Nitrogen-fixing Nepalese alder (Alnus nepalensis D. Don.) is a fast-growing early successional species which often forms pure stands in areas affected by landslides and sometimes it occurs mixed with other species in the central Himalayas. In this study, we assessed the distribution of ecosystem carbon storage in plants and soil in a chronosequence of A. nepalensis forest stands in central Himalaya. We examined six forest stands: (1) A. nepalensis-early regeneration (AER) forest, (2) A. nepalensis-late regeneration (ALR) forest, (3) A. nepalensis- mature oak mixed (AMOM) forest, (4) A. nepalensis- mix with rhododendron (AMR) forest, (5) A. nepalensis –mix with old oak (AMOO) forest and (6) A. nepalensis-planted by the forest department in the degraded forest (APDF). The ecosystem C stock increased with an increase in stand total basal area (TBA). C storage in A. nepalensis tree biomass in different stand AER, APDF, ALR, AMOM, and AMR, AMOO, was 8.97, 51.41, 16.07, 53.74, 144.77, and 101.14 Mg ha-1, respectively. Soil organic C (SOC) in different soil depths in successional stages AER (0-10 cm), APDF (0-30 cm), ALR (0-100 cm), AMOM (0-100 cm), AMR (0-100 cm), and AMOO (0-100 cm) was 3.31, 31.21, 75.47, 157.04, 159.43 and 210.13 Mg ha-1, respectively, with decrease in SOC concentration with increasing soil depth. The ecosystem C storage averaged 15.85, 183, 216.26, 390.32, 403.66, and 500.08 Mg ha-1 in AER, APDF, ALR, AMOM, AMR, and AMOO sites, respectively. Overall, in A. nepalensis forest development markedly ameliorated both vegetation and soil succession in central Himalaya.

Population and conservation genetics seek to understand how adaptive diversity is shaped by the interweaving forces of molecular evolution in small and endangered populations. On the one hand, selection shapes variation, on the other hand, genetic drift impedes the selection by stochastic changes of allele frequencies. Drift is hypothesised to prevail if the population size is small. However, in practice empirical estimates of the population size are often challenging. Here we used island size as a proxy to population size to reveal the evolutionary constraints of molecular diversity in Toll-like receptors (TLRs) of mockingbirds (genus Mimus) inhabiting Galápagos islands. TLRs are crucial for pathogen recognition by host immunity and thus under various selection constraints. We focused on the interaction of drift and selection in TLR1B, TLR4, and TLR15 across 12 size-variable insular populations and compared them with the mainland population of the northern mockingbird (Mimus polyglottos), aiming to test if population size impacts selection efficiency. Nucleotide diversity positively correlated with the island size indicating an increasing effect of genetic drift in small populations. Despite this pattern, functional TLR properties were largely conserved, presumably due to purifying selection opposing drift independently on the island size. The degree of protein conservatism differed between the loci with TLR15 being the least conserved. Island colonisation did not lead to relaxed selection or to local adaptations. Together with the invariable physicochemical properties of the TLR variants, these observations imply that drift did not outweigh purifying selection despite restricted population size.

High temperatures (HTs) during the crop reproductive stage impact seed yield and quality. The changing climate will require consideration of the effects of repeated HT events following evidence for non-additive effects due to beneficial stress memory or amplification of individual event effects. Maturing seeds of the sulfur (S)-demanding crop, oilseed rape, were exposed to several HT sequences that varied in intensity, duration and frequency at the onset of seed maturation. The effects of these sequences in combination with two contrasting S supplies are reported. The results indicated that (i) as the number of HT days in a sequence increased, fatty acid (FA) concentrations decreased, the proportion of unsaturated FAs decreased, seed membranes were damaged, desiccation tolerance was lost, and dormancy increased, regardless of event intensity and (ii) a mild stress event prior to heat peaks had a priming effect on desiccation tolerance and the phytohormones involved in HT-induced thermoinhibition. Low S nutrition amplified or alleviated the effects of the HT sequences due the requirement for S in enhancing seed storage synthesis or inducing stress memory-associated mechanisms. This work provides insights to define thermopriming protocols in relation to the timing of quality building processes and their respective optimal temperature.

