Background: Selective IgM deficiency (sIgMD), classified under primary immunodeficiencies, is characterized by low serum IgM(<2SD for age), normal IgG and IgA levels. The aim of this study was to define immunologic and clinical features of sIgMD. Method: We assessed a retrospective medical record of patients who fullfilled the criteria for sIgMD in a Pediatric Immunology department. Results: There were 55 patients with sIgMD. Out of 55 patients, thirteen(23.6%) diagnosed with a well-defined primary immunodeficiency (PID) during the follow-up.The ratio of the sIgMD was %0.12 in the out-patient clinic of pediatric immunology. Out of 33 patients, 8(23.5%) were asymtomatic during the follow-up period. Fifteen(45.4%) patients presented with several type of infections). Six patients (18%) had chromosomal anomaly, or syndrome (trisomy 21, 22q11.2 deletion 1p deletion, CHARGE syndrome, and Cohen Syndrome). Six (18%) had autoimmune/inflammatory diseases, such as Behcet’s disease, immune thrombocytopenic purpura, Crohn disease, Guillain Barre syndrome, and diabetes mellitus. Five(15%) had allergic disorders. Three(9%) have developed malignancy. The diagnoses of thirteen PID patients were combined immunodeficiency, common variable immunodeficiency, autoimmune lymphoproliferative syndrome, chronic granulomatous disease, adenosine deaminase deficiency, and congenital neutropenia. Genetic disorders, autoimmune/inflammatory and allergic diseases may accompany sIgMD. Approximately one third of the patients were asymptomatic in our series. Malignancy risk is relatively increased. We observed that an important ratio of patients with low IgM (23.6%) got sooner the diagnosis of a specific PID in the follow-up period. Conclusion: Thus, patients with sIgMD should be followed regularly in immunology clinics.

Background:The inappropriate mechanical ventilation strategy could improve the mortality rate of patients with influenza A-associated ARDS.Therefore, clinical data are needed to support the timing of NIV therapy for patients with influenza A-associated ARDS. Methods: For this retrospective cohort study, data were obtained from the Fuzhou Pulmonary Hospital of Fujian, China. Differences in baseline factors, risk factors, and outcome parameters were studied between patients with and without invasive mechanical ventilation. Results: Among this cohort, 24 patients received successful NIV with an average age of (57.96±17.08) years. NIV failure occurred in 21 patients with an average age of (54.19±14) years. Mortality data were obtained for the successful NIV group and the mortality rate was lower than in the failed NIV group [4.17%vs42.86%, X2=7.591, P = 0.003]. The independent risk factors for the success of NIV were APACHE II score and LDH (OR=1.830, 95%CI 1.105-3.032 and OR=1.011, 95% CI 1.001-1.020, respectively). When the OI is <95 mmHg, APACHE II>19 and LDH>498U/L, the sensitivity and specificity of predicting failed NIV were [66.67% (95% CI 43% - 85.4%) , 87.5% (95% CI 67.6% - 97.3%)], [85.71% (95% CI 63.7%-97%), 79.17% (95% CI 57.8%-92.9%)] and [90.48% (95% CI 69.6%-98.8%), 62.5% (95% CI 40.6%-81.2%)], respectively. Conclusions: Overall, patients with influenza A-associated ARDS receiving successful NIV have lower mortality rates than those for whom NIV failed. Independent risk factors for successful NIV are LDH and APACHE II scores.Invasive mechanical ventilation can possibly be avoided in some patients with 200 mmHg > OI > 95 mmHg.

Polycythemia vera (PV) characterize by an increase in RBCs and hemoglobin concentration. The typical presentation of PV is a plethora and thrombosis. Sites of thrombosis are Lower limbs. Rare sites of thrombosis are sagittal sinus. We report a case of 52 years old women with polycythemia complicated with sagittal thrombosis

Sexual armaments are usually structures or other traits used during agonistic displays that evolve by intrasexual competition. The role of parasites in their evolution remains obscure. We investigated the relation of infection by three parasites with the agonistic behavior of males Sceloporus occidentalis in male contests staged in the lab. The rivals' both behavior and blue patch chroma best predicted the aggression intensity of focal males. Infections by haemococcidians and ticks also contributed to explain the intensity of aggression in focal males. Lizards with fewer ticks engaged in more intense fights, while lizards with more ticks or haemococcidians were less aggressive. Interestingly, males with lower blue chroma were infected by intestinal coccidians and received more aggression. This study reveals direct roles for ticks and haemococcidians in male competition, and an indirect role of intestinal coccidians mediating sexual selection of a color armament in lizards.

