Background and Purpose. Since the onset of COVID-19 many clinical trials of drugs and/or vaccines are continuing and new ones are introduce daily. Yet the international research process failed to develop a preventative vaccine or potent therapeutic drugs for relieving the severity of the disease. Therefore, at present the best recommendation to people to slow the spread of the disease is; please stay at home and maintain social distancing! Experimental approach. Many aspects of pharmacotherapeutic mechanism of action of some previously approved drugs with anti-inflammatory effects, such as colchicine, in various disorders is not fully understood. Therefore, many potential therapeutic uses for these drugs and its analogues can be imagined. In this hypothesis article, an attempt has been made to evaluate some potential therapeutic effects of colchicine that may be benefit against COVID-19. Key Results. Prophylactic therapy with colchicine regulates the innate inflammatory response by blocking intracellular signaling pathways. This can inhibit respiratory alveolar destruction following COVID-19 pneumonia, which is the main cause of ARDS and death in these patients. Conclusion and Implications Since the macrophage and granulocytes are the main pro-inflammatory mediators in the lung, it seems application of therapeutic doses of colchicine, before the onset of respiratory problems, will protect the lung against severe damages and respiratory failure in COVID-19 patients. Obviously, many clinical trials are required to prove the validity of this claim.

Intestinal pseudo-obstruction (IPO) is defined as an intestinal obstruction without mechanical obstructive lesion. It’s a rare complication of systemic lupus erythematosus (SLE). We report a case of SLE inaugurated by IPO to emphasize the importance of early recognition of the diagnosis especially that SLE-related IPO responds well to corticosteroid therapy.

A document by Katherine Carvalho. Click on the document to view its contents.

In recent decades, the world has experienced several emerging virus outbreaks, among which the most recent compromise the respiratory system and are caused by the SARS-CoV2 coronavirus, H1N1, H5N1 viruses, and the H7N9 virus of the severe acute respiratory syndrome (SARS). In this article, we present epidemiological dynamics based on a SIR-type model with nonlinear incidence rates that reflect the impact of the media and the psychological effects on the spread of the disease. The mathematical model of the problem corresponds to a three-dimensional non-linear ODE system. The Rach-Adomian-Meyers (MDM) decomposition method is used to compute an approximation to the solution of the governing system of non-linear differential equations. The present proposed approach is based on dividing the entire domain into subintervals. In each subinterval, the 12-term MDM solution is sufficient to obtain fairly accurate and convergent results.

Aim of the presented study is to investigate the numerical solution of fifth-order nonlinear Lane-Emden (LE) based singular system at the origin with different shape factors developed on the analogous pattern of standard second order LE equations. The stochastic neuro-evolution computing is exploited for numerical outcomes by using the artificial neural networks (ANNs) for applicable mapping and learning of decision variables with integrated meta-heuristics of genetic algorithms (GAs) for global search aided with the rapid local search of active-set (AS) i.e., ANN-GA-AS algorithm. The designed numerical computing approach ANN-GA-AS implemented effectively for solving fifth-order nonlinear LE singular system and results of statistical assessments further authenticate the accuracy, convergence, and stability.

In this paper, we consider a nonlinear viscoelastic problem with infinite history and a nonlinear feedback localized on the domain and a relaxation function satisfying $$g^{\prime}(t) \le -\xi(t)G(g(t)).$$ We establish explicit and general decay rate results, using the multiplier method and some properties of the convex functions. Our results are obtained without imposing any restrictive growth assumption on the damping term and without imposing any assumption on the boundedness of initial data used in many earlier papers in the literature.

In this article, the notion of BL-function on a nonempty set P will be studied and for an arbitrary BL-algebra L and the element l ∈ L, the notions of l-functions and l-subsets will be introduced. Moreover, using these notations, the BL-code CL introduce and some related properties and examples will be provided. Finally, I show that the structure of a BL-algebra and the correspondence BL-code are the same.