Oligogalacturonides (OGs) are fragments of pectin released from the plant cell wall during insect or pathogen attack. They can be perceived by the plant as damage signals, triggering local and systemic defence responses. Here, we analyse the dynamics of local and systemic responses to OG perception in tomato roots or shoots, exploring their impact across the plant and their relevance in pathogen resistance. Targeted and untargeted metabolomics and gene expression analysis in plants treated with purified OGs revealed that local responses were transient, while distal responses were stronger and more sustained. Remarkably, changes were more conspicuous in roots, even upon foliar application of the OGs. The treatments differentially activated the synthesis of defence-related hormones and secondary metabolites including flavonoids, alkaloids and lignans, some of them exclusively synthetized in roots. Finally, the biological relevance of the systemic defence responses activated upon OG perception was confirmed, as the treatment induced systemic resistance to Botrytis cinerea. Overall, this study shows the differential regulation of tomato defences upon OGs perception in roots and shoots and reveal the key role of roots in the coordination of the plant responses to damage sensing.

The problem of determining the economic order quantity has long attracted the attention of researchers, and several models have been developed to meet requirements under different circumstances at minimum cost. In the present paper, we conduct a structural content analysis of 317 selected peer-reviewed research articles that were published during the period 2001-2018 and ranked with a quartile score of Q1 by either ISI or Scopus database. By discussing the main topics of the inventory modeling literature, we provide a comprehensive view of the past research dealing with the management of deteriorating items. Here, we focus on items undergoing physical modification during the planning period, which encompasses a wide variety of products such as fresh produce, processed food, pharmaceuticals and blood products. Therefore, based on our holistic analysis, we identify new trends and we highlights crucial research opportunities to develop more comprehensive and practical models.

In this paper we apply the fractional integrals with arbitrary order depending on the fractional operators of Riemann type (ABR) and Caputo type (ABC) with kernels of Mittag Lefller in three parameters $E_{\alpha,\mu}^\gamma(\lambda,t)$ for solving the time fractional parabolic nonlinear equation. We utilize these operators with homotopy analysis method (HAM) for constructing the new scheme for generating the successive approximations. This procedure are used successfully on two examples for finding the solutions. The effectiveness and accuracy are verified by clarifying the convergence region in the $h$-curves as well as by calculating the residual error and the results were accurate. Depending on this results, this treatment can be used to find the approximate solutions to many fractional differential equations.

Several kinds of research have proved that the overall investor sentiment has a non-negligible impact on the return of the stocks. Meanwhile, there exist many irrational elements in the overall investor sentiment. However, little research has been conducted on how rational investors can better arrange their investment strategies in the face of this complex situation. Our manuscript explores the dynamic optimal portfolio of the returns of the stock affected by the sentiment of the investors. Applying the approach of the stochastic control, the HJB equation of the final wealth is constructed. Hence, the optimal investment strategy and the effective frontier are obtained employing the Legendre transformation and the duality theory. An illustrative example is provided to support our theoretical model. Taking into account the overall investor sentiment and its irrational components, a rational investor would do not invest so much in the stocks during the periods of the negative sentiment or the period of being excessively positive sentiment. Furthermore, the sentiment-adjusted mean-variance relation has been derived from our model that still adopts the principle of the Security Market Line (SML).