Species redistributions are causing novel interactions and leading to profound regime shifts globally. In temperate reefs, the range expansion of tropical herbivorous fish has been linked to the disappearance of temperate kelps, but consequent effects on resident fish communities are not clear. Here, we show overall increases in species richness and abundance (measured as probability of occurrence) of both tropical and temperate fishes identified on video surveys over a 17-year period of kelp loss. Tropical herbivores increased most markedly as kelp declined, while temperate planktivores declined, a potential consequence of tropicalisation not previously identified that suggests important changes to energy pathways. We identified 22 tropical and temperate species from four trophic guilds that significantly increased in occurrence, and only four temperate species that declined. Morphological trait space models suggest increases in fish diversity and overall occurrence are unlikely to be driven by uniqueness of traits amongst tropical range expanders.

We present a class of higher-dimensional Hilbert-type inequalities on a fractal set $(\mathbb{R}_+^{\alpha n})^{k}$. The crucial step in establishing our results are higher-dimensional spherical coordinates on a fractal space. Further, we impose the corresponding conditions under which the constants appearing in the established Hilbert-type inequalities are the best possible. As an application, our results are compared with the previous results known from the literature.

Chronic obstructive pulmonary disease (COPD) often tends to respond poorly to glucocorticoid (GC) therapy. Reduced Histone deacetylase-2 (HDAC-2) activity is an important mechanism behind this GC insensitivity. In this study, we investigated the effects of three phosphodiesterase inhibitors (PDEIs), with anti-inflammatory propensity, on cigarette smoke (CS) induced pulmonary inflammation and HDAC-2 activity. Male C57BL/6 mice were exposed to cigarette smoke (CS) over the course of 30 weeks. Administration of the PDEIs commenced from the 29th week and followed a schedule of once daily treatments, 5 days a week, for 2 weeks. Roflumilast (ROF) was administered intragastrically (5 mg·kg-1), while pentoxifylline (PTX) (10 mg·kg-1) and theophylline (THEO) (10 mg·kg-1) were administered intraperitoneally, either alone or in combination with a GC (triamcinolone acetonide or TRI, 5 mg·kg-1, i.m., single injection). Lung morphometry, as well as the activity of HDAC-2, pro-inflammatory cytokines and reactive oxygen species (ROS) were assessed at the end of the 30 week course. CS exposure was associated with a reduction in HDAC-2 activity and the up-regulation of ROS expression. PTX, ROF and THEO administration led to the partial restoration of HDAC-2 activity, however combining TRI to any of these PDEIs did not synergistically augment this effect. The restoration of HDAC-2 activity was favorably associated with the reduction of ROS expression.Inactivation of HDAC-2 due to long-term CS exposure is closely related to exaggerated oxidative stress, and this reduced HDAC-2 activity could partially be restored through the use of PDEIs. This finding provides a potential novel approach for further clinical research.

