Background: Concerns about virus spread during surgery contributed to changes in the clinical management of ectopic pregnancies (EP) during the COVID19 pandemic. Objective: To compare published data on EP management prior versus during the COVID-19 pandemic and evaluate any difference in the management, rupture rate and complications where Early Pregnancy Unit (EPU) structures exist. Search strategy: We performed a systematic review of the literature using a keyword strategy based on our PICO criteria. Selection criteria: We included studies which recruited women diagnosed with ectopic pregnancy and compared the management during and prior the COVID-19 pandemic peak. Data collection and Analysis: Three independent reviewers screened the literature and extracted the data. Meta-analysis of the data was performed on Revman. Main Results: Our search yielded 34 studies; 12 were included in our meta-analysis (3122 women). We found no difference in the type of management of EP between the pre-Covid and Covid cohorts [2714 women, OR 0.99(0.63-1.55), p=0.96, I2=77%]. We observed a non-statistically significant reduction of surgical management within the EPU branch ([OR 0.47(0.19-1.13), p=0.09, I2=81%]). There was no difference in the ectopic rupture rate in units with EPU [OR= 0.66 (0.33-1.31), p=0.24, I2=37%]. In contrast, in non-EPU (NPEU) the risk of ruptured EP [OR=2.86(1.84-4.46), p<0.01 I2=13%] and complications [OR=1.69(1.23-2.31), p=0.001, I2=45%] were increased. Conclusions: The worldwide trend was not reflected in the UK suggesting that EPU may have contributed to prompt diagnosis and safe management of EP. Funding: No funding was received. Keywords: ectopic pregnancy, COVID 19, meta-analysis, early pregnancy unit
Conventional approach of establishing soil conservation strategies in degraded drylands has had negligible success. This has been contributed by many constraints, including; lagging of farmers in technology adoption, inadequate resources, and lack of motivation. Thus, a study was conducted among three agro-pastoral community farmer groups in Korellach Parak, Kapkitony, and Kaporowo villages domiciled in Chepareria ward, West Pokot, Kenya, to assess contributory factors and consequences of adopting terracing as a soil conservation measure. Mixed methods comprising; one-on-one interviews, cross-sectional field measurements, and focus group discussions (FGDs), were used for data collection. Results indicate that the agro-pastoral communities are fully aware of soil degradation and its impacts. Besides terracing, farmers practice stone bands, enclosures, agroforestry, and ridges. Terracing is a recently adopted farm-level soil conservation practice achieved through organized farmer groups dubbed “Kemorokorenyo” (meaning let us reclaim our land) merry-go-round. Within the three villages, 60% of the households have their farms terraced with an average terrace volume of 103.8±21.45m3, 105.89±33.126m3, and 129.6±15.966m3 in Parak Kapkitony and Kaporowo, respectively. Rapid sedimentation of terraces dykes, which contributes to the reduced effectiveness of the terrace system was identified as the major challenge. The sediment volume significantly differs along the slope, with the highest sediment build-up experienced on high slopes as shown by the Kruskal Wallis test; H (2) =6.699, p=0.035. Terrace embankments reinforcement practice to counter sedimentation challenge has faced slow adoption. The poor reinforcement is attributable to the lack of knowledge on suitable local context multipurpose materials to meet the community’s needs.
Background The interconception period is considered a time when parents are likely to engage with health messages and are in frequent contact with healthcare professionals. Objectives Through this literature review and policy analysis, we synthesised articles and guidelines on interconception care to provide recommendations to improve health outcomes for parents, infants and future generations. Search Strategy Four databases were searched systematically, using MeSH and free-text terms based on ‘interconception’ and ‘postpartum’. Selection Criteria Selected articles included reviews, pilot studies and guidelines on interconception and postpartum interventions published in English by UK public health organisations and government agencies between 1st January 2010-12th January 2021. Data Collection and Analysis 30% of titles, abstracts and full-text papers were double-screened. The description table of identified guidelines were qualitatively analysed to generate categories, later developed into a framework of six domains. Findings are described using a narrative synthesis approach. Main Results We found 47 documents with guidelines, 29 reviews and six pilot studies on interconception and postpartum care. Interconception care opportunities include the postpartum period, family planning, routine practice, and risk assessments. Health and non-healthcare professionals have a role to play in the interconception period including GPs, health visitors, dieticians, nutritionists, health psychologists, community groups, local authorities and charities such as Tommy’s and First Step Nutrition. Conclusions The interconception and postpartum periods offer crucial opportunities to intervene to reduce possible long-term effects of suboptimal nutrition. Though the policy analysis for this review focused on the UK, the recommendations can have wider implications for other countries.
Primitive neuroectodermal tumor (PNET) is a highly aggressive tumor and mostly develops in children and young adults. PNETs of peripheral nerves are uncommon. Ulnar nerve, in particular, is an extremely peculiar origin for PNET and to the best of our knowledge only few well-documented cases have been yet reported.