EP Rounds

Aims - Although less common, typical atrial flutter (AFL) shares similar pathophysiologic roots with atrial fibrillation (AF). Following successful cavo-tricuspid isthmus ablation using radiofrequency (RF), many patients, however, develop AF in the mid-to-long-term. This study sought to assess whether pulmonary vein isolation (PVI) conducted at the same time as cavo-tricuspid isthmus ablation would significantly modify the AF burden upon follow-up (FU) in patients suffering from typical AFL. Methods - This was a multicenter randomized controlled study involving AFL patients with history of non-predominant AF (1 AF episode only in 67% of population) who were scheduled for CTI RF ablation. Patients were randomly assigned to either undergo cavo-tricuspid isthmus (CTI) ablation alone or CTI plus PVI (CTI+). PVI was performed using cryoballoon technology. An outpatient consultation with ECG and 1-week Holter monitoring was performed at 3, 6 months, 1 year, and 2 years post-procedure. The primary endpoint was AF recurrences lasting more than 30 s at 2 years post-ablation. Results - Of the patients enrolled, 36 were included in each group. At 2-year FU, the AF recurrence rate was significantly higher in the CTI versus CTI+ group (25/36, 69% vs. 12/36, 33% respectively; p<0.001), with similar AFL recurrence rates. There were no differences in quality of life or undesirable events, except for transient phrenic nerve palsy reported from three PVI patients (8.3%). Conclusion - PVI using cryoballoon technology was proven to significantly reduce the AF incidence at 2 years post-CTI-ablation.

Based on the good properties of reproducing kernel space, a new method com bining the simplified reproducing kernel method (SRKM) and homotopy per turbation method (HPM) for solving the nonlinear Volterra-Fredholm integro differential equations (V-FIDE) is proposed. The HPM can convert nonlinear problems into linear problems. And then using the SRKM to solve linear prob lems. The uniform convergence of the approximate solution is proved. Some numerical examples are prepared to illustrate the efficiency and rapidity of this method.

This paper is about the study of space-time fractional Fokas-Lenells equation that describes nonlinear wave propagation in optical fibers. Three prominent schemes are employed for extracting different types of exact soliton solutions. In particular, the expa function method, the hyperbolic function method and the simplest Riccati equation scheme are investigated for the said model. As a sequela, a series of soliton solutions are obtained and verified through Mathematica. The obtained solutions are significant additions in some specific fields of physics and engineering. Furthermore, the 3D graphical descriptions are left to analyze the pulse propagation for the reader.

Objectives This study aimed to measure the prevalence of potentially inappropriate medications (PIMs) in Chinese elderly population according to the 2019 Beers Criteria and to evaluate the associative factors of PIMs. Methods Prescriptions of patients aged over 65 years who were hospitalized during January 2017 to December 2017 were retrieved from Hospital Prescription Analysis Cooperation Project, covering seventy-six facilities in six cities in China. PIMs were identified by 2019 Beers Criteria. Results In total, 40.1% elderly patients were treated with at least one PIM independent of their diagnoses or conditions according to the 2019 Beers Criteria. The most frequently prescribed inappropriate medications independent of diagnoses or conditions were proton-pump inhibitors (12.9%). Diuretics (8.2%) and central nervous system medications (6.9%) also showed a relatively high prevalence among the investigated patients. Based on the Beers Criteria’s lists of drug-disease interactions, elderly patients with central nervous system conditions (including delirium, dementia or cognitive impairment) or with a history of falls or fractures were most commonly exposed to PIMs. Logistic regression revealed that inappropriate medication use was associated with age (≥80 years old), number of conditions (≥5), number of medications prescribed (≥10) and class of healthcare facilities. Conclusion This study was able to confirm that the phenomenon of prescribing potentially inappropriate medications was common in China. Our findings support the importance of developing explicit criteria to detect PIMs in China and implementing effective interventions to promote better quality of prescribing for elderly patients.

