Persistent Weakness Research Articles

Effect of Meniscal Treatment on Functional Outcomes 6 Months After Anterior Cruciate Ligament Reconstruction.

Background:Meniscal injuries are commonly associated with anterior cruciate ligament (ACL) tears. Treatment of meniscal injuries can impart delayed weightbearing and range of motion restrictions, which can affect the rehabilitation protocol. The effect of meniscal treatment and subsequent restrictions on strength recovery after ACL reconstruction is unclear.Purpose/Hypothesis:The purpose of this study was to compare strength, jumping performance, and patient-reported outcomes between patients who underwent isolated ACL reconstruction (ACLR) and those who underwent surgical intervention for meniscal pathology at the time of ACLR. Our hypothesis was that patients who underwent concurrent meniscal repair (MR) would have lower strength recovery owing to postoperative restrictions.Study Design:Cohort study; Level of evidence, 3.Methods:Patients with ACLR were stratified into isolated ACLR, ACLR and meniscectomy (ACLR-MS), or ACLR-MR groups and were compared with healthy controls. The ACLR-MR group was restricted to partial weightbearing and to 90° of knee flexion for the first 6 weeks postoperatively. All participants completed patient-reported outcomes (International Knee Documentation Committee [IKDC] and Knee injury and Osteoarthritis Outcome Score [KOOS]) and underwent bilateral isokinetic and isometric strength tests of the knee extensor and flexor groups as part of a return-to-sports test battery at 5 to 7 months postoperatively.Results:A total of 165 patients with ACLR (50 with isolated ACLR, 44 with ACLR-MS, and 71 with ACLR-MR) and 140 healthy controls were included in the study. Follow-up occurred at a mean of 5.96 ± 0.47 months postoperatively. The control group demonstrated higher subjective knee function, unilateral peak extensor torque, and limb symmetry than did the ACLR-MS and ACLR-MR groups combined (P < .001 for all). There were no differences in IKDC, KOOS subscales, or unilateral or limb symmetry measures of peak knee extensor or flexor torque among the isolated ACLR, ACLR-MS, and ACLR-MR groups.Conclusion:Persistent weakness, asymmetry, and reduced subjective outcome scores at 6-month follow-up after ACLR were not influenced by meniscal treatment. These findings suggested that the weightbearing and range of motion restrictions associated with meniscal repair recovery do not result in loss of early strength or worse patient-reported outcomes.

Found Down Extremity Compartment Syndrome Secondary to Substance Use: An Observational Multicenter Study.

Background:With the worsening opioid epidemic in America, more patients are developing found down extremity compartment syndrome (FDECS). The purpose of this study was to describe this patient population, including their presenting symptoms, laboratory test results, and clinical outcomes.Methods:We performed a 2-center retrospective review of adult patients who developed FDECS secondary to substance use from January 2006 to December 2019. Patients were managed operatively or nonoperatively at the surgeon’s discretion. Data on patient demographic characteristics, laboratory values, hospital course, and clinical outcomes were collected from electronic medical records.Results:In this study, 91 patients were included: 85 patients were managed operatively, and 6 patients were managed nonoperatively. Most patients were male, and the mean patient age (and standard deviation) was 37 ± 11 years. Opioids were the most common substance used. Patients managed operatively underwent a mean of 4 ± 3 surgical procedures, 44% received a skin graft, 25% developed a wound infection, and 11% underwent limb amputation. Patients managed nonoperatively did not undergo a subsequent fasciotomy or amputation. At a mean follow-up of 2.3 years, persistent weakness (66%), pain (78%), persistent sensory deficits (53%), and contractures (18%) were common.Conclusions:Patients who develop FDECS secondary to substance use have high surgical complication rates and poor clinical outcomes. We found high rates of wound infection, revision surgical procedures, and amputation, often leaving young adults with lifelong disability.Level of Evidence:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The Impact of Meniscal Treatment on Functional Outcomes Six Months After Anterior Cruciate Ligament Reconstruction (107)

