A 60-year-old lady with a past history of rheumatic mitral stenosis (MS), percutaneous valvuloplasty and persistent atrial fibrillation represented with heart failure. Cardiac ECHO confirmed severe MS, moderate tricuspid and aortic valve regurgitation and pulmonary hypertension. She underwent mitral and aortic valve replacements, a tricuspid valve repair and left atrial appendage clip. She developed a LV wall rupture and underwent repair of defect. Cardiogenic shock persisted despite IABP counter-pulsation and escalating inotropic support. Central veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and 9 days later, a percutaneous Protek Duo right ventricular assist device (RVAD) for RV failure afforded a successful outcome.

In this paper, we propose and study a (3+1)-dimensional generalized Hirota-Satsu-Ito equation, which is an important physical model. Here, by using the Hirota bilinear method, we derive its lump-type solutions, which are almost rationally localized in all spatial directions. The interaction solutions play an important roel in studying nonlinear phnoemnon, such as nonlinear optics. Thus, three kind of localized interaction solutions are constructed, respectively. In order to study the dynamic behaviours, numerical simulations are implemented, which show that there are two interesting physical phenomen: one is that fission and fusion ohenoenon happen during the collision; the other is that rogue wave phenomena is triggered by the interaction between a lump-type wave and a soliton wave (see Figure 2). The proposed (3+1)-dimensional model and results obtained can be applyied to the research on other nonlinear localized waves.

A model for one-dimensional bistable systems characterized by a deformable double-well energy landscape, is introduced in order to investigate the effect of shape deformability on the order of phase transition in quantum tunneling, and on the quasi-exact integrability of the classical statistical mechanics of these systems. The deformable double-well energy landscape is modelled by a parametrized double-well potential possessesing two fixed degenerate minima and a constant barrier height, but a tunable shape of its walls which affects the confinement of the two wells. It is found that unlike bistable models involving the standard $\phi^4$-field model for which the transition in quantum tunneling is predicted to be strictly of second order, a parametrization of the double-well potential also favors a first-order transition occurring above a universal critical value of the shape deformability parameter. The partition function of the model is constructed within the framework of the transfer-integral formalism, with emphasis on low-lying eigenstates of the transfer-integral operator. A criteria for quasi-exact integrability of the partition function is formulated, in terms of the condition for possible existence of exact eigenstates of the transfer-integral operator. The quasi-exact solvability condition is obtained analytically and from this, some exact eigenstates are derived at several temperatures. The exact probability densities obtained from the analytical expressions of the groundstate wavefunctions at different temperatures, are found to be in excellent agreement with the probability density obtained from numerical simulations of the Langevin equation.

In this work, we study the sufficient condition for convergence of the reduced differential transform method for non-linear differential equations. The main power of this method is its ability and flexibility in solving non-linear problems properly and easily and obtain solutions both numerically and analytically. Simple approaches of reduced differential transform method and the convergence results for different classes of differential equations such as linear and non-linear ordinary, partial, fractional, and system of differential equations are briefly discussed. Eight examples are checked to confirm convergence results as well as the strength and efficiency of the method.

This paper is concerned with stationary distribution and extinction of a stochastic SIQR epidemic model with media coverage which is disturbed by both white and telegraph noises. By using the stochastic Lyapunov function method, we obtain sufficient conditions for the existence of a stationary distribution of the global positive solution to the model. Then we establish sufficient conditions for extinction of the disease. A stationary distribution means that all the individuals can be coexistent and persistent in the long term. Finally, numerical simulations are introduced to illustrate our theoretical results.

By using Schaefer's fixed point theorem combined with the selection theorem of Bressan and Colombo for lower semi-continuous maps with decomposable values, we prove the existence of solutions for a rst-order differential inclusion system . and also we prove a Filippov-Gronwall type inequality for solutions for this problem type. We end our work by some examples about drilling model systems to give some conditions for existence of solution.