Rationale, aims and objectives Patients with anterior crucial ligament injury are faced with a choice between surgery or non-surgical treatment with intensive rehabilitation. Evidence shows that surgical treatment is not superior to non-surgical treatment. To offer patients a treatment meeting their individual values, lifestyle and conditions, patients must be involved in the decision-making. The aim of the study was to develop and evaluate a patient decision aid to support shared decision-making. Method Development of the patient decision aid was based on international criteria, current literature, and former patients’ experiences and suggestions on how to optimize the decision-making process. The patient decision aid was evaluated by the SDM-Q9 questionnaire and semi-structured interviews with patients and doctors. Results A patient decision aid for patients with and an anterior crucial ligament injury was developed. On a scale from 0-5, patients experienced a high degree of shared decision-making in their treatment decision both before (score 4.3) and after (score 4.3) implementation of the patient decision aid. No statically significant difference was found (p=0.72). From interviews, patients expressed that they found the patient decision aid very useful. Especially, reflection time was important for some patients. Doctors reported that the patient decision aid improved shared decision-making by supporting the dialogue clarifying patients’ values concerning issues important for treatment choices. Conclusion No statically significant difference in the SDM Q9 -score was found between patients’ perceptions of shared decision-making before and after implementation of a patient decision aid. However, patients experienced the decision aid as very useful when making treatment decisions, and doctors reported that it improved the dialogue clarifying patients’ values important for the treatment options. Keywords patient-centered care, evaluation, person-centered medicine

INTRODUCTIONPostpartum haemorrhage(PPH) is the leading cause of maternal mortality worldwide1 with about 35% of all maternal deaths globally attributed to it2 and the adverse effects more severe in the developing countries3. An African woman’s lifetime risk of dying from pregnancy-related causes is about 100 times higher than that of a woman in a developed country3. Every year, about 14 million women around the world suffer from postpartum haemorrhage4 with uterine atony being the leading cause of postpartum haemorrhage whatever the mode of delivery. Its severe forms are often unexpected and may occur in the absence of recognized risk factor5. Postpartum heaemorrhage occurs in 4-6% of deliveries6and it is severe in 1 to 2 percent of life births7.There are many management modalities for postpartum haemorrhage ranging from the conservative use of drugs like oxytocin, misoprostol etc to prevent it to more conservative uterine sparing surgeries and finally hysterectomy as the final treatment8,9. Uterine compression sutures have been shown to be effective in the management of postpartum haemorrhage10,11 with reported success rates ranging from 76% to 100% with an added advantage of preservation of the uterus12,13. This makes them proven as essential treatment options for postpartum haemorrhage.Apart from the B- Lynch sutures first reported in 199717, various methods of uterine compression sutures have been proposed and have yielded good outcomes with success rates of 76-100%12. In August 2020, the Esike’s technique of uterine compression method was published as a new, safe, simple and effective treatment for massive life-threatening postpartum haemorrhage5. Its use preserves the uterus and the success rate is 89 percent15.Despite the impressive effectiveness and safety of uterine compression suture methods, concern has been raised in some quarters concerning its safety and preservation of fertility. A few studies have reported that use of uterine compression sutures can lead to changes in fertility that might have effect on subsequent pregnancies16-18. This has made it imperative for any pregnancy outcome from such methods especially new ones like the Esike’s technique to be reported to the scientific community since subsequent pregnancies in women desiring more pregnancies is about the surest way of confirming, not just the safety and effectiveness of such methods, but also the usefulness of the preservation of the uterus that is amongst many other advantages that are inherent in the uterine compression methods of combating postpartum haemorrhage. We report a successful pregnancy outcome in a multipara with one previous caesarean section then who had placenta praevia type 4 and subsequently delivered by repeat caesarean section in her last pregnancy on 14 June 2017 and subsequently had life-threatening PPH that was controlled with the Esike’s technique with preservation of her uterus. She conceived and successfully delivered a life 3.7kg male baby with good outcome at term.

We report on pregnant woman affected by NF1 and HIV infection. So far, both NF1 and HIV in pregnancy had never reported. During 7-year follow-up, she experienced 4 pregnancies without any complication linked to NF1. The newborns were HIV-negative. A multidisciplinary counseling could improve ante and post-partum management.