In the present article, we implement a new numerical scheme, the quasilinearization semiorthogonal B-spline wavelets method, combining the semiorthogonal B-spline wavelets collocation method with the quasilinearization method, for a class of the multi-term nonlinear fractional order equations. The fractional order equations contain Riemann-Liouville fractional integral operator and Caputo fractional differential operator. The quasilinearization method is firstly utilized to convert the multi-term nonlinear fractional order equation into a multi-term linear fractional order equation, which is solved by means of semiorthogonal B-spline wavelets subsequently. Herein, we investigate the operational matrix and the convergence of the proposed scheme. Several numerical results are given to confirm the accuracy and efficiency of our scheme.

In this paper, a new adaptive-node refinement algorithm for multiquadric (MQ) method applied to nearly singular PDEs, has been presented. Besides, for the first time, the concept of the gradient has been employed in the refinement index. Regions with high gradients are identified based on the average value of the proposed function solution. The solution is approximated using a first-order derivative of interpolation with MQ. In the framework of the adaptive algorithm, the average of the proposed function was used as an indicator that determines where the point distribution can be refined and nodes can be added or removed based on this indicator. Different applications of the proposed adaptive algorithm are investigated through numerical examples. It has been revealed that the proposed algorithm is able to identify the singularities both in the domain and near boundaries and the numerical results of the MQ method confirm the accuracy and efficiency of the algorithm. The main advantage of this algorithm is that in the first steps, the regions with high gradients are identified correctly and the convergence speed of the algorithm increases continuously.

Background: Office based laryngeal procedures have dramatically changed the management of many laryngeal procedures. Such practice offers advantages to patients, surgeons and institutions. From patients perspective it has the benefit of eliminating the risk of general anaesthesia completely, most especially in patients with significant co-morbid conditions, or those in need of repeated procedures as recurrent laryngeal papillomatosis. Moreover, it allows titration of amount of injection required during vocal fold injections as it’s effect on patients voice can be instantly heard and assess during injection. This also minimise the risk of over injection and stridor. In addition, it is cost-effective to institutions and saves theatres’ slots. It also allows patients to return to normal activities sooner compared to surgery under a general anaesthesia. Aim: Review of outpatient based laryngology procedures in Manchester Royal infirmary and determining patients’ tolerance to outpatient procedures using pain score for the nose and throat. Study Design: This is a retrospective study of the outpatient based laryngology procedures under local anesthesia in Manchester Royal Infirmary, Department of Ototrhinolaryngology, Head and Neck Surgery from January 2018 till June 2019. Results: Eighty-eight outpatients procedures recorded during that time period, including trans-nasal laryngoscopy laser vocal fold procedures, biopsies, vocal fold injections augmentation, trans-nasal oesophagoscopy and biopsy, and balloon dilatation. Other procedures recorded were laryngeal EMG and Trans-nasal oesophagoscopy and tracheo-esophageal puncture for speech valve insertion. Average pain scores from all procedures according to pain score from 0-10, revealed average score of 2.71 ±0.87 in the nose and 3.35 ±0.99 in the throat. There were no recorded complications. Conclusion: Laryngeal outpatients procedures are generally safe to perform and well tolerated by patients. In addition to being cost-effective for hospitals and institutions. Keywords: Office based procedures, Trans-nasal laryngoscopy, Balloon dilatation, Vocal fold Injection, Office based laser procedures

Introduction: It is an established practice to use non-EPI DWI MRI scans to detect the presence of cholesteatoma post operatively. In the present era of Covid-19 where routine surgery to remove cholesteatoma has been suspended resulting in potentially unprecedented demands on the service, a review of serial MRI scans performed over a 7 year period was undertaken to determine the rate of growth of cholesteatoma. Materials and methods: A retrospective longitudinal study identified 24 middle ear cholesteatomas in 17 patients with serial non-EPI DWI MRI scans (having excluded those having surgical intervention between scans) for a median period of 33 months (range of 6-91 months). Cholesteatomas were measured by the first author and by the consultant radiologist. Results: Of 24 cholesteatomas, 1 resolved completely, 5 reduced, 6 stayed the same size, 4 grew slowly and 8 grew significantly. Conclusion: Non-EPI DWI MRI scans to determine cholesteatoma growth in asymptomatic ears is useful in triaging patients in the Covid-19 era. Key words: Cholesteatoma MRI scans covid-19