Objectives:The incidence of anterior cruciate ligament (ACL) injuries continues to rise, and meniscal injuries are commonly associated with these tears. Treatment of meniscal injuries can impart delayed weightbearing range-of-motion restrictions, which can affect the post-operative rehabilitation protocol. These limitations after a meniscal repair could change how patients are managed and progressed through rehab. The effect of the meniscal treatment and subsequent restrictions on strength recovery after ACL reconstruction (ACLR) is unclear and may affect return-to-play assessments. The purpose of this study was to compare strength, jumping performance and patient reported outcomes between isolated ACLR patients and those undergoing surgical intervention for meniscal pathology at the time of ACLR surgery at a scheduled functional testing assessment an average of 6 months after surgery. Our hypothesis is that those undergoing meniscal repair will have lower strength recovery due to post-operative restrictions.Methods:In this retrospective cohort study, ACLR patients and healthy controls completed patient-reported outcomes (IKDC and KOOS), underwent bilateral isokinetic and isometric strength tests of the knee extensor and flexor groups, as well as functional hop testing as part of a return-to-sport test battery at 5-7 months post-operatively. ACLR patients were stratified as isolated ACLR, ACLR+Meniscectomy (ACLR-MS), ACLR+Meniscal Repair (ACLR-MR) and compared to healthy controls. Patients treated with meniscus repair were restricted to partial weight bearing and to 90 degrees of knee flexion for the first 6 weeks post-surgery. Comparisons were performed between meniscal treatment groups with regard to demographics, patient reported outcomes scales, knee extensor and flexor strength, while stratifying by graft type.Results:305 participants, including 165 ACLR patients (50 isolated ACLR, 71 ACLR + Meniscal Repair, 44 ACLR + Meniscectomy) and 140 healthy controls were included with an average time post-operatively to functional testing of 5.96±0.47 months. Heathy controls demonstrated higher subjective knee function, unilateral peak extensor torque, and limb symmetry than all meniscal subgroups (p<.001). There were no differences between the IKDC, KOOS subscales, or in unilateral or limb symmetry measures of peak knee extensor or flexor torque between ACLR, ACLR+MS, and ACLR+MR patients (all p-values>.05).Conclusions:Persistent weakness, asymmetry and reduced subjective outcome scores measured at approximately 6 months post index surgery were not influenced by meniscus treatment. Knee flexor and extensor strength, limb symmetry, and patient reported outcomes did not significantly differ across patients undergoing isolated ACLR, ACL + Meniscus Repair, and ACL + meniscectomy. These findings suggest that the weightbearing and range-of-motion restrictions associated with meniscus repair recovery do not result in loss of early strength or patient reported outcomes, and they can be progressed through therapy accordingly.

SHIBOR Fluctuations and Stock Market Liquidity: An MF-DCCA Approach

ABSTRACT This paper examines the nonlinear and dynamic cross-correlations between SHIBOR and Chinese stock market liquidity by employing MF-DCCA method. The cross-correlations display weak persistence and multifractal characteristics, explaining the variations in the relationship between them. The multifractality strength of the cross-correlations decreases after a recent liberalization reform. Moreover, interest rates have a significantly strong influence on stock market liquidity during tight monetary policy and emergencies, indicating the asymmetric and time-varying impact of interest rates on stock market liquidity. In addition, the effectiveness of interest rate transmission decreases in the period of the COVID-19 pandemic.

Influential factors of surgical decompression for ulnar nerve neuropathy in Guyon's canal.

Guyon's canal syndrome is nerve compressive pathology which can lead to sensory and/or motor function deficits. This problem is usually difficult to distinguish from cubital tunnel syndrome and relatively less common than cubital tunnel syndrome. This study evaluated the functional results and patient-reported outcomes following decompression of the ulnar nerve in Guyon's canal. Patients who were diagnosed with Guyon's canal syndrome confirmed by electrodiagnostic studies and underwent nerve decompression surgery were included in this study. The functional improvement by examining the Froment's sign, Wartenberg's sign, static two-point discrimination, and Semmes Weinstein monofilament examination as physical examination scores was evaluated. The visual analogue scale of satisfaction and the disabilities of the arm, shoulder, and hand questionnaire were used for the postoperative patient-reported outcome evaluation. From 2003 to 2019, 38 cases had been enrolled with a mean age of 53 years, ranging from 19 to 85 years. There were seven patients with comorbidity of diabetes mellitus and 28 patients who received additional neurolysis combined with the Guyon's release procedure. There were 19 patients with a good response to surgery and 10 patients with a poor surgical outcome due to persistent paresthesia or weakness. After statistical analysis, it was revealed that several influential factors could have been related to a compromised functional outcome, including a symptom duration of more than 3 months, combination with additional neurolysis of ipsilateral extremity, and/or comorbidity with diabetes mellitus. It was concluded that promising functional outcomes after surgical release of ulnar neuropathy in Guyon's canal could be achieved if the patients did not need additional neurolysis or the symptom duration was within 3 months.

