Post renal transplant patients are generally immunosuppressed and remain at a higher risk for getting bacterial and viral infections. Most of these patients are taking immunosuppressive medications, including steroids. This case series highlights the clinical outcomes and characteristics of 8 post renal transplant patients who acquired COVID-19.

Submersion and exposure from the operation of the Three Gorges Reservoir (TGR) can alter soil properties and plant characteristics at different elevations of the water level fluctuation zone (WLFZ), possibly influencing soil detachment capacity (Dc), but the vertical heterogeneity of this effect is uncertain. Soil samples were taken from 6 segments (5 m elevation per segment) along a slope profile in the WLFZ of the TGR to clarify the vertical heterogeneity of Dc. Scouring experiments were conducted at 5 slope gradients (17.63%, 26.79%, 36.40%, 46.63%, and 57.74%) and 5 flow rates (10, 15, 20, 25, and 30 L min–1) to determine Dc. The results indicate that the soil properties and biomass parameters of the WLFZ are strongly affected by elevation. Dc fluctuates with increasing elevation, with maximum and minimum average values at elevations of 145-150 m and 165-170 m, respectively. Linear equations accurately describe the relationships between Dc and hydrodynamic parameters. τ, ω, and E perform much better than U. Furthermore, a clear improvement is seen when using the general index of flow intensity to estimate Dc. Dc is significantly negatively correlated with MWD (p < 0.05) and organic matter (p < 0.01) but not significantly correlated with other soil properties (p > 0.05). At elevations of 145-150 m and 170-175 m, rill erodibility was greater than at other elevations. The critical hydraulic parameters were highest in the 165-170 m segments, both showing obviously fluctuation in the vertical direction of slope surface. This research highlighted the vertical heterogeneity of the soil detachment and was helpful to understand the mechanisms of soil detachment processes in the WLFZ of the TGR.

We report the case of a woman with schizoaffective disorder, killing her child under the effect of an impulse motivated by Capgras syndrome in a strange crime scene including evisceration and enucleation. This case help to better understand the association between misidentification syndromes and homicide and to promote preventive measures.

Aims: Lysosomal β-glucocerebrosidase (GBA) deficiency causes Gaucher disease (GD), a recessive disorder caused by bi-allelic mutations in GBA. The prevalence of GD is associated with ethnicity, but largely unknown and potentially underestimated in many countries. GD may manifest with organomegaly, bone involvement and neurological symptoms as well as abnormal laboratory biomarkers. This study attempted to screen for GD in patients using abnormal platelet, alkaline phosphatase (ALP) and ferritin results from laboratory databases. Methods: Electronic laboratory databases were interrogated using a 2-4 year time interval to identify from clinical biochemistry records patients with a phenotype of reduced platelets (<150x109/L) and either elevated ALP (>130iu/L) or ferritin (>150 (female) or >250µg/L(male)). The mean value over the screening window was used to reduce variability in results. A dried blood spot sample was collected for the determination of GBA activity in patients meeting these criteria. If low GBA activity was found then the concentration of the GD-specific biomarker glucosyl-sphingosine (lyso-GB1) was assayed, and the GBA gene sequenced. Results: Samples were obtained from 1058 patients; 232 patients had low GBA activity triggering further analysis. No new cases of GD with homozygosity for pathogenic variants were identified but 12 patients (1%) were identified to be carriers of a pathogenic variant in GBA. Conclusions: Pathology databases hold routine information that can be used to screen for patients with inherited errors of metabolism. However, biochemical screening using mean platelets, ALP and ferritin has a low yield for unidentified cases of Gaucher Disease.

Reactive transport codes are today one of the cornerstones of environmental research. They now contain multiphysics with very complex algorithms, including flow, transport, chemical and sometimes heat transport, mechanical and/or biological algorithms. Because of this complexity, some parts of these algorithms still have not been sufficiently studied. Here, we present a comparison of 3 algorithms for activity correction, a specific subset of equilibrium chemistry algorithms. We show that the most used algorithm (the inner fixed-point algorithm) or the most rigorous algorithm (the full Newton) might not be the most efficient, and we propose the outer fixed-point algorithm, which is more robust and faster than other algorithms.