Purpose:It is known that because of the pandemic, the psychosocial conditions of health workers have been affected and this carry the risk of increasing COVID-19-related mortality and morbidity by obstructing effective contact tracing. Purpose this study to determine anxiety disorders which may occur in primary contact tracers and family health center workers, and to determine their perceptions of institutional support and support from their coworkers. Results:It was found that 56.1% of participants had anxiety, 44.2% insomnia, 43.6% a low perception of organizational support, and 37.5% a lack of support from coworkers. Females and those with chronic illnesses had high levels of anxiety and insomnia and low perceptions of support from coworkers. Insomnia severity in contact tracers was high, and their support from coworkers was low. There was a positive correlation between anxiety and insomnia, and a negative correlation between organizational support and support from coworkers. It was shown in our study that sleep problems and a reduction in team and institution support increased anxiety, and reduced the team cohesion of field workers and trust in the institution. Because contact tracing is preformed independent of time, an increase in the frequency of contacts may cause anxiety and insomnia. High anxiety in females may be a result of a perception of low support from coworkers. Conclusion:Plans should be made to increase the effectiveness of training and support given to primary healthcare workers, and to operate speaking and reward mechanisms to increase motivation. For this the organizational strength of primary health care providers should be increased.

For nearly all organisms, dispersal is a fundamental life history trait that can shape their ecology and evolution. Variation in dispersal capabilities within a species exists and can influence population genetic structure and ecological interactions. In fungus-gardening (attine) ants, co-dispersal of ants and mutualistic fungi is crucial to the success of this obligate symbiosis. Female-biased dispersal (and gene flow) may be favored in attines because virgin queens carry the responsibility of dispersing the fungi, but a paucity of research has made this conclusion difficult. Here, we investigate dispersal of the fungus-gardening ant Trachymyrmex septentrionalis using a combination of maternally- (mitochondrial DNA) and biparentally-inherited (microsatellites) markers. We found three distinct, spatially isolated mitochondrial DNA haplotypes. Two were found in the Florida panhandle and the other was found in the Florida peninsula. In contrast, biparental markers illustrated significant gene flow across this region and minimal spatial structure. The differential patterns uncovered from mitochondrial DNA and microsatellite markers suggest that most long-distance ant dispersal is male-biased and that females (and concomitantly the fungus) have more limited dispersal capabilities. Consequently, the limited female dispersal is likely an important bottleneck for the fungal symbiont. This bottleneck could slow fungal genetic diversification, which has significant implications for both ant hosts and fungal symbionts regarding population genetics, species distributions, adaptive responses to environmental change, and coevolutionary patterns.

Peptide drugs are generally compounds with less than 100 amino acids connected by peptide bonds and having drug effects. Because of their unique advantages such as significant activity, strong specificity, and low toxicity, they are widely applied in the treatment of various diseases. The design and development of new peptide drugs have broad prospects, and determining the molecular characteristics of disease-related peptide drugs is the key to drug design. This research takes anti-cancer peptides and anti-hypertensive peptides as the research objects, and we propose a novel method of describing peptide drugs, making use of the topological attribute values in an amino acid interaction network to represent the characteristics of peptides. In addition, peptide drugs are described from different perspectives by combining the information of the primary, secondary and tertiary structures. Three algorithms including support vector machine (SVM), K-nearest neighbor (KNN) and random forest (RF) are utilized to train the model. Then the support vector machine based on recursive feature elimination method (SVM-RFE) removes redundant features and identifies the key characteristics of different types of drugs. The added network features can more comprehensively describe peptide drugs, providing a theoretical basis for the analysis and design of new peptide drugs. The web sever of ACHP is freely available at http://118.178.58.31:9801/.

Carcinoid disease is a rare neoplasm but it's an important etiology of intrinsic right heart valve disorders that leads to right heart failure. carcinoid heart involvement is a common complication of disease that effects on morbidity and mortality of the patient.

