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Research article

Postural orthostatic tachycardia syndrome in patients of orthostatic intolerance symptoms: an ambispective study

  • Received: 03 October 2020 Accepted: 01 December 2020 Published: 08 December 2020
  • Background A Postural orthostatic tachycardia syndrome (POTS) is infrequently diagnosed in routine practice because of the variable range of symptoms that could be seen in cardiac rhythm disorders, vertigo, chronic fatigue syndrome and anxiety panic disorder. POTS is a chronic debilitating condition that affects day to day efficient working of an individual. We have planned a study to look for POTS in patients who are having orthostatic intolerance symptoms and underwent a head-up tilt table test (HUTT).
    Aim To study the prevalence of POTS in patients of orthostatic intolerance (OI) symptoms and to analyze symptomatology, its association with neurocardiogenic syncope (NCS), and its outcome.
    Methods We reviewed the medical records of 246 patients presented with symptoms of OI seen at our centre from January 2010 till March 2019. Out of them, 40 patients included, those qualifying the criteria for POTS on HUTT.
    Results The mean age of the cohort was 25.90 ± 10.33 years with a range of 15 to 55 years, and males comprised 52.5% (21/40) of total patients. The most frequent presenting orthostatic symptoms of POTS patients are loss of consciousness (77.5%), lightheadedness (75%), and palpitation (67.5%). A total of 18 patients (45%) had coexisting neurocardiogenic syncope.
    Conclusion POTS is a prevalent condition and have a significant impact on the quality of life, and the majority of patients may not present with OI symptoms during HUTT. We have to keep this possibility in young patients of transient loss of consciousness because it may coexist with NCS.

    Citation: Dinesh Chouksey, Pankaj Rathi, Ajoy Sodani, Rahul Jain, Hashash Singh Ishar. Postural orthostatic tachycardia syndrome in patients of orthostatic intolerance symptoms: an ambispective study[J]. AIMS Neuroscience, 2021, 8(1): 74-85. doi: 10.3934/Neuroscience.2021004

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  • Background A Postural orthostatic tachycardia syndrome (POTS) is infrequently diagnosed in routine practice because of the variable range of symptoms that could be seen in cardiac rhythm disorders, vertigo, chronic fatigue syndrome and anxiety panic disorder. POTS is a chronic debilitating condition that affects day to day efficient working of an individual. We have planned a study to look for POTS in patients who are having orthostatic intolerance symptoms and underwent a head-up tilt table test (HUTT).
    Aim To study the prevalence of POTS in patients of orthostatic intolerance (OI) symptoms and to analyze symptomatology, its association with neurocardiogenic syncope (NCS), and its outcome.
    Methods We reviewed the medical records of 246 patients presented with symptoms of OI seen at our centre from January 2010 till March 2019. Out of them, 40 patients included, those qualifying the criteria for POTS on HUTT.
    Results The mean age of the cohort was 25.90 ± 10.33 years with a range of 15 to 55 years, and males comprised 52.5% (21/40) of total patients. The most frequent presenting orthostatic symptoms of POTS patients are loss of consciousness (77.5%), lightheadedness (75%), and palpitation (67.5%). A total of 18 patients (45%) had coexisting neurocardiogenic syncope.
    Conclusion POTS is a prevalent condition and have a significant impact on the quality of life, and the majority of patients may not present with OI symptoms during HUTT. We have to keep this possibility in young patients of transient loss of consciousness because it may coexist with NCS.


    For a convex function f:IRR on I with c,dI and c<d, the Hermite–Hadamard inequality states that [1]:

    f(c+d2)1dcdcf(t)dtf(c)+f(d)2. (1.1)

    The Hermite-Hadamard integral inequality (1.1) is one of the most famous and commonly used inequalities. The recently published papers [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17] are focused on extending and generalizing the convexity, Hermite-Hadamard inequality, and other inequalities for convex functions.

    The situation of the fractional calculus (integrals and derivatives) has won vast popularity and significance throughout the previous five decades or so, due generally to its demonstrated applications in numerous seemingly numerous and great fields of science and engineering [18,19,20].

    Now, we recall the definitions of Riemann-Liouville (RL) and generalized Riemann–Liouville (GRL) fractional integrals given by Sarikaya and Ertuğral.

    Definition 1.1 ([18,19,20]). Let fL1[c,d]. The Riemann–Liouville (RL) fractional integrals RLIνc+f and RLIνdf of order ν>0 with c0 are respectively defined by

    RLIνc+f(x)=1Γ(ν)xc(xt)ν1f(t)dt,c<x, (1.2)

    and

    RLIνdf(x)=1Γ(ν)dx(tx)ν1f(t)dt,x<d, (1.3)

    with RLI0c+f(x)=RLI0df(x)=f(x).