In this paper, we apply the $\tan(\circleddash/2)$ expansion and the Kudryashov general approaches to the time fractional perturbed Radhakrishnan-Kundu -Lakshmanan (RKL) equation. These integration schemes provide a number of optical soliton solutions of the model. The solutions registered with constraint conditions on the parameters that follow their existence criteria. To the constraint conditions, the solutions offer various transmission signals through optical fibres, such as double periodic optical solitons, combo optical periodic and rogue waves, combo periodic and shock waves, combo periodic and solitons, and combo double singular solitons. Moreover, after interaction of rogue and periodic waves, it is shown that the rogue waves are going to diminish after a certain time keeping periodic nature of the interaction. In fact, interaction of periodic and rogue waves produces periodic rogue type breather waves, that indicates the amplitude of the rogue waves gradually decreases, and vanishes after a certain time. Some dynamical signals are plotted in the graphs by picking suitable values on the parameters.

In this paper, the authors obtain some new blow up criteria for the smooth solution to the three dimensional magnetic B\’enard equation without thermal diffusion in terms of pressure. We prove that if $\pi\in L^2(0, T; L^{\f3r}(\R^3))$ with $0

Purpose: To evaluate the effect of partial nephrectomy on renal function and to identify predictors of estimated glomerular filtration rate (eGFR) at six months after partial nephrectomy. Methods: Medical data of 154 consecutive patients who underwent partial nephrectomy for a renal mass between January 2015 and March 2020 were retrospectively analyzed. The primary outcome measure was eGFR at six months postoperatively. A non-linear regression analysis was performed to examine the association between primary outcome measure and candidate predictors. Results: Of the patients, 66 (42.9%) were females and 88 (57.1%) were males with a median age of 60 (range, 50 to 67) years. The median baseline eGFR was 90.40 (range, 74.96 to 102.97) mL/min/1.73 m2, while the median eGFR at six months was 77.12 (range, 61.06 to 91.93) mL/min/1.73 m2 (p<0.001). Baseline eGFR (=22.691, 95%CI: 18.821 to 26.460, when baseline eGFR levels change from 74.97 ml/min/1.73 m2 to 102.68 ml/min/1.73 m2, p<0.001) was found to be directly associated with the postoperative eGFR levels at six months. In contrary, advanced tumor size (=-3.168, 95%CI: -5.332 to -1.005, when tumor size levels change from 3 to 6 cm, p<0.001) and presence of hypertension ( = -3.479, 95%CI: -6.956 to -0.0031, p=0.049) were also found to be inversely associated with the postoperative eGFR levels at six months. Conclusion: Baseline eGFR values, tumor size, and presence of hypertension are significant predictors of eGFR values in the mid-term in patients undergoing partial nephrectomy.

Deep learning has the potential to revolutionize process analytical technology in the pharmaceutical industry. Here, we used Raman spectroscopy-based deep learning strategies to develop a tool for detecting microbial contamination. We built a Raman dataset for microorganisms that are common contaminants in the pharmaceutical industry for Chinese Hamster Ovary (CHO) cells, which are often used in the production of biologics. Using a convolution neural network (CNN), we classified the different samples comprising individual microbes and microbes mixed with CHO cells with an accuracy of 95-100%. The set of 12 microbes spans across Gram-positive and Gram-negative bacteria as well as fungi. We also created an attention map for different microbes and CHO cells to highlight which segments of the Raman spectra contribute the most to help discriminate between different species. This dataset and algorithm provide a route for implementing Raman spectroscopy for detecting microbial contamination in the pharmaceutical industry.

Abstract Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant disorder with tumor predisposition in the parathyroid gland, anterior hypophysis and pancreatic islet cells. Here we describe the first Costa Rican MEN1 case with a novel MEN1 mutation in a 37-year-old male with history of nephrolithiasis and recurrent hypoglycemia

We present the case of a patient with patch-stage mycosis fungoides who developed ulcerative tumors compatible with large cell transformation. Tumor cells were positive for CD30 and CXCR3 and negative for CCR3, and subsequently exhibited spontaneous regression. Thus, large cell transformation in early mycosis fungoides may not indicate poor prognosis.