Impact of Autumn-Winter Tibetan Plateau Snow Cover Anomalies on the East Asian Winter Monsoon and Its Interdecadal Change

The present study investigates the impacts of autumn-winter Tibetan Plateau (TP) snow cover anomalies on the interannual variability of the East Asian winter monsoon (EAWM). It is found that the northern component of EAWM is significantly associated with October-November-December-January (ONDJ) snow cover anomalies over the eastern TP, whereas the TP snow cover changes have little impact on the southern component of EAWM. However, the relationship of the northern component of EAWM to ONDJ TP snow cover experienced an obvious change in the mid-1990s. During 1979–1998, due to the high persistence of TP snow anomalies from autumn to winter, extensive ONDJ TP snow cover anomalies have a prominent influence on atmospheric circulation over Asia and the North Pacific, with more TP snow cover followed by an enhanced Siberian high and a deepened Aleutian low in winter, resulting in stronger EAWM. During 1999–2016, TP snow cover anomalies have a weak persistence. The atmospheric circulation anomalies display a different distribution. As such, there is a weak connection between the northern component of EAWM and the TP snow cover anomalies during this period.

A Curious Case of Progressive Respiratory Failure Due to Anterior Spinal Cord Infarction in an Adolescent Boy: A Case Report and Review of the Literature

AbstractClinical features of cervical spontaneous spinal cord infarctions (SSCIs) remain poorly described in the literature. The goal of this article was to improve recognition of cervical SSCI, a rare but life-threatening condition. We presented a 15-year-old adolescent male patient who developed neck pain with weakness and numbness in all four limbs half an hour after returning from a hike in the late afternoon. The next morning, he was brought to the emergency room due to persistent weakness, vomiting, and progressive respiratory distress. He was promptly intubated for airway protection. Pupils were 2 mm, sluggishly reactive, and all four extremities were flaccid. He was found to have anterior spinal cord syndrome. Light touch (brush) was normal down to the posterior aspect of shoulders. Cervical magnetic resonance imaging (MRI) showed increased T2/short-tau inversion recovery and decreased T1 signal of the anterior spinal cord from C3 to C7. Four days later, MRI of the spinal cord showed restricted diffusion of anterior spinal cord consistent with radicular artery territory infarction. The work-ups for infection, thrombosis, and cardioembolism were all negative. Three months later, he still had incomplete Brown-Séquard's syndrome, as position sense was preserved. There was in addition bilateral loss of pain and temperature sensations below the clavicles. MRI showed cervical myelomalacia most severe between C3 and C5. Furthermore, MRI showed changes in C3–C4 intervertebral disc, consistent with a fibrocartilaginous embolism via retrograde arterial route into the anterior spinal artery. This article demonstrates the importance of recognizing subtle clinical clues leading to cervical SSCI diagnosis.

Association Between SARS-CoV-2 Infection and Immune-Mediated Myopathy in Patients Who Have Died