    Definition 1.2 ([21]). Assume that the function :[0,+)[0,+) satisfies the following condition:

    10(t)tdt<+.

    Then, the left sided and right sided generalized Riemann–Liouville (GRL) fractional integrals, denoted by GRLIc+ and GRLId, are defined as follows:

    GRLIc+f(x)=xc(xt)xtf(t)dt,c<x, (1.4)
    GRLIdf(x)=dx(tx)txf(t)dt,x<d. (1.5)

    Remark 1.1. From the Definition 1.1 one can obtain some known definitions of fractional calculus as special cases. That is,

    If (t)=tνΓ(ν), then Definition 1.2 reduces to Definition 1.1.

    If (t)=tνkkΓk(ν), then the GRL fractional integrals reduce to k–RL fractional integrals [22].

    If (t)=tνexp(1ννt), then the GRL fractional integrals reduce to the fractional integrals with exponential kernel [23].

    If (t)=t(yt)ν1, then the GRL fractional integrals reduce to the conformable fractional integrals [24].

    With a huge application of RL fractional integration and Hermite–Hadamard inequality, many researchers in the field of fractional calculus extended their research to the Hermite–Hadamard inequality, including RL fractional integration rather than ordinary integration; for example see [25,26,27,28,29,30,31,32].

    On the one hand, it is well known that RL and GRL fractional integrals have the same importance in theory of integral inequalities, and the GRL fractional integrals are more convenient for calculation. Therefore it is necessary to study the Hermite-Hadamard integral inequalities by using the GRL fractional integrals while by using the RL fractional integrals. Fortunately, studying the Hermite-Hadamard integral inequalities via the GRL fractional integrations can unify the research of ordinary and fractional integrations. So it is necessary and meaningful to study Hermite-Hadamard integral inequalities via the GRL fractional integrations (see for details [21,33,34,35,36]).

    In this paper, we consider the integral inequality of HHM type that depends on the Hermite-Hadamard and Jensen–Mercer inequalities. For this reason, we recall the Jensen–Mercer inequality: Let 0<x1x2xn and α=(α1,α2,,αn) nonnegative weights such that ni=1αi=1. Then, the Jensen inequality [37,38] is as follows, for a convex function f on the interval [c,d], we have

    f(ni=1αixi)ni=1αif(xi), (1.6)

    for all xi[c,d] and αi[0,1], i=1,2,...,n.

    Theorem 1.1 ([11,38]). If f is convex function on [c,d], then

    f(c+dni=1αixi)f(c)+f(d)ni=1αif(xi), (1.7)

    for each xi[c,d] and αi[0,1], i=1,2,...,n with ni=1αi=1.

    For some results related to Jensen-Mercer inequality, see [39,40,41].

    Based on the above observations and discussion, the primary purpose of this article is to establish several inequalities of HHM type for convex functions by using the GRL fractional integrals.

    Throughout this attempt, we consider the following notations:

    Λ(t):=t0((yx)u)udu<+andΔ(t):=t0((yx2)u)udu<+.

    Theorem 2.1. For a convex function f:[c,d]R, we have the following inequalities for GRL:

    f(c+dx+y2)f(c)+f(d)12Λ(1)[GRLIx+f(y)+GRLIyf(x)]f(c)+f(d)f(x+y2), (2.1)

    and

    f(c+dx+y2)12Λ(1)[GRLI(c+dy)+f(c+dx)+GRLI(c+dx)f(c+dy)]f(c+dx)+f(c+dy)2f(c)+f(d)f(x)+f(y)2. (2.2)

    Proof. From Jensen-Mercer inequality, we have for u,v[c,d]:

    f(c+du+v2)f(c)+f(d)f(u)+f(v)2. (2.3)

    Then, for u=tx+(1t)y and v=ty+(1t)x, it follows that

    f(c+dx+y2)f(c)+f(d)f(tx+(1t)y)+f(ty+(1t)x)2, (2.4)

    for each x,y[c,d] and t[0,1]. By multiplying both sides of (2.4) by ((yx)t)t and integrating the result with respect to t over [0,1], we can obtain

    f(c+dx+y2)Λ(1)[f(c)+f(d)]Λ(1)12[10((yx)t)t[f(tx+(1t)y)+f(ty+(1t)x)]dt]=[f(c)+f(d)]10Λ(1)12[10((yx)t)tf(tx+(1t)y)dt+10((yx)t)tf(ty+(1t)x)dt]=[f(c)+f(d)]Λ(1)12[yx(yw)ywf(w)dw+yx(wx)wxf(w)dw]=[f(c)+f(d)]Λ(1)12[GRLIx+f(w)+GRLIyf(w)].