Focused Intensive Care Echo (FICE) is recommended in critically unwell patients to assess haemodynamic status. In certain circumstances, FICE can also be used as a diagnostic tool. We present a case where FICE identified a large left atrial mass in an intensive care patient with acute hypoxia and thromboembolic sequelae.

We present the case of an adult patient with acute dyspnoea and stridor following thyroidectomy. After excluding other causes of postoperative stridor, we concluded the patient was suffering from laryngospasm due to hypocalcaemia secondary to postoperative hypoparathyroidism. It is important to consider hypocalcaemia as a differential diagnosis in stridor.

The biological father of an 11-year-old girl infects his daughter, who returns to her biological mother's family before the father's diagnosis. The daughter endures a 1-day, mild illness. However, despite close physical contact prior to and during the girl's illness, her mother, stepfather and 1-year-old half-brother were not infected.

This case showed that anticancer drug administration induces unhealthy subcutaneous tissue (thrombus or edema) without subjective symptoms, abnormal sign by palpation or inspection, which have an extravasation risk. Especially, short-term interval therapy such as a weekly chemotherapy have high risk for anticancer drug infusion to the risky site.

As microbiome research moves away from model organisms to wildlife, new challenges for microbiome high throughput sequencing arise caused by the variety of wildlife diets. High levels of contamination are commonly observed emanating from the host (mitochondria) or diet (chloroplast). Such high contamination levels affect the overall sequencing depth of wildlife samples thus decreasing statistical power and leading to poor performance in downstream analysis. We developed an amplification protocol utilizing PNA-DNA clamps to maximize the use of resources and to increase the sampling depth of true microbiome sequences in samples with high levels of plastid contamination. We chose two study organisms, a bat (Leptonyteris yerbabuenae) and a bird (Mimus parvulus), both relying on heavy plant-based diets that sometimes lead to traces of plant-based faecal material producing high contamination signals from chloroplasts and mitochondria. On average, our protocol yielded a 13-fold increase in bacterial sequence amplification compared with the standard protocol (Earth Microbiome Protocol) used in wildlife research. For both focal species, we were able significantly to increase the percentage of sequences available for downstream analyses after the filtering of plastids and mitochondria. Our study presents the first results obtained by using PNA-DNA clamps to block the PCR amplification of chloroplast and mitochondrial DNA from the diet in the gut microbiome of wildlife. The method involves a cost-effective molecular technique instead of the filtering out of unwanted sequencing reads. As 33% and 26% of birds and bats, respectively, have a plant-based diet, the tool that we present here will optimize the sequencing and analysis of wild microbiomes.

Mesenteric cysts are rare tumours that are difficult to diagnose given their vague symptomatology such as abdominal pain and nausea. Our case demonstrates a patient presenting with suspected ureteric colic, whereby early imaging revealed this rarity

Neoplastic meningitis remains a diagnostic challenge due to its varied clinical manifestations. We discuss a presentation with dizziness with an initial diagnosis of Benign Paroxysmal Positional Vertigo. We highlight the hallmark findings and reflect on how clinicians may miss evolving features in recurrent attenders due to ‘anchoring’ to previous diagnoses.

Key pointsQuestionWhat are the specific experiences of olfactory disorder patients affected by the qualitative symptoms of parosmia and phantosmia including both triggers for symptoms and self-help measures they have tried?FindingsParosmia was reported as a daily symptom in 67% compared to 31% for phantosmia. Only 4% of respondents reported having received any successful treatment for their qualitative symptoms and 58% reported having received no treatment whatsoever. Stimulating the nose with other smells was the most common self-management method despite 61% stating external odours as triggers for their symptoms.MeaningThe duration of qualitative olfactory symptoms, the relative lack of interest from medical professionals and the lack of therapeutic options for them mean there is a significant burden for these patients and further research for treatment options and coping strategies is needed.