Introduction. Data regarding the left atrial (LA) electroanatomical substrate in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF) are missing. In this electroanatomical mapping (EAM) study, we evaluated the extent of LA fibrosis and its impact on catheter ablation outcomes in patients with HCM and AF. Methods. High-density LA EAM was performed during AF in 28 consecutive patients with obstructive HCM and AF (42.9% displayed paroxysmal AF and 57.1% persistent AF). After propensity matching (PS), 28 non-HCM patients with AF were selected, and served as controls. Two different cut-off values of bipolar signal amplitude were investigated for fibrosis characterization (≤0.25 mV and ≤0.4 mV). HCM patients underwent pulmonary vein antral isolation (PVAI) and roof line, while non-HCM patients PVAI only. Results. After the 3-month blanking period, 10 HCM patients (35.7%) displayed atrial arrhythmia recurrence. Univariate analysis revealed that the extent of LA fibrosis was the only predictor of AF recurrence. HCM patients with arrhythmia recurrence showed significantly greater low voltage areas defined as either bipolar voltage ≤0.25 mV (22.5±10% vs. 5.5±6.4%, p=0.001) or ≤0.4 mV (32±13.9% vs. 5.9±5.1%, p<0.001). The presence of low voltage areas ≤0.4 mV greater than 14.1% of the total LA area also predicted arrhythmia recurrence with excellent sensitivity (100%) and specificity (100%). After PS matching with non-HCM patients, patients with HCM exhibited wider fibrotic regions ≤0.25 mV compared to non-HCM patients (p=0.016). Conclusions. High-density EAM reveals extensive LA fibrotic disease in patients with HCM, an event with certain implications in catheter ablation outcomes.

Repeated homoploid hybrid speciation (HHS) events with the same parental species have rarely been reported. In this study, we used population transcriptome data to test paraphyly and HHS events in one conifer Picea brachytyla. All analyses identified and supported non-sister relationships for the two lineages of P. brachytyla. The southern lineage was placed within the re-circumscribed P. likiangensis species complex (PLSC) while P. brachytyla sensu stricto (s.s.), comprising only the northern lineage, parallels both PLSC and the closely related P. wilsonii. In addition, both phylogenetic and coalescent analyses suggested that P. brachytyla s.s. arose from homoploid hybrid speciation between the ancestor of the PLSC before its diversification (into the current varieties or species), and P. wilsonii, through an intermediate hybrid lineage at an early stage and backcrossing to the ancestral PLSC. These two parental ancestors also produced another homoploid hybrid species, P. purpurea, in the same way but at a later stage, through the same extinct lineage but backcrossing to the other parent, P. wilsonii. We reveal the first case that backcrossing to different parents of the same extinct hybrid lineage produced two different hybrid species. Our results highlight the existence of more reticulate evolution during species diversification in the spruce genus and more complex homoploid hybrid events than have previously been identified.

A mathematical model of simultaneous heat and mass transfer was presented to describe for the first time the effects of the variation in the characteristic parameters of the membrane during the VMD process on the permeation flux. The modelling approach was derived by dividing the module axially into multi-cells and a set of nonlinear simultaneous equations representing the VMD process were numerically solved via FSOLVE code. The validation of the presented model was estimated by simulation with a wide range of 135 diverse published experimental results related to the influence of various operating conditions, module properties, and membrane characteristics on the water permeation flux through the membrane. A good agreement was obtained between the experimental data and the results of the developed model. The same change in the membrane characteristics during the MD operation reported experimentally in the literature was confirmed by the simulation results of the developed model.

Many industrial processes such as metallurgical, chemistry, ceramic and cement industry often involve solid-solid reactions. To develop a quantitative representation of the solid-solid reaction of powders for the binary reactants system, the investigation of modelling which involved particle shape, surface area, particle size distribution and diffusion rate of reactants was carried out. In this model, the interface of particles were divided into reaction surface and non-reaction surface, and the particle shape was divided into the first level shape and the second level shape. The area of reaction interface was calculated, while the concentration distributions of reactants are numerically expressed. The simulated kinetics curves of fractional conversion α with time in different average particle size and in different diffusion coefficient were shown to be useful to evaluate the kinetics of solid-solid reactions. The simulated kinetics curves and experimental data from references were compared and it achieved good accuracy.