Hydrogen reduction of tungsten oxide is currently the most widely applied ultrafine tungsten powder production process. The process has the advantage of short, pollution free and simple production equipment. But it is difficult to effectively control the morphology and particle size of the tungsten powder because of lacking in-depth understanding of the dynamic mechanism of the process. The first-principles calculations are carried out to explore the diffusion and internal adsorption of hydrogen on the WO-terminated surface of WO3 based on the density functional theory. The results show that hydrogen can diffuse from the WO terminal surface to the inside of WO3, the activation energy of diffusion is 46.682 Kcal/mol. It’s preferable for hydrogen to diffuse from the surface to the inside than diffuse within the WO3 lattice. The adsorption energy of hydrogen on the WO termination surface of WO3 is 15.093 Kcal/mol, the adsorption energy of hydrogen inside the WO termination surface of WO3 is 14.116 Kcal/mol, which means the hydrogen is easier to adsorb inside the WO3 lattice.
Objective: To compare emergency department (ED) presentations and hospital admissions for urgent early pregnancy conditions in Victoria before and after the onset of COVID-19 lockdown on 31 March 2020. Design: Population-based retrospective cohort study Setting: Australian state of Victoria Population: Pregnant women presenting to emergency departments or admitted to hospital Methods: We obtained state-wide hospital separation data from the Victorian Emergency Minimum Dataset and the Victorian Admitted Episodes Dataset from January 1, 2018, to October 31, 2020. A linear prediction model based on the pre-COVID period was used to identify the impact of COVID restrictions. Main outcome measures: Monthly ED presentations for miscarriage and ectopic pregnancy, hospital admissions for termination of pregnancy, with subgroup analysis by region, socioeconomic status, disease acuity, hospital type. Results: There was an overall decline in monthly ED presentations and hospital admissions for early pregnancy conditions in metropolitan areas where lockdown restrictions were most stringent. Monthly ED presentations for miscarriage during the COVID period were consistently below predicted, with the nadir in April 2020 (790 observed vs 985 predicted, 95% CI 835-1135). Monthly admissions for termination of pregnancy were also below predicted throughout lockdown, with the nadir in August 2020 (893 observed vs 1116 predicted, 95% CI 905-1326). There was no increase in ED presentations for complications following abortion, ectopic or molar pregnancy during the COVID period. Conclusions: Fewer women in metropolitan Victoria utilized hospital-based care for early pregnancy conditions during the first seven months of the pandemic, without any observable increase in maternal morbidity.
Quantum chemical calculations have been performed on B3 ring stabilized Y-Y interaction (Y = Be, Mg, Ca) to understand the possibility of binuclear sandwich type complex formation. Calculations indicate single reference character of the studied systems. The complexes have been found to be stable towards dissociation into different fragments. Thermodynamic consideration also indicates the favourability of their formation. Increase in aromaticity of the parent B3 ring upon complexation is observed which is expected to provide extra stability to the complexes.
In this case study, we report an 11-year-old male patient who had jaundice, hepatosplenomegaly, and chronic mild congenital non-autoimmune hemolytic anemia. In our patient, a novel homozygous missense mutation in the PIEZO1 gene was detected using a gene-targeted Next-Generation Sequencing panel: c.3364G>A (p.Glu1122Lys), confirming the diagnosis of DHS.
Climate change causes fluctuations in temperature and precipitation. As a result, it affects the discharge of rivers, the most important consequence of which is the tendency toward extreme events such as torrential rains and widespread droughts. River discharge is one of the most important climatic and hydrological parameters. Investigating the changes in this parameter is one of the main prerequisites in the management and proper use of water resources and rivers. Most trend detection studies are based on analyzing changes in the mean or middle of the data. They do not provide information on how changes occur in different data ranges. Therefore, to investigate parameter changes in a different range of the data series, various regression models were proposed. Frequentist quantile regression and Bayesian quantile regression models were used to estimate their trend and trend slope in different quantiles of discharge in different seasons of the year for Arazkouseh, Tamar, and Galikesh stations of Gorganroud basin in northern Iran with the statistical period of 1346–1396 (1966–2016). The results show that in most seasons of the year, high discharge rates for all 3 stations have decreased with a steep slope, and only in summer, Tamar and Galikesh stations have had an increasing trend, but low discharge rates have not changed significantly. Spatially, the discharge values at Arazkouseh station have a decreasing trend with a higher slope rate, and in terms of time, the most decreasing trend has been in spring. Comparing the models also shows that the Bayesian quantile regression model provides more accurate and reliable results than the frequency-oriented quantile regression model. In general, quantile regression models are useful for predicting and estimating extreme high and low discharge changes for better management to reduce flood and drought damage.