Myalgia, increased levels of creatine kinase, and persistent muscle weakness have been reported in patients with COVID-19. To study skeletal muscle and myocardial inflammation in patients with COVID-19 who had died. This case-control autopsy series was conducted in a university hospital as a multidisciplinary postmortem investigation. Patients with COVID-19 or other critical illnesses who had died between March 2020 and February 2021 and on whom an autopsy was performed were included. Individuals for whom informed consent to autopsy was available and the postmortem interval was less than 6 days were randomly selected. Individuals who were infected with SARS-CoV-2 per polymerase chain reaction test results and had clinical features suggestive of COVID-19 were compared with individuals with negative SARS-CoV-2 polymerase chain reaction test results and an absence of clinical features suggestive of COVID-19. Inflammation of skeletal muscle tissue was assessed by quantification of immune cell infiltrates, expression of major histocompatibility complex (MHC) class I and class II antigens on the sarcolemma, and a blinded evaluation on a visual analog scale ranging from absence of pathology to the most pronounced pathology. Inflammation of cardiac muscles was assessed by quantification of immune cell infiltrates. Forty-three patients with COVID-19 (median [interquartile range] age, 72 [16] years; 31 men [72%]) and 11 patients with diseases other than COVID-19 (median [interquartile range] age, 71 [5] years; 7 men [64%]) were included. Skeletal muscle samples from the patients who died with COVID-19 showed a higher overall pathology score (mean [SD], 3.4 [1.8] vs 1.5 [1.0]; 95% CI, 0-3; P < .001) and a higher inflammation score (mean [SD], 3.5 [2.1] vs 1.0 [0.6]; 95% CI, 0-4; P < .001). Relevant expression of MHC class I antigens on the sarcolemma was present in 23 of 42 specimens from patients with COVID-19 (55%) and upregulation of MHC class II antigens in 7 of 42 specimens from patients with COVID-19 (17%), but neither were found in any of the controls. Increased numbers of natural killer cells (median [interquartile range], 8 [8] vs 3 [4] cells per 10 high-power fields; 95% CI, 1-10 cells per 10 high-power fields; P < .001) were found. Skeletal muscles showed more inflammatory features than cardiac muscles, and inflammation was most pronounced in patients with COVID-19 with chronic courses. In some muscle specimens, SARS-CoV-2 RNA was detected by reverse transcription-polymerase chain reaction, but no evidence for a direct viral infection of myofibers was found by immunohistochemistry and electron microscopy. In this case-control study of patients who had died with and without COVID-19, most individuals with severe COVID-19 showed signs of myositis ranging from mild to severe. Inflammation of skeletal muscles was associated with the duration of illness and was more pronounced than cardiac inflammation. Detection of viral load was low or negative in most skeletal and cardiac muscles and probably attributable to circulating viral RNA rather than genuine infection of myocytes. This suggests that SARS-CoV-2 may be associated with a postinfectious, immune-mediated myopathy.

STUDY OF THE PECULIARITIES OF FORMING THE CREATIVE POTENTIAL IN PROSPECTIVE NURSES IN THE COURSE OF PROFESSIONAL TRAINING

The article analyzes the process of forming the creative potential in prospective nurses in the course of professional training. The main reason for the existing problems connected with forming the creative potential in prospective nurses lies in the predominance in the students the external motives for choosing a profession since a significant number of the prospective nurses lose interest in the profession in the educational process. This takes place due to the imperfect methods, tools and forms used in the professional training in the educational institution. Other reasons of this situation are connected with the small number of practical activities, imperfections and outdated content of educational material. This, in turn, leads to a reproductive style of thinking and low cognitive motives in the perspective nurses when they do not want to develop pertinent skills and abilities, to improve their personality due to low level of inquisitiveness and weak persistence in achieving the goals. &#x0D; It is proved that modern requirements to professional functions and social role of specialists in the sphere of nursing activity necessitate the modernization of the educational environment for the prospective competitive nurses. This presupposes the creation of innovative systems of professional development with taking into account the changes and consequences of their impact on professional activities of the prospective nurses. This can be realized by implementing a special course "Skills and professional inspiration of a nurse", designed to train the prospective nurses in the 5th semester. &#x0D; It is established that one of the effective directions of developing the creative potential in the prospective nurses is related with updating the prospective nurses' professional training through the introduction of innovative educational technologies and interactive teaching methods into the educational process. &#x0D; It is also found out that the reform of professional and professional before-higher education determines the tendency to actualize individualized training in medical institutions concerning self-development of specialists' personality in the context of their future professional activity, as well as forming individual psychological qualities, professionally significant qualities in all participants in the educational process, providing opportunities for individual research activities, improving the educational process in different types of medical institutions. To accomplish this, the prospective specialist must turn from an object of educational influence into a subject whose main features are activity, individuality and independence. This, in turn, presupposes the integration of the students into the creative educational environment of the educational institution, strengthening its development capabilities as a complex of systematized innovative educational resources with pertinent methodological, technological, organizational support.

Strengthening the Case for Cluster Set Resistance Training in Aged and Clinical Settings: Emerging Evidence, Proposed Benefits and Suggestions.