As an efficient approach to high-purity hydrogen, the sorption-enhanced steam reforming (SESR) is usually highly energy-intensive. Herein, the sorbent decarbonation was conducted in the presence of O2 to enable the exothermic reaction between CaO and cobalt oxides to form calcium cobaltate (CCO). By utilizing CCO as oxygen carrier (OC), the chemical looping methane combustion (CLMC) was employed prior to the SESR of glycerol (SESRG). The CCO was pre-reduced to generate a multi-functional material composed of metallic Co catalysts and CaO sorbent, which can significantly improve the H2 yield from SESRG. With a simple Pt-doped CCO acting as pre-catalyst, CO2 sorbent and OC, we realized 70% CH4 conversion and 96 vol.% H2 with 120% yield for 20 cycles. The promoting effects of Pt towards CH4 conversion and H2 production were rationalized by CH4-TPR, XPS, SEM and TEM. Our results demonstrate the feasibility of process integration and intensification enabled by multi-functional materials.

The hydrodynamics of gas-phase fluidized beds is non-ideal due to high velocity. Micro-fluidized beds have distinct flow patterns because of the wall and the diameter constrains bubble velocity. We measured the gas phase RTD in a 8 mm ID quartz tube loaded with fluid catalytic cracking catalyst (FCC). We devised a feed manifold to introduce a 4-component tracer gas as a bolus pulse. The FCC separated the gases based on diffusivity like chromatography. At ambient temperature, the trailing edge of CO, CH4, and CO2 have extended tails and an axial dispersion model accounts only for 92 % of the variance. We developed a model to characterize the tailing that includes diffusion from the bulk gas to the FCC pores and adsorption-desorption of the gas on the catalyst. This model accounted for 98.6 % of the variance in the RTD. At 300°C the tailing disappeared consistent with expectations in chromatography.

We describe a technique for particle-based simulations of heterogeneous catalysis in open-cell foam structures, which is based on isotropic Stochastic Rotation Dynamics (iSRD) together with Constructive Solid Geometry (CSG). The approach is validated by means of experimental results for the low-temperature water-gas shift reaction in an open-cell foam structure modeled as inverse sphere packing. Considering the relation between Sherwood and Reynolds number, we find two distinct regimes meeting approximately at the strut size Reynolds number 10. For typical parameters from the literature, we find that the catalyst density in the washcoat can be reduced considerably without a notable loss of conversion efficiency. We vary the porosity to determine optimum open-cell foam structures, which combine low flow resistance with high conversion efficiency and find large porosity values to be favorable not only in the mass transfer limited regime but also in the intermediate regime.

We describe a new computational method for the numerically stable particle-based simulation of open-boundary flows, including volume conserving chemical reactions. The novel method is validated for the case of heterogeneous catalysis against a reliable reference simulation and is shown to deliver identical results while the computational efficiency is significantly increased.

The aim of this study was to develop a prediction model and identifying relative important factors in the evaluation of moisture content of pharmaceutical granules using Artificial Neural Network (ANN) and Support Vector Machine (SVM) techniques for the data sets of Addis Pharmaceutical Factory (APF). Optimal models of ANN and SVM models were developed and compared, utilizing Matlab16.0 as a software tool. The performance of the models is evaluated using a quantitative error metric; mean squared error (MSE), Regression(R) and Confusion Matrix (CM). This study reveals that the ANN model is an optimal model for predicting moisture content of pharmaceutical granules for the datasets of APF. The model of ANN, with MSE of 0.016941 and classification accuracy of 98.7% is built and accepted as optimal model for predicting moisture content of pharmaceutical granules. Temperature, Mixer time, Initial moisture, air flow rate and drying time respectively are the most important factors in determining the moisture content of the granules.

In this paper, a dynamic biomass gasification model was developed based on the hybrid peripheral fragmentation and shrinking-core (HPFS) model. To improve the accuracy of syngas generation transient prediction, the chemical kinetic model was trained using global surrogate optimization techniques. The pre-exponential factors of kinetic reactions are calibrated under non-catalytic conditions, employing experimental transient data of syngas generation rate and compositions under different temperatures and gasifying agents. The DYCORS and GOMORS were employed as the numerical solvers for finding the global optimum solution of the pre-exponential factors. The calibrated kinetic models based on both single-objective and multi-objective approaches have been validated by experimental data in four different biomass gasification scenarios. The calibrated kinetic model shows an over 95% decrease in terms of integrated squared error (ISE)-based model mismatch when compared to the original kinetic model.