocardiography found that the papillary muscle vegetation was attached and diagnosed as infective endocarditis.

Sophorolipids (SLs) are regarded as one of the most promising biosurfactants. They have a low toxicity and are easily degradable without polluting the environment. However, high production costs are the main obstacle to extended SLs application. Semi-continuous fermentation is a promising technology for achieving high SLs productivity, which is based on in-situ separation. In this study, the sedimentation mechanism of SLs was analyzed. The formation of a hydrophobic mixture of SLs and oil was a key factor in sedimentation. The hydrophobicity and density of the mixture determined SLs sedimentation rate. According to the mechanism, ultrasonic enhanced sedimentation technology (UEST) was introduced, by which the sedimentation rates were increased by 46.9% to 485.4% with different Oil/SLs ratios. UEST-assisted real-time rational in-situ separation and semi-continuous fermentation were performed. We observed that SLs productivity and yield were 2.15 g/L and 0.58 g/g, whereas the loss ratio of cells, glucose, and oil was reduced by 68.2%, 16.2%, and 65.5%, respectively. In-situ SLs separation efficiency and rate were increased by 34.5% and 26.4%, respectively. This study provides the foundation and new horizon for the optimization of the SLs fermentation process.

This article describes how a step-stress accelerated life test (SSALT) can be designed for testing the fatigue life and reliability of structural components with a single failure mode. With simple numerical simulations of the crack’s propagation in the notched area of the structural part for different loading levels, the slope of the S-N curve for a structural component is initially estimated. Then, a very few fatigue-life experiments are carried out in the high-cycle domain to determine the intercept of the structure’s S-N curve. By considering the scatter from the material’s P-S-N curve, different SSALT designs for the structural component can be composed and checked for their expected acceleration factor. The procedure is experimentally validated for the case of a notched specimen and two different SSALT designs. From the results it can be concluded that the predicted durations of the SSALT experiments correlate well with the real experiments.

Hematologic malignancies are becoming more prevalent, manifesting in various clinical scenarios. Chronic myelogenous leukemia (CML) is usually diagnosed on routine complete blood count as it is typically asymptomatic. However, it can cause multiple signs and symptoms. We present a patient with appendicitis revealing CML during his workup for abdominal pain.

A document by Godfrey Akpojotor. Click on the document to view its contents.

A document by Delphi Ward. Click on the document to view its contents.

It is a sad commentary that after several months of the first confirmed case of the COVID-19 pandemic in Nigeria, there are still very scanty local data and information on the virus. As a result, the country still relies on foreign data and information. The purpose of this preliminary study is to investigate the perception and belief of the pandemic in Delta State of Nigeria a month after the first index case in the state. A questionnaire of 27 items was designed to represent five research questions (RQs). Both the hard and electronic copies of the questionnaire were randomly administered to residents in the state. The data collected were analyzed using simple percentages, bar and pie charts that are self-explanatory to make the results accessible and comprehensive to the general public. The results showed that many Deltans believed that the COVID-19 was real and not a product of the conspiracy theories. On the biological background of the disease, 89.3% of the respondents are conversant with the general clinical symptoms of COVID-19. Further, more of the respondents believed that both the elderly and people with health challenges were more likely to be killed by the virus. Remarkably, 70% of the respondents believe that the COVID-19 infection was preventable and curable and 60% of the respondents opined that Nigeria had the expertise to find a cure to the disease. However, 36.26% of the respondents opined that the response/handling of the pandemic by government and relevant agencies such as the NCDC is adequate while 50.5% of them have contrary view. Though many of the respondents believed that the closing of international borders, interstate land borders and obeying the government lockdown rules were responsible for the relatively low spread of the COVID-19 pandemic, more than half of the respondents (53.6%) did not believe that Deltans are committed to adhering to all the guidelines given by government during the easing of the lockdown. These findings on some aspects of epidemiological study have provided local information on the perception of COVID-19 pandemic in Delta State which is now in public domain for further discussion and possible adoption. We also provided a few recommendations which included the need to fill the gap in the local information and data in order to enhance the possibility of achieving efficacious local treatment of this disease.

Background and objectives: Studies analyzing the frequency of diarrhea and constipation with exclusive enteral nutrition therapy (ENT) enriched with fibers assessing the time effect in clinical outcomes are scarce. So, this was the aim of the present study. Methods: This is a prospective study carried out in hospitalized patients who were fed exclusively on ENT for at least seven days. Those patients were followed daily until reaching 14 days of exclusive ENT diet. The frequency of diarrhea and constipation, the data related to the ENT, the liquids and the medicines received were logged daily. Generalized Estimated Equation was used for statistical analysis (p<0.05). Results: The sample was of 28 patients (64.21±17.70 years and 75% men), 15 patients remained until the end of the study. The percentage of diarrhea was 3.6% to 14.3%, and constipation was 32.1% to 0% (p=0.035). Normal intestine function was more frequent and increased during the study (p=0.001). Patients with diarrhea and constipation presented lower infusion speed, dietary volume and adequacy of total fibers (p<0.05). The daily medication was the only variable that remained associated to diarrhea (β=0.125;p=0.04) after multivariated analyses. Age (β=-0.021;p<0.001) and liquids (β=-0.001; p<0.001) were inversely associated to constipation. The use medicines that reduced intestine motility was also associated with constipation (p<0.001). The prevalence of patients without gastrointestinal dysfunction using fiber-enriched diet was more expressive during the study. Conclusion: Age, medication and liquids were associated to both diarrhea and constipation.