Resistance training (RT) is a fundamental component of exercise prescription aimed at improving overall health and function. RT techniques such as cluster set (CS) configurations, characterized by additional short intra-set or inter-repetition rest intervals, have been shown to maintain acute muscular force, velocity, and 'power' outputs across a RT session, and facilitate positive longer-term neuromuscular adaptations. However, to date CS have mainly been explored from a human performance perspective despite potential for application in health and clinical exercise settings. Therefore, this current opinion piece aimsto highlight emerging evidence and provide a rationale for why CS may be an advantageous RT technique for older adults, and across several neurological, neuromuscular, cardiovascular and pulmonary settings. Specifically, CS may minimize acute fatigue and adverse physiologic responses, improve patient tolerance of RT and promote functional adaptations (i.e., force, velocity, and power). Moreover, we propose that CS may be a particularly useful exercise rehabilitation technique where injury or illness, persistent fatigue, weakness and dysfunction exist. We further suggest that CS offer an alternative RT strategy that can be easily implemented alongside existing exercise/rehabilitation programs requiring no extra cost, minimal upskilling and/or time commitment for the patient and professional. In light of the emerging evidence and likely efficacy in clinical exercise practice, future research should move toward further direct investigation of CS-based RT in a variety of adverse health conditions and across the lifespan given the already demonstrated benefits in healthy populations.

Surgical Treatment of Iatrogenic Nerve Injury Following Arthroscopic Capsulolabral Repair

Case reports of nerve injuries following arthroscopic capsulolabral repair emphasize the proximity of major nerves to the glenoid. This study describes preoperative localization using nerve-sensitive magnetic resonance imaging in a small cohort of patients with iatrogenic nerve injuries following arthroscopic capsulolabral repair and the outcomes of nerve repair in these patients. Cases of iatrogenic nerve injury following arthroscopic capsulolabral repair referred to 2 surgeons from January 2017 to December 2019 were identified. Clinical charts, electrodiagnostic testing, magnetic resonance imaging studies, and operative reports were reviewed. Four cases of iatrogenic nerve injury were identified. The time to presentation to our institution ranged from 2 weeks to 8 years. The axillary nerves in 3 cases were tethered by a suture at the inferior glenoid, whereas 1 case had a suture tied around the radial and median nerves inferior to the glenohumeral joint capsule. One case underwent excision and nerve transfer, 1 underwent excision and nerve repair, and 2 underwent suture removal and neurolysis. Open and arthroscopic approaches, including a recently described approach to the axillary nerve in the "blind zone," were used. Three cases demonstrated good recovery of all affected motor and sensory functions after surgery. At the 10-month follow-up, 1 case had persistent weakness, but there was evidence of axonal regeneration on electrodiagnostic testing. Arthroscopic capsulolabral repair places regional nerves, particularly the axillary nerve, at risk owing to their proximity to the joint capsule and inferior glenoid. Patients with neuropathic pain in the distribution of affected nerves with corresponding sensorimotor loss following arthroscopic capsulolabral surgery should undergo focused magnetic resonance imaging with nerve-sensitive sequences and electrodiagnostic testing to localize the injury. The use of multiple surgical windows to the axillary nerve in the "blind zone" enables full visualization for neurolysis, suture removal, and nerve repair or transfer. Therapeutic V.

Dynamics of a stochastic population model with predation effects in polluted environments

The present paper puts forward and probes a stochastic single-species model with predation effect in a polluted environment. We propose a threshold between extermination and weak persistence of the species and provide sufficient conditions for the stochastic persistence of the species. In addition, we evaluate the growth rates of the solution. Theoretical findings are expounded by some numerical simulations.

Comparative analysis of contributions of wet deposition and photodegradation to the removal of atmospheric BaP by MFDCCA