Objective. Clinicians and regulators are receiving reports of changes to menstrual periods following COVID-19 vaccination. However, it is unclear if the two are biologically linked. If they are, people using hormonal contraception are predicted to be less likely to report a change and spontaneously cycling people vaccinated prior to ovulation more likely. The objective was to test these hypotheses. Design. Retrospective cohort study. Setting. UK. Population. 1273 people who had received at least one dose of a COVID-19 vaccination, have periods or withdrawal bleeds and keep a record of the dates of these. Methods. Participants reported whether they use any hormonal contraception and, for each dose of the vaccine, on which day of their menstrual cycle they were vaccinated and details of how the timing and flow of their next period compared to their normal experience. Main outcome measures. Association between 1. the use of hormonal contraception and reported changes to timing or flow of the next menstrual period, and 2. the timing of vaccination within the menstrual cycle and reported changes to timing or flow of the next menstrual period. Results. The data from this cohort did not support the pre-specified hypotheses that people using hormonal contraception would be less likely to report a change, or that spontaneously cycling people vaccinated prior to ovulation would be more likely to report a change. Conclusions. This study did not detect strong signals supporting the idea that COVID-19 vaccination is linked to menstrual changes in most people. Funding. No specific funding.
We enrolled a patient diagnosed with blastic plasmacytoid dendritic cell neoplasm (BPDCN) . We have found that TET2, KRAS and BRAF may be involved in the development of the disease, and the combination therapy of Decitabine (DAC) and Arsenic acid (ASO) may be effective for BPDCN harboring the TET2 mutations.
A two-sublattice decorated Blume-Capel ferrimagnet has been investigated using the mean field theory. Interesting behaviors of long-range order are obtained depending on particular magnitudes of magnetocrystalline anisotropies for both sublattices sites. Distinguishable features have been discovered in two-dimensional decorated lattice consisting of spin-5/2 and decorating spin-7/2 ions on the bonds. It is found the present system shows two ferrimagnetic compensation temperatures. However, one compensation temperature for different or fixed values of decorated magnetic anisotropies with the values of J1=-0.5 , J2=-1.0 , or with J1=-1.0 , J2=-0.5, has been induced, respectively. The magnetization behavior in the (M,DB/IJ2I) space has not already been considered showing the crystalline anisotropy dependence of total magnetization remanences. Besides, the variations of net magnetizations versus the decorated crystal fields, i.e., in the(M,DA/IJ2I) space, have been done, with J1=-0.5, J2=-1.0 , for various values of T=2.0, 2.5,3.0 , respectively.
The Timber Rattlesnake (Crotalus horridus) has a large distribution spanning much of the eastern United States. Because temperature, habitat type, prey composition and abundance, and a variety of other factors may dictate reptile behavior, populations of conspecific species may exhibit behavioral differences across latitudinal and elevational gradients. Using radio telemetry, we tracked 10 adult Timber Rattlesnakes (7 males, 3 females) from May 2016 to June 2017 in southeastern Louisiana to examine the spatial ecology of male and non-gravid female snakes. Mean annual and seasonal home ranges of non-gravid female Timber Rattlesnakes were not statistically different from that of males. Mean seasonal home range sizes and average distances travelled of both sexes was smallest in winter, and had a general increasing trend beginning in spring with a peak in fall. These increases seemed to coincide with the breeding season, taking place from early July until the end of November. Comparison of this study with other studies throughout its distribution could have implications towards future management of conservation for other southern populations of Timber Rattlesnakes.
Building on the work in , this paper shows how Conformal Geometric Algebra (CGA) can be used to model an arbitrary two-port scattering matrix as a rotation in four dimensional Minkowski space, known as a spinor. This spinor model plays the role of the wave-cascading matrix in conventional microwave network theory. Techniques to translate two-port scattering matrix in and out of spinor form are given. Once the translation is laid out, geometric interpretations are given to the physical properties of reciprocity, loss, and symmetry and some mathe- matical groups are identified. Methods to decompose a network into various sub-networks, are given. An example application of interpolating a 2-port network is provided demonstrating an advantage of the spinor model. Since rotations in four dimensional Minkowski space are Lorentz transformations, this model opens up the field of network theory to physicists familiar with relativity, and vice versa.