Inducible lysine decarboxylases (LDCs) are essential in various cellular processes of microorganisms and plants, especially under acid stress, which induces expression of genes encoding LDCs. In this study, a novel Serratia marcesenes LDC (SmcadA) was successfully expressed in E. coli and structural modeling showed the protein as a decamer with a molecular weight of approximately 75 kDa. Further structural analysis of the protein network interactions showed that specific N-terminal and C-terminal residues with significant node size-degree correlation and high color intensity possessed high values of betweenness, suggesting they played a key role in protein function and activity. Molecular dynamics simulations further revealed that hydrogen bonds were vital interactions for stabilization of cofactor PLP and formation of intermediates, hence improved biocatalysis. Furthermore, mutations coffered structural changes of the protein residues and PLP hence altered the type of interacting residues with the ligand, causing changes in conformation of PLP. Moreover, temperature also induced changes in orientation of cofactor PLP and amino acid residues. This work therefore demonstrates the role of protein-ligand interactions in altering cofactor and binding site residue conformations thus contributing to improved biocatalysis.

Objective: We hypothesized that neuromuscular retraining therapy combined with botulinum toxin injections (NMRT-B) could enhance the effectiveness of treatment for facial problems caused by facial paralysis. Also, we developed a new method to evaluate facial functions in a detailed, accurate, and objective manner. Methods: It has been recommended that patients with one-sided facial paralysis that does not resolve for more than 6 months undergo scheduled treatment with NMRT-B. The patients were scheduled to begin NMRT after 1–2 weeks of botulinum toxin A injection on the affected side and/or on the unaffected side. The second botulinum toxin A injection was conducted at 6 months after the first injection, and NMRT was continued for more than 6 months. And we used a computer-based numeric scoring system alone to confirm facial functions. Results: Most patients with chronic facial paralysis who underwent NMRT-B treatment exhibited better results after 1 year. NMRT-B provided satisfactory control of synkinesis as well as primary movement. Using our method for evaluation of facial asymmetry, the average primary facial function movement score was calculated as 57.3 (0.573), average secondary facial function movement score was 14.2 (0.142), and average final facial function movement score was 43.1 (0.431) before treatment Conclusions: We demonstrated that NMRT-B was effective for patients with synkinesis and facial asymmetry and that the results differed depending on the degree of facial paralysis. We also established a method to evaluate facial paralysis in an objective manner that excludes subjective judgment.