Benzo [a] pyrene (BaP) in the atmosphere possess great carcinogenic potential to human health, and the understanding of its scavenging mechanisms has attracted considerable attention. In this work, a new quantitative method is proposed to make a comparative analysis of the long-term contributions of wet deposition and photodegradation to BaP removal based on multi-fractal detrended cross-correlation analysis (MFDCCA). According to the precipitation and global solar radiation (GSR) observations from 1998 to 2016 for two urban sites (Central/Western District and TsuenWan) in Hong Kong, the wet deposition and photodegradation of BaP are analyzed. Using MFDCCA method, long-term cross-correlation between precipitation/GSR and BaP are investigated. Moreover, the differences of multifractal features in cross-correlations of precipitation-BaP and GSR-BaP system are analyzed. Strong long-term persistence is observed in the cross-correlations for precipitation-BaP system in a one-year cycle; while cross-correlations between GSR and BaP show weak persistence over the whole timescale. Based on the meteorology in Hong Kong, this difference has been discussed. Then, contributions of wet deposition and photodegradation to atmospheric BaP removal are quantified based on MFDCCA method, which are further compared between summer and winter. The comparative analysis suggests that wet deposition plays a more significant role in the removal of atmospheric BaP. Specifically, in summer, the contributions of wet deposition are twice as much as that of photodegradation for both two sites; while in winter, the contribution of photodegradation is a little higher than that of wet deposition to BaP removal. Meanwhile, for wet deposition, the contributions in summer are about ten times greater than that in winter; while for photodegradation, the difference in contributions between summer and winter are relatively smaller. Furthermore, based on sliding window technique, the temporal evolutions in the contributions of wet deposition/photodegradation to BaP removal have been presented for both two sites. On this basis, it is discovered that the comprehensive contributions of wet deposition and photodegradation peak in June, and reach their lowest levels in December for both two sites. Quantifying the contribution of meteorological factors to the removal of atmospheric BaP is help for understanding its geochemical cycle.

Autonomic Dysfunction and SIADH as First Signs of Guillain-Barre Syndrome

A 68-year-old woman was admitted to our Internal Medicine Unit for severe hyponatremia and new onset resistant hypertension for two weeks. She also complained of nausea, weakness and paresthesia of the limbs in the previous 4 days. Several diagnostic tests were performed (blood, hormonal and urinary tests, echocardiography, ECG, renal arteries Doppler-US, total body CT scan), showing only severe hyponatremia, mild hypokalemia and mild hypochloremia. Hypertension was treated with isosorbide and doxazosin, whereas in the suspect of a Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH), hyponatremia was treated with hypertonic saline solution with progressive normalization of serum sodium levels. Despite improvement in the presenting symptoms, after 10 days the neurological scenario worsened, with persistence of weakness and onset of areflexia of lower limbs, constipation and urinary retention. Therefore, the patient was evaluated by a neurologist who, hypothesizing a Guillain-Barre Syndrome (GBS), required an EMG, which confirmed this clinical suspect. Intravenous immunoglobulins were immediately started and administered for 5 days, with partial improvement of weakness and areflexia. The patient was then transferred to a rehabilitation institute for the recovery path. We report a rare form of GBS where hypertension and SIADH, not frequent clinical features of this acute inflammatory polyneuropathy, preceded the neurological manifestation. In fact, the delay in the manifestation of the neurological pattern made harder and delayed the diagnosis. However, it is important to stress that a high clinical suspicious should rise in presence of multi-resistant hypertension with, even mild, neurological symptoms and electrolytes disturbances.

Five-Month Trial of Whole-Food Plant-Based Diet in a Patient With Coexisting Myasthenia Gravis and Lambert-Eaton Myasthenic Syndrome.

Introduction: Nutritional intervention, such as a whole-food plant-based (WFPB) diet, is suggested to improve symptoms of autoimmune disorders. Its effects on neuromuscular junction (NMJ) diseases are less known. Case Description: A 56-year-old female with a combined myasthenia gravis and Lambert-Eaton myasthenic syndrome presented with persistent musculoskeletal weakness and pain, fatigue, and diminished concentration. Methods: A WFPB diet was implemented for 5 months in this case study. Functionality, biometrics, and quality of life were assessed at regular intervals via blood work, vital signs, and patient surveys. Results: After 10 weeks, 2 medications were de-prescribed due to improvement in blood glucose levels and blood pressure readings. Neuromuscular symptoms lessened as measured by the Myasthenia Gravis Illness Index. Weight loss of 18.7 pounds was achieved. No deterioration in physical activity was reported throughout the 5-month trial of WFPB diet. Discussion: Our results have implications that an individualized dietary strategy may be considered as one component of management of NMJ diseases. The effects of WFPB diet on NMJ diseases remain inconclusive.

Stochastic effects of the tumor‐T cell immune model

To investigate the effects of environmental factors on the tumor growth and the T cell growth, we establish a stochastic tumor‐immune model consisting of cytotoxic T cells and helper T cells. By using the Itô formula and the strong law of large numbers, we prove the existence of globally unique positive solution and obtain the sufficient conditions of the extinction and the weak persistence of tumor cells and T cells. Moreover, according to our obtained theoretical results, we perform some numerical simulations to show that different noise intensities lead to different states of tumor cells, cytotoxic T cells and helper T cells, including extinction and weak persistence, which can be useful for the prevention and control of tumor deterioration and for explaining tumor escape phenomena of clinical medicine.