Vaccination against the COVID-19 virus began in December 2020 in the UK and is now running at 5% population/week. High Levels of social restrictions were implemented for the third time in January 2021 to control the second wave and resulting increases in hospitalisations and deaths. Easing those restrictions must balance multiple challenging priorities, weighing the risk of more deaths and hospitalisations against damage done to mental health, incomes and standards of living, education outcomes and provision of non-Covid-19 healthcare. Weekly and monthly officially published values in 2020/21 were used to estimate the impact of seasonality and social restrictions on the spread of COVID-19 by age group, on the economy and healthcare services. These factors were combined with the estimated impact of vaccinations and immunity from past infections into a model that retrospectively reflected the actual numbers of reported deaths closely both in 2020 and early 2021. It was applied prospectively to the next 6 months to evaluate the impact of different speeds of easing social restrictions. The results show vaccinations are significantly reducing the number of hospitalisations and deaths. The central estimate is that relative to a rapid easing, the avoided loss of 57,000 life years from a strategy of relatively slow easing over the next 4 months comes at a cost in terms of GDP reduction of around £0.4 million/life-year loss avoided. This is over 10 times higher than the usual limit the NHS uses for spending against Quality Adjusted Life Years (QALYs) saved. Alternative assumptions for key factors affecting give significantly different trade-offs between costs and benefits of different speeds of easing. Disruption of non-Covid-19 Healthcare provision also increases in times of higher levels of social restrictions. In most cases, the results favour a somewhat faster easing of restrictions in England than current policy implies.

Introduction: In dermoscopic studies on dermatofibromas, some publications divide the appearance of lesions into standardized patterns, and some publications classify the clinical appearance of the lesions by comparing them with existing dermatological lesions. Objectives: This study aims to re-evaluate the dermoscopic findings and patterns of dermatofibromas from a different perspective. Methods: In this study, 142 lesions of 72 patients were evaluated dermoscopically and their patterns were schematized. Results: In our study, a total of 15 patterns consisting of main and sub-patterns were created. The most common patterns we detected were pattern 1 (1a: 13.4%, 1b: 8.5%), pattern 8 (8a: 10.6%, 8b: 4.2%), pattern 2 (2a: 9.2%, 2b: 4.2%), respectively. Conclusions: Patterns of DFs were reclassified while preserving basic patterns. We think that the new sub-patterns and schematization with this study can contribute to better understanding of DFs.

This article specically deals with the asymptotic synchronization of non-identical complex dynamic fractional order networks with uncertainty. Initially, by using the Riemann-Liouville derivative, we developed a model for the general non-identical complex network, and based on the properties of fractional order calculus and the direct Lyapunov method in fractional order, we proposed that drive and response system if nonidentical complex networks ensuring asymp-totic synchronization by using neoteric control. Second, taking into account the uncertainties of non-identical complex networks in state matrices and evaluating theirrequirements forasymptotic synchronization. In addition, to explain the eectiveness of the proposed approach, two numerical simulations are given.

Heterotopic pregnancy (HP) describes the simultaneous presence of two pregnancies at different implantation sites. One is intrauterine and the other is ectopic. It is challenging to diagnose HP. We present a very rare case of HP diagnosed in the first trimester by US and MRI and managed successfully.

Background and Purpose Liver failure is often associated with psychiatric alterations, partly resulting from the increased dopamine levels in brain. We aimed to investigate relationship between increased dopamine levels and mental abnormalities using bile duct ligation (BDL) rats and document mechanism that liver failure increased dopamine levels in SH-SY5Y cells. Experimental Approach Psychiatric alterations were operated following 14-day BDL. Dopamine and its metabolite levels in cortex, expressions of enzymes and transporters related to dopamine metabolism and transport in cortex and hippocampus were measured. SH-SY5Y cells were used to investigate whether NH4Cl, bile acids and bilirubin affected expression of tyrosine hydroxylase (TH) or not. TH expression in SH-SY5Y cells co-incubated with bilirubin and signal pathway inhibitors was measured. Key Results Open-field test results showed a remarkable increase in exploratory behavior following BDL. BDL increased dopamine levels and expression of TH protein in cortex. MAO-A and Mb-COMT slightly but significantly decreased. Data from SH-SY5Y cells showed that increased bilirubin levels was a factor in inducing TH expression. Both inhibitor of NF-κB pathway BAY117082 and silencing p65 remarkably reversed bilirubin-induced upregulation of TH protein. NF-κB activator TNF-α increased expression of TH protein. Roles of bilirubin in TH expression and increases in dopamine levels were documented using hyperbilirubinemia rats. Significant increases in dopamine levels, expressions of TH, p65 and p-p65 protein were observed in hyperbilirubinemia rats. Conclusion and Implications BDL significantly increased dopamine levels in rat cortex partly due to bilirubin-mediated TH induction. Increased bilirubin induced TH expression via activating NF-κB signaling pathway.