IntroductionBackground and rationaleSmell is the forgotten sense; even when facing a problem with their sense of smell, patients often struggle to get recognition, let alone diagnosis or treatment from healthcare professionals. Olfactory disorders are as common as profound hearing loss and blindness affecting an estimated 5% of the population1. Common causes of olfactory disorders include chronic rhinosinusitis, post-viral olfactory loss and post-traumatic olfactory loss2 as well as it being present in the majority of cases of Parkinson’s disease and common in Alzheimer’s disease. We are now also witnessing the rise of sudden onset anosmia as a marker of Covid-19 coronavirus infection3-9. It remains to be seen how many new cases of lasting olfactory loss will arise from those afflicted by the pandemic.Recent population studies have now identified anosmia as an independent risk factor for shortened longevity, even after controlling for dementia and cardiovascular disease10-13. It is not clear why this is so but may suggest that the olfactory system acts as a barometer of environmental impact on the central nervous system as a whole. As this phenomenon has been observed in several countries it clearly demonstrates that olfactory disorders deserve to receive greater attention than they currently do.Taste is often thought to be lost by those affected by olfactory disorders due to the misperception of retronasal olfaction as a “taste” sensation. In reality only a small percentage of people reporting a problem with their sense of smell or taste experience a true gustatory disorder, but due to this common misperception alongside the need to be representative of all patients with chemosensory disorders, it is always important to encapsulate both senses within any work of this kind.Fifth Sense, the UK charity for people affected by smell and taste disorders, was founded in 2012 when authors DB and CP met and agreed on the need for patient advocacy to tackle the unmet needs of patients affected by olfactory disorders. Since then, with the help of a growing membership, we have been able to characterise the significant impact of olfactory disorders on those affected14,15 and we have also become aware of the frustrations many members in their dealings with the medical profession and getting their sensory loss taken seriously15-17. In 2019, Fifth Sense was awarded a National Lottery Grant for £238,815 to enable it to develop and grow its work, including the establishment of a network of patient support hubs.ObjectivesFollowing on from the above, this study aimed to characterise the details of the difficulties faced by patients with olfactory disorders in accessing healthcare as a patient and public co-production18. This will help us jointly address these issues through the work of the National Lottery Grant in 2020-2023.

Abstract Objective To find some plasma differential proteins in Bronchopulmonary dysplasia(BPD) sensitive to dexamethasone therapy.Methods 30 cases of BPD from NICU of the affiliated Huaian first people’s hospital of Nanjing Medical University were selected,the plasma samples were collected before a 10-day course dexamethasone therapy for all objects,and the therapeutic effect was judged sooner after the therapy finished.The infants who showed significant therapeutic effect were collected the plasma samples again.Then,3 infants were picked at random from the dexamethasone sensitive infants ,whose plasma samples before and after dexamethasone therapy were analyzed by DIA,and the differential proteins were found and analyzed by bioinformatics.Results 10 of 30 cases were sensitive to dexamethasone.There are 23 differential proteins between two groups(before and after dexamethasone administration) in total, from which, 27 proteins are downregulated,while 6 upregulated. Bioinformatics analysis showed that differential proteins may involve multiple genes and signal pathways..When combined with literature retrieval,both low-density lipoprotein receptor-related protein 1(LRP1) and S100A8 might be consindered as potential targets for dexamethasone intervention of BPD.Conclusion We found the differential proteins related to the sensitivity to glucocorticoids for BPD, which will provide the direction for the choice of glucocorticoids in the treatment of BPD .

A document by Reza Adelkhani. Click on the document to view its contents.

In this paper, we introduce two simple inertial algorithms for solving the split variational inclusion problem in Banach spaces. Under mild and standard assumptions we establish the weak and strong convergence of the proposed methods, respectively. As theoretical realization we study existence of solutions of the split common fixed point problem in Banach spaces. Several numerical examples in finite and infinite dimensional spaces compare and illustrate the performances of our schemes. Our work generalize and extend some recent relate results in the literature and also propose a simple and applicable method for solving split variational inclusions. .2in _2000 Mathematics Subject Classification:_ 65K10; 65K05; 47H10; 47L25. _Keywords:_ Split variational inclusion problem; inertial technique; Banach spaces.