Endometriosis is often described as a chronic condition. Surgical or medical treatment approaches do not cure it, and recurrence of the disease or its symptoms is common. Medical treatment is usually used to achieve symptomatic control whilst surgery aims to eliminate the visible lesions. However, recurrence is frequently seen even after very radical surgery.Endometriomas are frequently used for diagnosis and as a marker of recurrence due their easy recognition on imaging. In this issue of BJOG, Wattanayingcharoenchai et al (BJOG 2020 xxxx) present their systematic review and network metaanalysis (NMA) on the efficacy of postoperative medical therapies in reducing endometrioma recurrence with some mixed messages. They conclude that evidence from randomised controlled trials (RCTs) do not support the use of postoperative hormonal therapies, whereas data from cohort studies indicate a significant protective effect of levonorgestrel intrauterine system (LNG-IUS) followed by dienogest, gonadotrophin releasing hormone agonists (GnRHa) + LNG-IUS, continuous and cyclical oral contraceptives (OC). The most effective postoperative therapy (although non-significant) was GnRHa+LNG-IUS, followed by continuous OC and GnRHa based on RCTs.Direct meta-analysis of RCTs in the Wattanayingcharoenchai et al. article indicate an approximately 40-50% reduction with OCs but this remained statistically non-significant. This finding is in contrast to an earlier meta-analysis (Vercellini et al. Acta Obstet Gynecol Scand. 2013;92:8-16) which concluded that the postoperative OC use dramatically reduced the risk of endometrioma recurrence and international guidelines that recommend use of hormonal contraceptives for the secondary prevention of endometrioma (Dunselman et al. Hum Reprod. 2014;29:400-12). So what are we to believe and what should we advise women affected by endometriosis to do?There is a wide variation in the design of studies on which metaanalyses and the current NMA are based on in terms of inclusion criteria, duration of treatment and definition of recurrence. Some studies allocate the participants on the basis of their disease stage without taking the preoperative cyst size and bilaterality into account. The definition of a ‘recurrent cyst’ varies from ‘no definition’ to endometrioma of > 1 cm or >3 cm. These introduce significant heterogeneity which potentially compromise the validity of any meta-analysis. Furthermore, there is also a conceptual difference between using medical treatment (e.g. GnRHa) for 3-6 months postoperatively and continuing with therapy (e.g. hormonal contraceptives) in the long term and assessing the recurrence rates at 1-5 years. In fact the ESHRE guideline (Dunselman et al.) proposed distinguishing postoperative adjunctive treatment of < 6 months that aims to improve the outcome of surgery and longer treatments with the intention to reduce recurrences (secondary prevention). The former may have a significant side effect profile whereas the latter has a good safety record.It is very plausible that suppression of ovulation and reducing/eliminating menstrual flow in the long term would reduce recurrences. The current literature is too heterogeneous and fragmented to confirm or refute this. Properly designed large scale studies with the required power are still required. The Pre-Empt trial which is currently ongoing in United Kingdom may give some of the answers.Disclosure of interest: None. A completed disclosure of interest form is available to view online as supporting information.

Acute myocardial infarction (AMI) in teenagers and young adults is an uncommon phenomenon. The etiology and pathophysiology of AMI in this age group is different than the AMI in older population. We report an interesting and rare case of AMI in a teenage girl due to occlusion of LMCA

A 70-year old patient with chronic atrial fibrillation, a large atrial septal defect (ASD) and severe tricuspid regurgitation of rheumatic aetiology was admitted to our unit for elective surgery, through a mini right thoracotomy (RT).

This paper is devoted to invest an optimal investment strategy for a defined-contribution (DC) pension plan under the Ornstein-Uhlenbeck (O-U) process and the loan. By considering risk-free asset, a risky asset driven by O-U process and a loan in the financial market, we firstly set up the dynamic equation and the asset market model which are instrumental in achieving the expected utility of ultimate wealth at retirement. Secondly, the corresponding Hamilton-Jacobi-Bellman(HJB) equation is derived by means of dynamic programming principle. The explicit expression for the optimal investment strategy is obtained by Legendre transform method. Finally, different parameters are selected to simulate the explicit solution and the financial interpretation of the optimal investment strategy is given.

A way to obtain approximate periodic solutions to nonlinear oscillators arising in a micro-electro-mechanical system (MEMS) is presented for the case of zero initial conditions and magnetostatic excitation. The frequency-amplitude relationship is derived by adopting He’s frequency formulation. The obtained analytical results are illustrated graphically. The proposed simple approach gives the fast insight into the dynamics of the singular oscillator and can be useful for design of MEMS devices.