Mutations in PRPH2, encoding peripherin-2, are associated with the development of a wide variety of inherited retinal diseases (IRDs). To determine the causality of the many PRPH2 variants that have been discovered over the last decades, we surveyed all published PRPH2 variants up to July 2020, describing 720 index patients that in total carried 245 unique variants. In addition, we identified seven novel PRPH2 variants in eight additional index patients. The pathogenicity of all variants was determined using the ACMG guidelines. With this, 107 variants were classified as pathogenic, 92 as likely pathogenic, one as benign, and two as likely benign. The remaining 50 variants were classified as variants of uncertain significance. Interestingly, of the in total 252 PRPH2 variants, more than half (n=137) were missense variants. All variants were uploaded into the Leiden Open source Variation Database. Our study underscores the need of experimental assays for variants of unknown significance to improve pathogenicity classification, which is needed to better understand genotype-phenotype correlations, and in the long-term, hopefully also support the development of therapeutic strategies for patients with PRPH2-associated IRD.

Merkel cell carcinoma (MCC) is a rare tumor with neuroendocrine origin. It presents as a single red nodule in the sun-exposed area by rapid and aggressive growth. This study presented a rare case of MCC on an unusual site, associated with chronic lymphocytic leukemia.

Psoriasis is one of the most common chronic cutaneous skin disorders, having genetic and immunological components. It is currently unknown what exactly triggers it, or how far reaching are the etiological factors, although great strides have been made in uncovering the pathophysiological cascade. Presently, there is a wide diversity of treatment methods for psoriasis, yet not all are applicable for each patient. Selection of both drug and dosage depends on both the knowledge and experience of the treating dermatologist, but also on the specific characteristics of each patient. Therefore, the treating physicians should be made aware of the management possibilities, their advantages, as well as their side effects. Current therapies are divided into topical, systemic, and biological agents. In the following manuscript, we present an updated version of these therapies, alongside their indications, posology and most common side effects, a guide that may be useful for every practitioner in this field.

In this paper, we study the initial-boundary-value problem (IBVP) for coupled Korteweg-de Vries equations posed on a finite interval with nonhomogeneous boundary conditions. We overcome the requirement for stronger smooth boundary conditions in the traditional method via the Laplace transform. Our approach uses the strong Kato smoothing property and the contraction mapping principle.

Neck tumors are rare fetal conditions. They can receive their growth stimuli by activating missense mutations characterizing disorders with benign overgrowth, collectively known as PIK3CA-Related-Overgrowth-Spectrum. This results in segmental overgrowth with phenotypic variation, genetic heterogeneity or tissue specific distribution. Thus, clinical and molecular diagnosis as well as treatment remains challenging.

In this study, Volterra-Fredholm integral equation is solved by Hosoya Polynomials. The solutions obtained with these methods were compared on the figure and table. And error analysis was done. Matlab programming language has been used to obtain conclusitions, tables and error analysis within a certain algorithm.

This paper studies the inhomogeneous nonlinear Schrödinger equations, which may model the propagation of laser beams in nonlinear optics. Using the cross-constrained variational method, a sharp condition for global existence is derived. Then, by solving a variational problem, the strong instability of solitary waves of this equation is proved.

In this paper, using the compatible theory of differential invariants, a class of exact solutions is obtained for nonhomogeneous quasilinear hyperbolic system of partial differential equations (PDEs) describing rate type materials; these solutions exhibit genuine nonlinearity that leads to the formation of discontinuities such as shocks and rarefaction waves. For certain nonconstant and smooth initial data, the solution to the Riemann problem is presented providing a complete characterisation of the solutions.