In this study, we give the structure of ruled surfaces parameterized on a product time scale. Mean and Gaussian curvatures of these surfaces are constructed on distinct time scales. Then, we obtain principal curvatures for ruled surfaces. Finally, we will clarify the issue with some examples.

Background The prognosis of children with acute lymphoblastic leukemia (ALL) has improved considerably over the past decades. However, to achieve cure in patients with refractory disease or relapse new treatment options are mandatory. Methods In the multicenter-trial CoALL-08-09, an additional treatment element consisting of the rarely used chemotherapeutic agent amsacrine combined with etoposide and methylprednisolone (AEP) (amsacrine 2 x 100 mg/m2, etoposide 2 x 500 mg/m2 and methylprednisolone 4 x 1000 mg/m2) was implemented into the first-line treatment of pediatric patients with a poor treatment response at the end of induction (EOI) measured by minimal residual disease (MRD). These patients were stratified into a high-risk intensified arm (HR-I) including an AEP element at the end of consolidation. Patients with induction failure (IF), i.e. lack of cytomorphological remission EOI, were eligible for hematopoietic stem cell transplantation (HSCT) after remission had been reached later on. These patients received AEP as a part of their MRD-guided bridging-to-transplant treatment. Results A significant improvement in probality of overall survival (pOS) for the CoALL-08-09 HR-I patients was noted compared to MRD-matched patients from the preceding CoALL-07-03 trial in the absence of severe or persistent treatment-related toxicities. Relapse rate and probability of event-free survival (pEFS) did not differ significantly between trials. In patients with IF a stable or improved MRD response after AEP was observed without severe or persistent treatment-related toxicities. Conclusion In conclusion, AEP is well-tolerated as a component of the HR treatment and useful in bridging-to-transplant settings.

In this work, stationary states in nonequilibrium plasmas of chemical reactions that can produce hydrogen are explored, namely the water splitting and water gas shift reactions. For both reactions, the effluent from the reactor at long gas residence times in the plasma was found to be independent of the influent speciation. In other words, feeding the reactor either 0.1 H2O or 0.1H2+0.05O2 by mole produced the same effluent composition, and similarly, feeding the reactor 0.1CO+0.1H2O produced nominally the same effluent as 0.1CO2+0.1H2. For both reactions, the effluent from the plasma was found to be very far from local equilibrium at the total pressure and background temperature of the reactor. An important conclusion of this work is that special attention must be paid to the recombination zone in plasma chemical processes. The recombination zone tends to drive the gas composition from plasma stationary states back towards local equilibrium.

One of the most effective defenses of avian hosts against obligate brood parasites is the ejection of parasitic eggs from the nests. Despite the clear fitness benefits of this behavior, individuals within so-called “egg rejecter” host species still show substantial variation in their propensity to eliminate foreign eggs from the nest. We argue that this variation can be further understood by studying the physiological mechanisms of host responses to brood parasitic egg stimuli: independent lines of research increasingly support the hypothesis that stress-related physiological response to parasitic eggs may trigger egg rejection. The “stress-mediated egg rejection” hypothesis requires that hosts activate the stress-response when responding to parasitic eggs. We tested this prediction by experimentally parasitizing incubating American robins Turdus migratorius, an egg rejecter host to obligate brood parasitic brown-headed cowbirds Molothrus ater, with mimetic or non-mimetic model eggs. To assess the stress response, we measured the heart rate in incubating females immediately after experimental parasitism. We also measured plasma corticosterone and, in a subset of birds, used RNA-sequencing to analyze the expression of proopiomelanocortin (POMC), a precursor of adrenocorticotropic hormone (ACTH), two hours after experimental parasitism. We found that egg type had no effect on heart rate. Two hours following experimental parasitism, plasma corticosterone did not differ between the differently colored model egg treatments or between rejecter and accepter females within the non-mimetic treatment. However, females exposed to non-mimetic eggs showed an upregulation of POMC gene expression in the pituitary compared to females treated with mimetic eggs. Our findings suggest that parasitic eggs may activate the stress-related hypothalamic-pituitary-adrenal axis in an egg-rejecter host species, although the dynamics of this response are not yet understood.

