Aim: This study aimed to use the micro-computed tomography to evaluate the interfacial adaptation and the presence of gaps of NeoMTA Plus, BioRoot RCS, and MTA in the root-end cavities. Methodology: Thirty standardized bovine roots measuring 15 mm in length were selected. Chemical-mechanical preparation was performed up to instrument #80 and obturation with the cold lateral compaction technique with cement based on zinc oxide and eugenol. The roots were kept at 37º C for seven days. Afterward, apicectomy of the apical 3mm and a root-end filling cavity was performed at 3mm depth. Micro-computed tomography (micro-CT) was performed to measure the volume of the retroactivity. The roots were divided by stratified randomization into three groups according to the retro-end filling material: NeoMTA Plus, BioRoot RCS, and MTA. A new micro-CT was performed to assess the presence of voids in the root-end filling material and between it and the canal wall. One-way ANOVA and Tukey tests were performed using the BioEstat 4.0 program. Results: There was no difference in the initial volume values of the root-end cavities (P > 0.05). After the insertion of root-end filling materials, the most significant volumes of voids were observed in the NeoMTA Plus group (P < 0.05), with no difference for the BioRoot RCS and MTA Angelus groups (P > 0.05). Conclusion: Micro-computed tomography showed that MTA and BioRoot RCS have better interfacial adaptation and presented fewer number of gaps than NeoMTA Plus when used as root-end filling materials.

In this paper, we study a class of sequential fractional differential inequalities involving Caputo fractional derivatives with different orders. The nonexistence of nontrivial global solutions is investigated in a suitable space via the test function technique and some properties of fractional integrals. Our results are supported by numerical examples.

A document by Prajwal Pudasaini. Click on the document to view its contents.

1. IntroductionCutaneous metastases occur in approximately 0.7–0.9% of all cancer patients.1 Cutaneous metastasis can cause symptoms such as exudates, bleeding, and pain, which remarkably reduce patient’s quality of life. Radiation therapy is one of the effective treatment methods for cutaneous metastasis.2,3 Recently, the “Quad Shot” regimen, comprising 2 days of twice-daily fractionation with a fraction size of 3.5–3.7 Gy (14.0–14.8 Gy per cycle) repeated at 3–6-week intervals for a total of three cycles, has been successfully adapted for palliative treatment of head and neck cancer.4,5 However, to the best of our knowledge, there is no reports of using the Quad Shot regimen for cutaneous metastasis.Herein, we report a case in which radiation therapy using the Quad Shot regimen was effective in the treatment of cutaneous metastasis from parotid gland cancer.

Compound/silicon heterojunction (SCH) solar cells have been widely studied due to the low parasitic absorption of the window layer, high short-circuit current, and simple preparation process. So far, most reported SCH solar cells are small-area devices. By depositing MoO x hole transport layer using hot-wire oxidation-sublimation deposition technique and employing a front-contact back-junction cell architecture, the large-area SCH solar cells are successfully fabricated on M6 (166 mm) n-type silicon wafers. Indium cerium oxide (ICO) film with the optimal thickness of about 110 nm is inserted between MoO x and Ag. The ICO/Ag stack functions well as a back reflector and is beneficial for increasing the short-circuit current density, reducing the contact resistance, and improving the device stability. A power conversion efficiency of 21.59% is achieved on the champion SCH solar cell with the device area of 274.15 cm 2.

Introduction: Following the “hygiene hypothesis” and the increase in prevalence of atopic diseases such as allergic rhinitis, a plethora of studies have investigated the role of sibship composition as a protective factor, but findings are conflicting. Aim: To synthesize the global literature linking birth order and sibship size (number of siblings) to the risk of allergic rhinitis. Methods: Fifteen databases were systematically searched, with no restrictions on publication date or language. Observational studies with defined sibship composition (birth order or sibship size) as exposure and allergic rhinitis or allergic rhinoconjunctivitis (self-reported or clinically diagnosed) as outcome were eligible. Study selection, data extraction, and quality assessment was performed independently in pairs. Relevant data were summarized in tables. Comparable numerical data were analyzed using meta-analysis with robust variance estimation (RVE). Results: Seventy-six reports with >2 million subjects were identified. Being second- or later-born child was associated with protection against both current (pooled risk ratio [RR] 0.79, 95%CI 0.73-0.86) and ever (RR 0.77, 95%CI 0.68-0.88) allergic rhinitis. Having siblings, regardless of birth order, was associated with a decreased risk of current allergic rhinitis (RR 0.89, 95% CI 0.83-0.95) and allergic rhinoconjunctivitis (RR 0.92, 95%CI 0.86-0.98). These effects were unchanged across age, time period, and geographical regions. Conclusion: Our findings indicate that primarily, a higher birth order, and to a lesser extent the number of siblings, is associated with a lower risk of developing allergic rhinitis.