Endoscopic Implantation of Bioinductive Patch for Chronic Partial Retearing After Hamstring Repair

Proximal hamstring tendon avulsions are a relatively rare type of hamstring injury associated with persistent morbidity, including pain, weakness, and functional limitations. Open or endoscopic surgical repair is the standard treatment for complete tendon avulsions or partial tears that remain symptomatic despite conservative management in relatively young, healthy, and active patients. However, complications known to occur include retearing of the hamstring, infection, nerve injury, inability to return to work or sport, subjective persistent weakness, and subjective persistent pain. In the case of persistent pain where the repair is partially retorn, a careful history, physical examination, and scrutiny of radiologic studies can help guide management. We describe a technique for using revision endoscopy and augmentation with a bovine bioinductive patch in a case of chronic persistently painful partial retear after a proximal hamstring repair.

Survival and ergodicity of a stochastic Holling-III predator\u2013prey model with Markovian switching in an impulsive polluted environment

Based on the effects of white noise and colored noise, we propose a stochastic Holling-III predator–prey model in an impulsive polluted environment. Firstly, we prove an existence and uniqueness theorem of the presented model. Secondly, we establish sufficient criteria of extinction, nonpersistence in mean, and weak persistence in mean for both prey and predator species. Thirdly, with the aid of Lyapunov functions, we prove that this system is ergodic and has a unique stationary distribution under certain conditions. Finally, we verify the theoretical results by performing some numerical simulations.

Spatiotemporal variation of moisture in rooted-soil

Soil moisture is of high variability both in space and time, and root growth may greatly alter the soil texture and lead to distinctive moisture patterns. In order to explore the spatiotemporal variability of rooted soil moisture, this study conducted a series of greenhouse tomato growth experiments using loess and under certain irrigation regimes. The experiment lasted for three months, and throughout the growth period, root lengths and hourly moisture values of different positions in the root zone soil were measured. It is found that the root length satisfies the Weibull distribution and the parameters are well related to the weight and area of the root system. As root grows, soil structure changes dramatically and becomes highly heterogeneous, then the moisture presents distinctive patterns, falling into subareas of high, middle, and low moisture levels. The patterns vary remarkably in the three growth stages (growing, developing, and maturation), and the subareas approach to a balance state at the end of growth. Furthermore, from the spatial moisture patterns one may derive the root-affected water routines, which approaches to a uniform moisture in the zone far away from the root. Finally, the spectrum analysis of the moisture series at hour scale indicated that the moisture in near root area bears a weak persistence character, responding to the rainfall (or irrigation) fluctuation, while the moisture in area distant to root system bears high persistence character, having power exponent similar to slope soils in general and hence representing the ordinary state of soil moisture. In summary, the findings of spatial moisture patterns and temporal spectrum exponents are expected to be heuristic for understanding the spatiotemporal variability of soil moistures in general.

Unapproved Combination Therapy of Doxycycline and Ivermectin in Covid-19 Pandemic, an Opportunistic Chance of Self-medication: A Case Report

To date, no standard drug therapy has proven effective to counter COVID-19 disease. There are only hit and trial based on assumptions and weak evidence that are directing prescribing practices for asymptomatic to symptomatic and serious cases of COVID-19. ICMR being the apex body, responsible for framing the guidelines for the management of disease in India has not yet approved the use of combination doxycycline and ivermectin in the prophylaxis or treatment of Covid-19 cases but being used in the treatment of COVID-19 infection. Their adverse drug reactions individually are well known among scientific community. Doxycycline ADRs range from gastrointestinal, urogenital, neuropsychiatric, respiratory, nervous system to skin and appendages. We have reported a case of doxycycline induced drug allergy (rashes) all over the trunk and legs as a result of self-medication. The event happened after a female patient had complaints of persistent fever and weakness consumed doxycycline and ivermectin on her friend’s advice and developed rashes on her trunk and legs. The above ADE is very mild but alarming for the medical fraternity that warrants strict compliance with the electronic/text/online prescription. The usage of doxycycline and ivermectin in the treatment of COVID-19 disease, as an indication of treatment should not be considered prior to any concrete evidence or issuance of treatment, guidelines by the apex body in India.