Background: An acute inguinal hernia remains a common emergency surgical condition worldwide. While emergency surgery has a major role to play in treatment of acute hernias, not all patients are fit for emergency surgery, nor are facilities for such surgery always available. Taxis is the manual reduction of incarcerated tissues from the hernia sack to its natural compartment, and can help delay the need for surgery for days to months. The aim of this study was to prepare a safe algorithm for performing manual reduction of incarcerated inguinal hernias in adults. Methods: Medline, Scopus, Ovid and Embase were searched for papers related to emergency inguinal hernias. In addition, the British National Formulary and Safe Sedation Practice for Healthcare Procedures: Standards and Guidance were reviewed. Results: A safe technique of manual reduction of an acute inguinal hernia, called GPS (Gentle, Prepared and Safe) Taxis, is described. It should be performed within 24h from the onset of a painful irreducible lump in groin, and when concomitant symptoms and signs of bowel strangulation are absent. Conscious sedation guidelines should be followed. The most popular drug combination is of intravenous morphine and short acting benzodiazepine, both titrated carefully for optimal and safe effect. The dose of drugs must be individualised, and the smallest effective dosage should be used to avoid oversedation. Following successful taxis, the patient can be safely discharged after a short period of observation to return form more planned urgent surgery. Conclusions: Taxis is a feasible and safe method for patients with an incarcerated inguinal hernias. It likely reduces the risk and complications of anaesthesia and surgery in the emergency settings. GPS Taxis should be considered as first line treatment in the majority of patients presenting with an acute inguinal hernia when existing bowel infarction is unlikely.

A document by Sinem Gülcan Kersin. Click on the document to view its contents.

Hyporheic exchange plays a critical role in driving the transport of colloids in the hyporheic zone, but it remains unexplored how the particle size distribution of colloids varies during their transport process. This study aims to investigate the particle size variations and effects of factors on different sized colloids via laboratory experiment and simulation. The results show that both settlement and convection-diffusion play a role in the exchange of colloids between the stream and the streambed. Settlement is the dominant factor determining the exchange of large-sized particles due to their high settling velocity; the transport of small-sized particles is affected more by convection and diffusion, and part of them can be released from the streambed to the stream; while the exchange of middle-sized particles is affected by both convection-diffusion and settlement. As the colloids can affect the environment and eco-system of hyporheic zone in both positive and negative ways, the knowledge of how size variations affect the transport patterns of colloids is significant to future studies.

Soil compaction resulted from heavy machineries in opencast coal mine areas alters soil macropore characteristics then affects soil hydraulic properties. Additional information related to hydraulic characteristics is needed to assess the effects of soil reconstruction to improve the soil quality. The aim of this study was to determine the hydraulic properties and macropore characteristics of compacted soil by simulation tests and CT scanning in laboratory and to explore the response of soil hydraulic properties to soil macropore characteristics. In this study, the disturbed soil samples from the dumping area of Pingshuo opencast coal mine of China were collected. The soil samples were processed in designed bulk density (BD) from 1.30 g·cm-3 to 1.70 g·cm-3, and the soil hydraulic properties, including soil-water characteristic curve (SWCC), saturated hydraulic conductivity ( Ks), soil moisture diffusivity (D(θ) ), field capacity (FC), wilting coefficient (WC) were measured and the soil macropore characteristics were obtained using CT scanning in laboratory. The path analysis method was applied to analyze the effect of macropore characteristics on soil hydraulic properties. Soil compaction resulted in severe effects on soil hydraulic characteristics and macropore properties. Under same soil suction, the water contents remained in soil decreased with increasing compaction. Soil-water holding capacity, soil saturated hydraulic conductivity, and soil water diffusivity decreased with increasing BD. The explanatory variables (average euler number (AEN), macropore throat number (PTN), and macropore fractal dimension (PFD)) were main determinants of soil-water holding capacity, and the indirect path coefficient of macroporosity. The effects of average euler number (AEN) and macropore fractal dimension (PFD) on soil infiltration properties were relatively high. The BD of 1.4 g·cm-3 was a critical point of affecting macropore properties then affecting soil hydraulic properties, and some soil reclamation measures should be conducted to make BD <1.4 g·cm-3 for compacted soil in opencast coal mining area. This study provides valuable data for soil restoration of soil hydraulic and macropore properties in mining areas.