Objective No study ever investigated the long-term risk of stroke in women with pre-eclampsia/eclampsia. The purpose of this study is to explore long-term stroke risks, differentiating subtypes and their time trends. Design Nationwide population-based cohort study Methods Between 2000 and 2017, 1,384,427 pregnant women were registered in the National Health Insurance Research Database in Taiwan. After excluding women with previous stroke history and exact matching with all confounders, 6,053 women with pre-eclampsia/eclampsia and 24,212 controls were recruited. Main Outcome Measures Hemorrhagic and ischemic strokes after child-birth Results Over the 17-year follow-up, the adjusted hazard ratio (aHR) for stroke in women with a history of pre-eclampsia/eclampsia was 2.05 (95% confidence interval, CI = 1.67-2.52, p<0.001). The 17 years overall risks of both ischemic and hemorrhagic stroke were 1.98 and 3.45, respectively (p<0.001). The stroke subtypes, hemorrhagic and ischemic, had different time trend risks, and hemorrhagic stroke risks kept higher than that of ischemic stroke. The ischemic stroke risk peaked during 1-3 years after childbirth (aHR=3.09). The hemorrhagic stroke risk peaked during 3-5 years (aHR=7.49). Conclusions Stroke risk persisted even after decades, for both ischemic and hemorrhagic subtypes. Women with pre-eclampsia/eclampsia history should be aware of the long-term risk of stroke. Tweetable abstract Both ischemic and hemorrhagic stroke risks persisted high even after decades, while their time trend risks were different. Keywords: pre-eclampsia/eclampsia; ischemic stroke; hemorrhagic stroke
a succesfull combination therapy with tagraxofusp-erz plus venetoclax for a pediatric case of Blastic plasmacytoid dendritic cell neoplasm brıdgıng to transplantBaşak Adaklı Aksoy 1,Selime Aydoğdu1,Özlem Başoğlu Öner 1,Gizem Zengin Ersoy 1,Funda Erol Çipe1, Ayşe Gonca Kaçar3, Zafer Başlar 3,Tiraje Celkan 3,Tunç Fışgın1,Ceyhun Bozkurt 21Altınbaş Üniversitesi Tıp Fakültesi, Medical Park Bahçelievler Hastanesi2İstinye Üniversitesi Tıp Fakültesi , Pediatrik Hematoloji- Onkoloji Bölümü3İstanbul Üniversitesi, Cerrahpaşa Tıp Fakültesi
The Yunnan-Guizhou Plateau (YGP) is characterized by the distinctive isolated habitat of limestone Karst Islands and features the Wumeng Mountains (Mts), which divide the YGP into the two Plateaus of Yunnan and Guizhou. This study aims to assess the effects of past geographic and environmental isolation and climate fluctuation on the flora distribution in the YGP. To this effect, we analyzed the phylogeographical pattern and genetic structure for Myrica nana, a vulnerable species endemic to the YGP, based on chloroplast and nuclear ribosomal DNA sequence. The results suggest that the genetic and haplotype network structures are divided into at least two groups—cpDNA haplotype H2 (or nrDNA haplotypes h1, h2, and the native haplotype) mainly distributed to the east of the Wumeng Mts, and cpDNA haplotype H1 and haplotypes H3–H10 (or nrDNA haplotype h3) distributed to the west of the Wumeng Mts. A deep genetic split was noted within the two groups to reach 25 steps, especially for the cpDNA fragment variation. The east–west divergence reveals the existence of a natural geographical isolation boundary in the form of the Wumeng Mts, which divides the YGP into the Yunnan and Guizhou Plateaus. Therefore, there existed at least two glacial refugia during the Quaternary glacial period, along with a genetic diversity center, and at least two large geographic protection units for the vulnerable species of M. nana, distributed throughout the eastern and western sides of the Wumeng Mts. This study not only clarifies that the phylogeographical pattern and genetic structure for M. nana can be attributed to geographic and environmental isolation and climate fluctuation, but it also proposes an effective strategy to protect vulnerable species and the important wild flora of the YGP.
Giant Tumor of the perineal regionKey clinical message: Giant condyloma acuminatum, also known as, Buschke-Lowenstein tumour is a very rare, sexually transmitted disease. It is a slow-growing, destructive lesion that affects the anogenital region. The HPV has been identified as an important contributory factor in the development of this tumor.Key words: Dermatology, oncology, Giant condyloma acuminatum , HPV.A 48-year old man presented with a giant lesion of the perineal region which appeared 10 years before and gradually increased in size. Clinical examination revealed a lobulated, exophytic, non-painful, non-bleeding, cauliflower-shaped lesion on the penis and the scrotum, measuring approximately 8 x 7 cm suggestive of a giant condyloma acuminatum (Figure 1). There were no enlarged inguinal nodes. Magnetic resonance imaging of the pelvis and the abdomen revealed no regional lymph node involvement or evidence of distant metastasis. A skin biopsy confirmed the diagnosis of papillary condyloma acuminatum secondary to human papillomavirus (HPV). Radical excision of the entire lesion showed no signs of invasion. Blood tests for detecting Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), Hepatitis C virus (HCV) and syphilis were negative. Giant condyloma acuminatum, also known as, Buschke-Lowenstein tumour is a very rare, sexually transmitted disease.1,2 It is a slow-growing, expansive, cauliflower-like, destructive lesion that affects the anogenital region.1,2 The HPV has been identified as an important contributory factor in the development of this tumor.1,2