    This gives the first inequality in (2.1). To prove the second inequality in (2.1), first we have by the convexity of f:

    f(u+v2)f(u)+f(v)2. (2.5)

    By changing the variables u=tx+(1t)y and v=ty+(1t)x in (2.5), we have

    f(x+y2)f(tx+(1t)y)+f(ty+(1t)x)2,t[0,1]. (2.6)

    Multiplying both sides of (2.6) by ((yx)t)t and integrating the result with respect to t over [0,1], we get

    f(x+y2)Λ(1)12[10((yx)t)tf(tx+(1t)y)dt+10((yx)t)tf(ty+(1t)x)dt]=12[yx(yw)ywf(w)+yx(wx)wxf(w)dw]=12[GRLIx+f(y)+GRLIyf(x)],

    which implies that

    f(x+y2)12Λ(1)[GRLIx+f(y)+GRLIyf(x)]. (2.7)

    By adding f(c)+f(d) on both sides of (1.4), we can obtain the second inequality in (2.1).

    Now we give the proof of inequalities (2.2). Since f is convex function, then for all u,v[c,d], we have

    f(c+du+v2)=f(c+du+c+dv2)12[f(c+du)+f(c+dv)]. (2.8)

    Then, for c+du=t(c+dx)+(1t)(c+dy) and c+dv=t(c+dy)+(1t)(c+dx), it follows that

    f(c+du+v2)12[f(t(c+dx)+(1t)(c+dy))+f(t(c+dy)+(1t)(c+dx))]. (2.9)

    for each x,y[c,d] and t[0,1]. Now, by multiplying both sides of (2.9) by ((yx)t)t and integrating the obtaining inequality with respect to t over [0,1], we obtain

    f(c+du+v2)Λ(1)12[10((yx)t)tf(t(c+dx)+(1t)(c+dy))dt+10((yx)t)tf(t(c+dy)+(1t)(c+dx))dt]=12[c+dxc+dy(w(c+dy))w(c+dy)f(w)dw+c+dxc+dy((c+dx)w)(c+dx)wf(w)dw]=12[GRLI(c+dy)+f(c+dx)+GRLI(c+dx)f(c+dy)],

    and this completes the proof of the first inequality in (2.2). To prove the second inequality in (2.2), first we use the convexity of f to get

    f(t(c+dx)+(1t)(c+dy))tf(c+dx)+(1t)f(c+dy), (2.10)
    f(t(c+dy)+(1t)(c+dx))(1t)f(c+dx)+tf(c+dy). (2.11)

    Adding (2.10) and (2.11), we get

    f(t(c+dx)+(1t)(c+dy))+f(t(c+dy)+(1t)(c+dx))f(c+dx)+f(c+dy)2[f(c)+f(d)][f(x)+f(y)]. (2.12)

    Multiplying both sides of (2.12) by ((yx)t)t and integrating the result with respect to t over [0,1], we obtain

    10((yx)t)tf(t(c+dx)+(1t)(c+dy))dt+10((yx)t)tf(t(c+dy)+(1t)(c+dx))dtΛ(1)f(c+dx)+Λ(1)f(c+dy)2Λ(1)[f(c)+f(d)]Λ(1)[f(x)+f(y)].

    By using the change of variables of integration and then by multiplying the result by 12Λ(1), we can obtain the second and third inequalities in (2.2). This completes the proof of Theorem 2.1.

    Remark 2.1. Let the assumptions of Theorem 2.1 be satisfied. Then,

    If (t)=t, then Theorem 2.1 reduces to [42,Theorem 2.1].

    If (t)=tνΓ(ν), then Theorem 2.1 reduces to [43,Theorem 2].

    If we set (t)=t, x=c and y=d in (2.2), then (2.2) becomes (1.1).

    If (t)=tνkkΓk(a) in Theorem 2.1 (Eq. (2.2)), we get

    f(c+dx+y2)Γk(ν+k)2(yx)νk[RLI(c+dy)+,kf(c+dx)+RLI(c+dx),kf(c+dy)]f(c+dx)+f(c+dy)2f(c)+f(d)f(x)+f(y)2.