Projections for future air mobility envisage intensely utilised airspace that does not simply scale up from existing systems with centralised air traffic control. This paper considers the implementation and test of a software and hardware framework for decentralised control of aerial vehicles within intensely used airspace. Up to 10 rotary wing vehicles of maximum all up mass of 1 kg are flown in an outdoor volume with length scale of 100 m with GPS and WiFi connectivity. Flight control is implemented using a Pixhawk 4 flight controller running the PX4 firmware with guidance algorithms run on a separate onboard companion computer. Deconfliction is implemented using a simple elastic repulsion model with a guidance update rate of 10 Hz. Traffic structures are constructed from a path of directed waypoints and associated cross sectional geometry. Junctions are implemented when two paths converge into one or when one path diverges into two. Agents engage with structures through execution of flow, merge and swirl velocity rules. Calibration experiments showed that the worst case latency in agents sharing position information was of the order of 0 .5 s made up from delays due to finite guidance update rate, WiFi processing and centralised message processing. A choice of vehicle cruise speed of 2 m/s and conflict radius of 2 .5 m provided an acceptable compromise between experiment time efficiency (speed) and spatial efficiency (resolution) within the test volume. Results from recirculating junction experiments show that peak deconfliction activity occurs at the junction node, however biased distribution of agents within a corridor means the peak intensity is pushed ahead of the node. Use of meshed helical junction structures significantly reduces the intensity of conflict at the expense of reduced junction time efficiency.

Background: Several countries, including Bahrain, used Wastewater surveillance for disease activity monitoring. This study aimed to determine the presence of SARS-COV-2 in untreated wastewater and to correlate it with the disease spread. Methods: A retrospective review was conducted for all wastewater samples tested for SARS-CoV-2 in public health laboratories from October 2020 to October 2022. Samples were collected weekly between February and October 2022 from different areas across Bahrain. Real-time polymerase chain reaction (PCR) was used to test for the presence of SARS-CoV-2 in wastewater, and the results were correlated with the number of COVID-19 cases in the same area. Results: Of a total of 387 wastewater samples, 103 (26.6%) samples tested positive for SARS-CoV-2. In late 2020, of 42 samples collected initially, 4 (9.5%) samples tested positive for SARS-CoV-2 in the 4 locations that hosted COVID-19 isolation facilities. Between February and October 2022, 345 specimens of wastewater were tested, and 99 (28.7%) were positive. The highest detection rate was in February, June, and July (60%, 45%, and 43%, respectively), which corresponded to COVID-19 peaks during 2022, and the lowest detection rate was in August and September (11% and 0%, respectively), corresponding to the low number of COVID-19 cases. Conclusion: The detection rate of SARS-COV-2 in wastewater samples from Bahrain was high and was significantly correlated with the number of reported COVID-19 cases. Wastewater surveillance can aid the existing surveillance system in monitoring SARS-CoV-2 spread.

Background Respiratory syncytial virus (RSV) infection in infants is a major cause of viral bronchiolitis and hospitalisation. We have previously shown in a murine model that ongoing infection with the gut helminth Heligmosomoides polygyrus ( H. polygyrus) protects against RSV infection through type I interferon (IFN-I) dependent reduction of viral load. Yet, the cellular basis for this protection has remained elusive. Given that recruitment of mononuclear phagocytes to the lung is critical for early RSV infection control, we assessed their role in this coinfection model. Methods Mice were infected by oral gavage with H. polygyrus. Myeloid immune cell populations were assessed by flow cytometry in lung, blood and bone marrow throughout infection and after secondary infection with RSV. Monocyte numbers were depleted by anti-CCR2 antibody or increased by intravenous transfer of enriched monocytes. Results H. polygyrus infection induces bone marrow monopoiesis, increasing circulatory monocytes and lung mononuclear phagocytes in a IFN-I signalling dependent manner. This expansion causes enhanced lung mononuclear phagocyte counts early in RSV infection that may contribute to the reduction of RSV load. Depletion or supplementation of circulatory monocytes prior to RSV infection confirms that these are both necessary and sufficient for helminth induced antiviral protection. Conclusions H. polygyrus infection induces systemic monocytosis contributing to elevated mononuclear phagocyte numbers in the lung. These cells are central to an anti-viral effect that reduces the peak viral load in RSV infection. Treatments to promote or modulate these cells may provide novel paths to control RSV infection in high risk individuals.