Objective: To explore the views of female genital mutilation (FGM) survivors, men, and healthcare professionals (HCPs) on the timing of deinfibulation surgery and NHS service provision. Design: Qualitative study informed by the sound of silence framework. Setting: Survivors and men were recruited from three FGM prevalent areas of England. HCPs and stakeholders were from across the UK. Sample: 44 survivors, 13 men and 44 HCPs. 10 participants at two community workshops and 30 stakeholders at a national workshop. Methods: Hybrid framework analysis of 101 interviews and three workshops. Results: There was no consensus across groups on the optimal timing of deinfibulation for survivors who wished to be deinfibulated. Within group, survivors expressed a preference for deinfibulation pre-pregnancy and HCPs antenatal deinfibulation. There was no consensus for men. Participants reported that deinfibulation should take place in a hospital setting and be undertaken by a suitable HCP. Decision making around deinfibulation was complex but for those who underwent surgery it helped to mitigate FGM impacts. Whilst there were examples of good practice, in general, FGM service provision was sub-optimal. Conclusion: Deinfibulation services need to be widely advertised. Information should highlight that the procedure can be carried out at different time points, according to preference, and in a hospital by suitable HCPs. Future services should ideally be developed with survivors, to ensure that they are clinically and culturally appropriate. Guidelines would benefit from being updated to reflect the needs of survivors and to ensure consistency in provision. Study registration number ISRCTN 14710507

t’s time for a fivesome. Commentary to: “The predictive value of five glomerular filtration rate formulas for long-term mortality in patients undergoing coronary artery bypass grafting” Coronary artery disease is an extremely common condition and coronary artery bypass-grafting is still one of the most important therapeutic strategy to treat it. Chronic kidney disease is often affecting patients with CAD. Nevertheless, the literature is still debating what formula estimate the best the glomerular filtration rate in patients undergoing CABG. Indeed, the formulas used in clinical practice have some differences some are more accurate in patients with diabetes, while there are some bias given by age and body mass index. In cardiac surgery, the choice of the most fitting formula to evaluate GFR has important clinical implication and, up to now, three formulas have been compared at most. Eilon Ram et al. present a retrospective study which compares the 5 most used formulas (CG, MDRD, CKD-EPI, Mayo, and IB) to derive GFR to evaluate the one with the best accuracy in predicting long-term mortality. In order to do so, they divided 3744 patients in three groups according to the estimated GFR by means of all 5 formulas: significant CKD according to all formulas, non-significant CKD according to all formulas and discordant results (meaning that at least one formula gave normal GFR and at least one formula gave abnormal GFR). Patients with the highest mortality were the ones with significant CKD according to all formulas.

Title : Submitral Aneurysm: Exploring a Rare PathologyAuthors : Kellen Round BS1, Jake L. Rosen BA1, Colin C. Yost BA1, T. Sloane Guy MD, MBA21Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St #100, Philadelphia, PA 191072Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Curtis Bldg, Ste 620, 1015 Walnut St Philadelphia, PA 19107Running Title: Submitral Aneurysm Commentary

A document by David Sanders . Click on the document to view its contents.

Objectives: To evaluate risks of preterm birth and severe maternal morbidity (SMM) in female adolescent and young adult cancer survivors; assess maternal comorbidity as a potential mechanism; determine whether associations differ by use of assisted reproductive technology (ART). Design: Retrospective cohort Setting: Privately insured females in the U.S. Sample: Female with live births from 2000 to 2019 within OptumLabs®, a U.S. administrative health claims dataset Methods: Log-binomial regression models estimated relative risks of preterm birth and SMM by cancer status and tested for effect modification. Causal mediation analysis based on a counterfactual approach evaluated the proportions explained by maternal comorbidity. Main Outcome Measures: SMM, preterm birth Results: Among 46,064 cancer survivors, 2,440 singleton births, 214 multiple births, and 2,590 linked newborns occurred after cancer. In singleton births, preterm birth incidence was 14.8% in cancer survivors versus 12.4% in females without cancer (aRR 1.19, 95%CI 1.06-1.34); SMM incidence was 3.9% in cancer survivors versus 2.4% in females without cancer (aRR 1.44, 95%CI 1.13-1.83). Cancer survivors had more maternal comorbidities before and during pregnancy; 26% of the association between cancer and preterm birth and 30% of the association between cancer and SMM was mediated by maternal comorbidities. Associations between cancer and outcomes did not differ between ART and non-ART births. Conclusion: Preterm birth and SMM risks were modestly increased after cancer. Significant proportions of elevated risks may be due to increased comorbidities. Prevention and treatment of comorbidities provides an opportunity to improve perinatal outcomes among cancer survivors.

CIED infection is a serious complication and remains the commonest indication for TLE.The patient exist two problems: bilateral venous access infection and pacing dependence. LP provide safe and effective pacing options for patients with device-related infections.