    If we set (t)=tνΓ(ν), x=c and y=d in (2.2), then we have

    f(c+d2)Γ(ν+1)2(ba)ν[RLIνc+f(d)+RLIνdf(c)]f(c)+f(d)2,

    which is derived in [25].

    If we set (t)=tνkkΓk(ν), x=c and y=d in (2.2), then we have

    f(c+d2)Γk(ν+k)2(dc)νk[RLIνc+,kf(d)+RLIνd,kf(c)]f(c)+f(d)2,

    which is derived in [44].

    If x=c and y=d, then inequalities (2.1) reduces to the following inequalities:

    f(c+d2)f(c)+f(d)12Λ(1)[GRLIc+f(y)+GRLIdf(x)]f(c)+f(d)f(c+d2).

    If x=c and y=d, then inequalities (2.2) reduces to [21,Theorem 5].

    Corollary 2.1. For a convex function f:[c,d]R, we have the following inequalities of HHM type for conformable fractional integrals:

    f(c+dx+y2)f(c)+f(d)ν2(yνxν)yxf(t)dνtf(c)+f(d)f(x+y2), (2.13)

    and

    f(c+dx+y2)ν(yνxν)c+dxc+dyf(t)dνtf(c+dx)+f(c+dy)2f(c)+f(d)f(x)+f(y)2. (2.14)

    Proof. By setting (t)=t(yt)ν1 in Theorem 2.1, we can directly obtain the proof.

    Remark 2.2. If we set x=c and y=d in (2.14), then we have the well-known conformable fractional HH integral inequality:

    f(c+d2)νdνcνdcf(t)dνtf(c)+f(d)2,

    which is derived by Adil Khan et al. in [45].

    Corollary 2.2. For a convex function f:[c,d]R, we have the following inequalities of HHM type for fractional integrals with exponential kernel:

    f(c+dx+y2)f(c)+f(d)(ν1)2[exp(1νν(yx))1][expIνx+f(y)+expIνyf(x)]f(c)+f(d)f(x+y2), (2.15)

    and

    f(c+dx+y2)(ν1)2[exp(1νν(yx))1][expIν(c+dy)+f(c+dx)+expIν(c+dx)f(c+dy)]f(c+dx)+f(c+dy)2f(c)+f(d)f(x)+f(y)2. (2.16)

    Proof. By setting (t)=tνexp(1ννt) in Theorem 2.1, we can easily obtain the proof of Corollary 2.2.

    Remark 2.3. If we set x=c and y=d in (2.16), then we have the HH inequalities for fractional integrals with exponential kernel:

    f(c+d2)(ν1)2[exp(1νν(dc))1][expIνc+f(d)+expIνdf(c)]f(c)+f(d)2,

    which is derived by Ahmad et al. in [46].

    Theorem 2.2. For a convex function f:[c,d]R, we have the following inequalities for GRL:

    f(c+dx+y2)12Δ(1)[GRLI(c+dx+y2)f(c+dy)+GRLI(c+dx+y2)+f(c+dx)]f(c)+f(d)f(x)+f(y)2. (2.17)

    Proof. From the convexity of f, we have

    f(c+du+v2)=f(c+du+c+dv2)12f(c+du)+f(c+dv). (2.18)

    By setting u=t2x+2t2y, v=2t2x+t2y, it follows that

    f(c+dx+y2)12[f(c+d(t2x+2t2y))+f(c+d(2t2x+t2y))], (2.19)

    for all x,y[c,d] and t[0,1]. Multiplying both sides of (2.19) by ((yx2)t)t and integrating its result with respect to t over [0,1], we get

    f(c+dx+y2)Δ(1)12[10((yx2)t)tf(c+d(t2x+2t2y))dt+10((yx2)t)tf(c+d(2t2x+t2y))dt]=12[c+dx+y2c+dy(w(c+dy))w(c+dy)f(w)dw+c+dxc+dx+y2((c+dx)w)(c+dx)wf(w)dw]=12[GRLI(c+dx+y2)f(c+dy)+GRLI(c+dx+y2)+f(c+dx)].

    Thus, the first inequality in (2.17) is proved. To prove the second inequality in (2.17), by using the Jensen–Mercer inequality, we can deduce:

    f(c+d(t2x+2t2y))f(c)+f(d)[t2f(x)+2t2f(y)] (2.20)
    f(c+d(2t2x+t2y))f(c)+f(d)[2t2f(x)+t2f(y)]. (2.21)

    By adding (2.20) and (2.21), we obtain

    f(c+d(t2x+2t2y))+f(c+d(2t2x+t2y))2[f(c)+f(d)]f(x)+f(y). (2.22)

    Multiplying both sides of inequality (2.22) by ((yx2)t)t and integrating the result with respect to t over [0,1], we get

    10((yx2)t)tf(c+d(t2x+2t2y))dt+10((yx2)t)tf(c+d(2t2x+t2y))dt2Δ(1)[f(c)+f(d)]Δ(1)[f(x)+f(y)].