Objectives: To investigate the association and the potential value of prelabour fetal heart rate short-term variability (STV) determined by computerised cardiotocography (cCTG) and maternal-foetal Dopplers in predicting labour outcomes. Design: Prospective cohort study. Setting: The Prince of Wales Hospital, a tertiary maternity unit, in Hong Kong SAR. Population: Women with a term singleton pregnancy in latent phase of labour or prior to labour induction were recruited during May 2019 – November 2021. Methods: Ultrasonographic assessment of foetal growth, Doppler velocimetry and the cCTG monitoring including Dawes-Redman CTG analysis. Main Outcome Measures: Umbilical Cord arterial pH, emergency delivery due to pathological CTG during labour and neonatal intensive care unit (NICU)/special care baby unit (SCBU) admission. Results: Of the 400 cases, 34 (8.5%) women underwent emergency delivery for pathological CTG during labour. A total of 6 (1.50%) and 148 (37.00%) newborns required NICU and SCBU admission, respectively. Middle cerebral artery pulsatility index (MCA-PI) and MCA-PI z-score were significant lower in pregnancies that required emergency delivery for pathological CTG during labour compared with those who did not [1.23 (1.07-1.40) vs 1.40 (1.22-1.64), p=0.002 and 0.55 (±1.07) vs 0.12 (±1.06), p=0.049,]. Umbilical cord arterial pH was associated with STV (r = 0.107, p = 0.035) and the independent predictors for umbilical cord arterial pH were smoking (p = 0.006) and STV (p = 0.025). Conclusions: In pregnant women admitted in latent phase of labour or for induction of labour at term, cCTG STV is associated with umbilical cord arterial pH but not predictive of emergency delivery due to pathological CTG during labour.

A document by Sophie Strong. Click on the document to view its contents.

Aim The prevalence of undocumented medical treatments among children is a significant issue, as well as many EU countries lack access to newly developed children friendly medicines. Consequently, there is a pressing need for supplementary resources that can facilitate informed decision-making regarding children’s medication. We therefore aim to describe the process of establishing a children’s Drug and Therapeutics Committee (cDTC), as well as the preparing and implementation of recommendations for children in the Capital region of Denmark Method Following the guidelines outlined by the World Health Organization a cDTC was established. Recommendations for pediatric medication practice were constructed from assessments of medication use patterns among children in the Capital Region between 2019 and 2021. The recommendations were meticulously crafted based on evaluation of the current marketing authorization landscape and existing best available evidence. Results In 2019, the Capital Region established the first cDTC supported by expert councils and an editorial board. A total of 2.429 purchase item numbers covering 1.222.846 defined daily doses and 592.088 purchased packages covering 10.200.000 defined daily doses were identified in the secondary and primary sectors, respectively. Three comprehensive lists covering recommendations for newborns and children were published between 2021 and 2020 totaling 331 recommended pharmaceutical products. The recommendations primarily intended for use in the secondary healthcare sector were implemented through the revision of 38 pediatric- and 6 neonatal product ranges throughout Capital region. Conclusion Recommendation lists for children governed by a cDTC provide a rational auxiliary tool that can be immediately implemented in the clinic.

A case of phantom pain and stump pain that was effectively controlled by ultrasound-guided ulnar and median peripheral nerve blocksShunya Sekiguchi, Yusuke Ishida, Yosuke Fujita, Mikiko Tomino, and Kiyoshige OhsetoDepartment of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan

Discussed is the case of a 13-year-old male with no significant past medical history, who presented to the hospital for evaluation of multisystem inflammatory syndrome in children (MIS-C). He arrived with findings of conjunctivitis, strawberry tongue, tachycardia at rest, and hypoxemia with oxygen saturation of 85%. The patient was recently hospitalized 1 week prior for viral pneumonia and hypoxemia due to SARS-CoV-2. During his inpatient stay he received combination therapy of remdesivir and dexamethasone. Following, he weaned to room air and his pulse oximetry (SaO2) order was switched to intermittent with floor vitals prior to his discharge.

Case Images

A document by Sarah Baïli. Click on the document to view its contents.

A general reaction norm model of any order can be formulated as a linear mixed model. From this follows that estimates of mean phenotypic traits in a population (fixed effects), and predictions of individual additive genetic deviations from mean reaction norm parameter values (random effects), can be found from the best linear unbiased predictions (BLUP) equation in matrix form. The resulting BLUP model is dynamical in the sense that the incidence matrix varies with time. This leads to a straightforward and multivariate alternative to infinite-dimensional and random regression modeling of reaction norms. Based on such a BLUP model, the within-generation changes in predicted mean reaction norm parameter values can be found by use of the Robertson-Price identity, applied on the predicted random effects. From this follows that the between-generation change in the mean values are found from Robertson’s secondary theorem of natural selection, applied on the predicted random effects. This explains why and to which extent the variances of BLUP random effects are underestimated, which is a well-known observation. The dynamical BLUP model will thus produce the mean reaction norms over time, which makes it possible to disentangle the microevolutionary and plasticity components in for example climate change responses. The BLUP responses will depend on the additive genetic relationship matrix A_t. When A_t is an identity matrix, the results will be identical to the results from a variant of the multivariate breeder’s equation, based on the selection gradient with respect to the individual phenotypic trait values. Parameters are assumed to be known and constant, but it is discussed how they can be estimated by means of a prediction error method. Generations are assumed to be non-overlapping, but adjustments for overlapping generations can easily be done.

Congenital Lobar Emphysema: A diagnostic dilemma with co-existent Congenital Heart Defects