Background Congenital lung anomalies pose a challenge for not only the pediatric surgeons but also for the treating physicians. Controversy exists regarding the diagnosis and the management of the cases. Objective: The aim of this study was to highlight the difficulty in diagnosis of congenital lesions of lung in children, and to create awareness among the physicians regarding avoiding the use of antitubercular treatment (ATT) and intercostal drainage (ICD) in managing these surgical conditions. Methodology: Retrospective analysis of records of all the children diagnosed with congenital lesion of lung and treated in our department from January 2005 to December 2018. Informed consent from the parents taken at the time of admission. Inclusion criteria included cases which received either ATT or ICD before being referred to our institute. Investigations include X -ray, and Contrast enhanced tomography (CECT) chest. Results: A total of 27 cases of congenital lesions of lung were operated between Jan 2005 to Dec 2018. Out of these 27, 13 (48.1%) received either ATT or ICD and formed our study group. Out of these 13, 8(61.5%) received ATT, while 5 (38.5%) received ICD as initial management before being referred to us. There were 19 (70.3%) male and 8(29.7%) females. The most common lesion was CCAM seen in 6 (46.1%) followed by CLE 4(30.7%), BPS in 2 (15.3%) and Bronchogenic cyst 1(7.6%). Conclusion: cystic lesions of lung in children should be investigated thoroughly and ATT should not be started empirically. Pneumothorax should be differentiated from other emphysematous/ cystic lesions before submitting the child for intercostals drainage. Keywords: Cystic lesions of lung, anti-tubercular, pneumothorax, emphysema, intercostal drainage.

Background: Baloxavir marboxil is a novel class of antiviral agent for influenza, introduced into clinical practice in 2018. A concern remains about the variant virus with reduced susceptibility after baloxavir exposure and its clinical consequences including healthcare seeking behavior. Methods: Using a healthcare database in Japan, we compared the medical resource use following baloxavir and neuraminidase inhibitors (NAIs) treatment among children aged 7- 15 years. Study period was from December 2018 to March 2019. The primary endpoint was the composite of hospitalization, laboratory and radiological tests, and antibiotic use over 1-9 days of antiviral treatment. As prespecified exploratory analyses, secondary outcomes were assessed and subgroup analyses comparing baloxavir with each NAI were done. Results: Data from 115 867 prescriptions in 115 238 children were analyzed (median age: 10 years, risk of severe influenza in 26%, baloxavir accounting for 43%). Overall, baloxavir use did not increase the subsequent medical resource utilization in the composite endpoint (adjusted odds ratio [aOR]: 1.002; 95% confidence interval [CI]: 0.999–1.005; P= .16), as were likelihoods of other secondary outcomes. In the subgroup analysis, baloxavir use was associated with higher medical resource use than oseltamivir (aOR: 1.011; 95% CI: 1.007–1.015; P < .001) and lower resource use than zanamivir (aOR: 0.995; 95% CI 0.991–0.999; P= .039). Conclusions: Prescribing baloxavir rather than NAIs did not increase medical resource utilization within 9 days of treatment, except in one exploratory comparison with oseltamivir. Our data were derived from single-year observation in one country, thereby requiring future researches.

The authors share their experience of managing the cardiac surgery services across London during the challenging Covid-19 pandemic. The Pan London Emergency Cardiac Surgery Service model could serve as a blueprint to design policies applicable to other surgical specialities and parts of the UK and worldwide.

In new decade new coronavirus emerged. By April 2020, there is no accepted antiviral drug or antibody against COVID-19. COVID-19 (SARS-CoV-2) has nucleic acid sequence similarity 96% with bat coronavirus, 79.6% SARS-CoV-1. SARS-CoV-2 and SARS-CoV-1have common human host-cell ACE2 receptor. This similarity helps for effective vaccine and antibody development. At Wuhan, China, convalescent plasma therapy achieved 70% recovery results. ABO blood group susceptibility study revealed O blood group were very low risk whereas A were at high risk against COVID-19. ABO natural antibodies have positive effect to slowdown COVID-19 in less hygienic environment (less developed region). Isolation of specific antibody from EBV transformed B-lymphocyte recovered patients is encouraged. Urgent production of potent neutralizing antibody and vaccine is required and we identified sensitive immunogenic amino acid segment (318-510) in S1-protein domain that contains important and essential amino acids including cysteine, glutamic acid and aspartic acid, which associated with ACE2 expression.