Objective: To investigate the epidemiology of acute kidney injury and to clarify the risk factors associated with the prognosis of acute kidney injury in critically ill patients in the Gansu Province.Methods: This was a multicenter, retrospective study. The clinical data of all patients from January 1, 2017, to December 31, 2019, in the intensive care unit of the selected hospitals were screened. Descriptive statistical analysis was performed first, and then the patients were divided into a survival group and a nonsurvival group based on survival status at discharge. RESULTS: (1) Among the 8106 patients admitted, a total of 3019 patients were excluded according to the exclusion criteria. Among the included patients, 890 patients met the diagnostic criteria for AKI, with an incidence of 17.5% and mortality of 41.3%. Among the selected AKI patients, AKI stage I accounted for 22.02%, AKI stage II accounted for 31.01%, AKI stage III accounted for 46.97%, and 35.8% of the AKI patients received renal replacement therapy. The higher the AKI stage was, the higher the percentage of renal replacement therapy use. (2) Logistic regression analysis showed that sex, age, AKI stage, RRT, infection, cardio-pulmonary resuscitation, cardiac output, mechanical ventilation, diuretics, white blood cells, platelets, blood urea nitrogen, prothrombin time and activated partial thromboplastin time were significantly associated with the prognosis of acute kidney injury (P <0.05). Further analysis showed that male sex, old age, high AKI stage, RRT treatment, low cardiac output, mechanical ventilation, elevated leukocyte count, reduced platelet count and reduced serum albumin were independent risk factors for a poor prognosis of AKI. Conclusions: Data from several representative general hospitals in the Gansu Province showed that the incidence and mortality of acute kidney injury in intensive care units were still very high. Sepsis and septic shock are the main causes of AKI.

A strategy is devised to make the WENO interpolation in the point values achieve optimal accuracy near the discontinuities. The classical WENO interpolation ensures the optimal accuracy when all stencils are smooth and ENO property when the discontinuity appears. When there exist more than two successive smooth stencils, the maximum theoretical accuracy near discontinuity is also preferred to be obtained. To achieve it, we divide the classical WENO algorithm into several sub-WENO procedures. In each sub-WENO procedure, only two stencils are used and the order of accuracy grows one at most. If both stencils are smooth, then sub-WENO procedure increases the order of accuracy by one. If there is a stencil is smooth and the left one is non-smooth, then algorithm conserves the order of interpolation by corresponding smooth stencil and keeps the ENO property. If both stencils are non-smooth, then the value constructed by sub-WENO procedure will be ignored in the latter procedures. The whole of new WENO algorithm can be expressed as a tree structure. The indicator of smoothness of every medium stencil in the tree structure is defined by the indicators of smoothness of corresponding stencils on the top of tree. Such definition is proved to be capable of obtaining the optimal accuracy and keep the ENO property. And the new WENO algorithm has almost the same computational cost as the classical WENO algorithm.

The present work is concerned with the well-posedness and efficient numerical algorithm for a terminal value problem with a generalized Caputo fractional derivative. We investigate the existence and uniqueness of the solution of the terminal value problem, and consider the continuous dependence of the solutions on the given data. To illustrate our theoretical results, we present a one step algorithm for solving the considered problems. Some numerical examples are shown to illustrate the theoretical results and the efficiency of the numerical method.

In this paper, a novel numerical method for solving the optimal control problems (OCPs) are presented. This method uses Genocchi polynomials. Some properties of Genocchi polynomials are given and the operational matrix of derivative is constructed. This matrix helps us to convert the nonlinear constrained optimal control problem to the nonlinear programming one that can be solved by Maple programming software. The presented method is applied on some numerical examples in order to show its advantages.

In this note, we show that the Hausdorff operator $H_{\Phi}$ is unbounded on a large family of Quasi-Banach spaces, unless $H_{\Phi}$ is a zero operator.

In this paper we study exact boundary controllability for a linear wave equation with strong and weak interior degeneration of the coefficients in the principle part of the elliptic operator. The objective is to provide a well-posedness analysis of the corresponding system and derive conditions for its controllability through boundary actions. Passing to a relaxed version of the original problem, we discuss existence and uniqueness of solutions, and using the HUM method we derive conditions on the rate of degeneracy for both exact boundary controllability and the lack thereof.