Uganda lies within the drier end of the natural distribution range of Coffea canephora and contains unexplored genetic material that could be drought-adapted and useful for developing climate-resilient varieties. Using experimental treatments, (i) ample and (ii) restricted-water, response of 148 genotypes were studied comprising wild, feral and cultivated C. canephora. Biomass allocation, standing leaf area and leaf area growth data were collected. Linear mixed effect models and PCA were used to analyse effect of drought on genotypes from different: (i) cultivation status, (ii) genetic groups and (iii) locations. We assessed the relationship between drought tolerance for relative growth rate in leaf area (RGRA), total number of leaves (TNL), total leaf area (TL) and total leaf dry weight (TLDW) of genotypes at final harvest. Restricted-water reduced RGRA across genetic groups (3.2 – 32.5%) and locations (7.1 – 36.7%) but not cultivation status. For TNL, TL and TLDW, genotypes that performed well in ample-water performed worse under restricted-water, indicating growth-tolerance trade-off. Drought tolerance in RGRA and TNL were negatively correlated with wetness index suggesting some degree of adaptation to local climate. Findings indicate a growth-tolerance trade-off within this tropical tree species and drought tolerance of Uganda’s C. canephora is somewhat associated with local climate.

Borderline ovarian Brenner tumors are rare, mainly diagnosed manopause. We reported in a previous article the first pregnancy after a fertility sparing surgery. We now report the first baby birth after unilateral salpingo-oophorectomy for a borderline ovarian Brenner tumor and a review of the literature on fertility sparing surgery.

Bipolar Ablation for Outflow Tract Ventricular Arrhythmias: When the Going gets Tough, Two Catheters may be Better than One Anurut Huntrakul, MD1,2 and Jackson J. Liang, DO11 Electrophysiology Section, Division of Cardiology, Cardiovascular Center, University of Michigan Medical Center, Ann Arbor, MI 48109, USA.2 Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok 10330, ThailandFunding: NoneDisclosures: None

We aimed to focus on clinical features, on diagnosis of this pathology and to review the most controversial aspect of management. We reviewed 10 in patients between 1995 and 2020. All patients were treated with broad-spectrum antibiotherapy, anticoagulation in 9 patients, and surgery required in 9 patients.

An economical and highly uranium extraction from seawater remains a crucial task for energy sources and environmental safety. Aiming for improving the mass transfer rate of uranium from seawater, a new synthetic strategy was adopted to synthesize 2D-open channel microporous bio-adsorbent for uranium extraction from seawater. Herein, a vapor phase modification approach was adopted to graft divinylbenzene(DVB), and polyacrylonitrile(AN) onto the surfaces of microporous frameworks via a free radical polymerization method. The post-synthetic functionalization was carried out by hydrothermal process, where amidoxime groups are structure-directing agents to trap uranium. Further, amidoxime groups not only enhanced hydrophilicity but also adjusts adsorbents pKa. AO-Fc faces minimum interference of competing ions and achieves a high uranium adsorption capacity of 8.57±0.02 and 409±1 mg/g in seawater and simulated solution. Despite its stable structure, AO-Fc exhibits a long life span and negligible weight loss revealed AO-Fc could be applied as a potential adsorbent for radionuclides

A new test specimen is proposed for investigation of mixed mode I/II/III fracture of materials. In the test specimen, by displacing the position of an inclined crack from the middle of the rectangular specimen, in addition to mode II loading, mixed mode I/III loading conditions are created under anti-symmetric four-point bending. To examine the applicability of the test set-up, the specimens made of PMMA (Polymethyl-methacrylate) with three crack angles and three different positions of crack with reference to the middle of the specimen are tested. The experimental fracture loads are compared with the theoretical predictions of the maximum principal stress fracture criterion. There is a satisfactory consistency between the test and theoretical results. Although the proposed test configuration has limitations in applying the mixed modes of I/III and II/III, it is an efficient test configuration easier and less expensive than other configurations utilizing complex crack geometry or complicated loading fixtures.

Primary herpetic gingivostomatitis(PHGS)is a manifestation of primary herpes infection with the simplex virus .It may be preceded by some prodromal symptoms.After the resolution of the primary infection, the virus remains latent in a nervous ganglion. The aim of this paper was to report a case of PHGS in a child

The production of hydrocarbons for the synthesis of readily available energy and multifunctional materials is of great importance in modern society. Zeolites have proven to be a boon for the targeted regulation of specific hydrocarbon as shape-selective catalyst in converting carbon resources. Yet our mechanistic understanding and quantitative description of shape-selectivity of zeolite catalysis remains rather limited, which restricts the upgrade of zeolite catalysts. Herein, we proposed quantitative principle of shape-selectivity for zeolite catalysis using methanol-to-hydrocarbons (MTH) as model. Combining with molecular simulations and infrared imaging, we unveil the competition of thermodynamic stability, preferential diffusion and favored secondary reactions between different hydrocarbons within zeolite framework are the essence of zeolite shape-selective catalysis. Notably, we provide methodology to in silico search for the optimal combination of framework topology and acidity properties of zeolites with operating conditions that potentially outperform commercial MTH catalysts to achieve high selectivity of desired hydrocarbon products.