Aim: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that has no approved treatment. There are some medications which may be prescribed for COVID-19 patients as investigational treatments. Drug-drug interactions (DDIs) of medications used in treating COVID-19 is an important issue to be studied. Current study aimed to evaluate potential DDIs (pDDIs) and their predictors in hospitalized COVID-19 patients. Methods: A retrospective chart review study was conducted in a tertiary respiratory hospital dedicated for COVID-19 patients. Interacting drug combinations, severity, reliability, mechanism, and clinical management of pDDIs in confirmed COVID-19 cases were identified using the Lexi-Interact database. Logistic regression was applied to assess the correlation between occurrence of severe interactions and probable risk factors. Results: Two hundred and twenty-seven patients’ medical charts were evaluated. About 68% of the patients had at least one comorbidity. The most common comorbidity was hypertension (30.4%), followed by obesity (27.8%) and diabetes (23.8%). At least one major or contraindicated interaction was detected in 37.9% of the patients. Above 50% of the interactions were between lopinavir/ritonavir (protease inhibitor) and commonly prescribed medications (e.g. atorvastatin, alprazolam, salmeterol, and tamsulosin) for management of comorbidities or COVID-19 symptoms. Logistic regression analysis demonstrated that two comorbidities (IHD and CRDs) and ICU admission are significantly associated with occurrence of major or contraindicated pDDIs. Conclusion: The frequency of pDDIs is relatively high in COVID-19 patients. Patients receiving a protease inhibitor and having comorbidity or critical conditions should be monitored carefully in terms of DDIs.

Objective The aim of this study was to investigate relations (or coactions) among maternal mental health measures, clinical and socio-demographic factors and salivary cortisol level of hospitalized mothers and babies. Design A cross-sectional observational and exploratory study at a tertiary referral centre. Setting Maternal and Neonatal Care Ward of the University Hospital of Brasilia, Brazil Population 89 mother-baby dyads at post-delivery period. Methods Dyads were recruited by convenience during the first 48 hours after birth. Main outcome measures The research protocol included maternal sociodemographic and clinical data, screening for maternal depression, self-efficacy and gestational stress, besides salivary cortisol collection from both mother and baby. Results: Exploratory analysis indicated a relation between high gestational stress, high depression symptoms, low self-efficacy perception and high baby’s cortisol level (p < 0.05). Maternal cortisol was positively related to infant cortisol and was indirectly influenced by maternal perception of self-efficacy in reading the baby’s behavior, especially for knowing what the baby likes, or what pleases her/him, maternal situational beliefs (within the concept of parental self-efficacy). Four binary logistic regression models were performed considering maternal mental state variables as factors and clinical and socio-demographic variables as covariates in order to predict the cortisol level of infants. Only two were strong predictors, namely maternal depression and higher gestational stress. Conclusion The findings suggest an important role of maternal mental health in neonatal salivary cortisol levels in the first days of life, which can be considered an early clinical marker for the infant’s reaction to maternal mental status.

Differential diagnoses of patients with multiple bony lesions that are confined to one side of the body should include polyostotic fibrous dysplasia with and without McCune-Albright Syndrome, particularly if there is no history of malignancy. Lesion biopsy ultimately provides the definitive diagnosis.

Nutcracker syndrome refers to symptomatic compression of left renal vein. There are many reasons for that. We report a case that the enlargement of splenic vein has caused to nutcracker syndrome. Results implies that not firm venous structures can be cause of nutcracker syndrome.