    By using change of variables of integration and multiplying the result by 12Δ(1), we can easily obtain second inequality in (2.17).

    Remark 2.4. Assume that the assumptions of Theorem 2.2 are satisfied.

    If (t)=t, then inequalities (2.17) becomes inequalities [42,Theorem 2.1].

    If we put (t)=t,x=c and y=d in Theorem 2.2, then inequalities (2.17) becomes inequalities (1.1).

    If (t)=tνΓ(ν), then Theorem 2.2 reduces to [43,Theorem 3].

    If we put (t)=tνΓ(ν),x=c and y=d in Theorem 2.2, then Theorem 2.2 reduces to [26,Theorem 4].

    If (t)=tνkkΓk(ν) in Theorem 2.2, we get

    f(c+dx+y2)2νk1Γk(ν+k)(yx)νk[RLI(c+dx+y2),kf(c+dy)+RLI(c+dx+y2)+,kf(c+dx)]f(c)+f(d)f(x)+f(y)2.

    If we put (t)=tνkkΓk(ν), x=c and y=d in Theorem 2.2, then Theorem 2.2 reduces to [44,Theorem 1.1].

    If x=c and y=d, then Theorem 2.2 becomes

    f(c+d2)12Δ(1)[GRLI(c+d2)f(c)+GRLI(c+d2)+f(d)]f(c)+f(d)2.

    Corollary 2.3. For a convex function f:[c,d]R, we have the following inequalities of HHM type for conformable fractional integrals:

    f(c+dx+y2)ν[yν(x+y2)ν]c+dxc+dyf(t)dνtf(c)+f(d)f(x)+f(y)2. (2.23)

    Proof. By setting (t)=t(yt)ν1 in Theorem 2.2, then we have proof of Corollary 2.3.

    Remark 2.5. If we set x=c and y=d in (2.23), then we get

    f(c+d2)ν[dν(c+d2)ν]dcf(t)dνtf(c)+f(d)2.

    Corollary 2.4. For a convex function f:[c,d]R, we have the following inequalities of HHM type for fractional integrals with exponential kernel:

    f(c+dx+y2)(ν1)2[exp(1νν(yx)2)1][expIν(c+dx+y2)f(c+dy)+expIν(c+dx+y2)+f(c+dx)]f(c)+f(d)f(x)+f(y)2. (2.24)

    Proof. By setting (t)=tνexp(1ννt) in Theorem 2.2, we get proof of Corollary 2.4.

    Remark 2.6. If we set x=c and y=d in (2.24), then we get

    f(c+d2)(ν1)2[exp(1νν(dc)2)1][expIν(c+d2)f(c)+expIν(c+d2)+f(d)]f(c)+f(d)2.

    In view of the inequalities (2.1) and (2.17), we can generate some related results in this section.

    Lemma 3.1. Let f:[c,d]R be a differentiable function on (c,d) such that fL[c,d]. Then, the following equality holds for GRL:

    f(c+dy)+f(c+dx)212Λ(1)[GRLI(c+dy)+f(c+dx)+GRLI(c+dx)f(c+dy)]=(yx)2Λ(1)10[Λ(t)Λ(1t)]f(c+d(tx+(1t)y))dt=(yx)2Λ(1)10Λ(t)[f(c+d(tx+(1t)y))f(c+d(ty+(1t)x))]dt. (3.1)

    Proof. By the help of the right hand side of (3.1), we have

    (yx)2Λ(1)10Λ(t)[f(c+d(tx+(1t)y))f(c+d(ty+(1t)x))]dt=(yx)2Λ(1)[10Λ(t)f(c+d(tx+(1t)y))dt10Λ(t)f(c+d(ty+(1t)x))dt]=(yx)2Λ(1)[S1S2]. (3.2)

    By applying integration by parts, one can obtain

    S2=10Λ(t)f(c+d(ty+(1t)x))dt=Λ(1)f(c+dy)yx+1yx10((yx)t)tf(c+d(ty+(1t)x))=Λ(1)f(c+dy)yx+1yx=Λ(1)f(c+dy)yx+1yx[GRLI(c+dy)+f(c+dx)].

    Similarly, one can obtain

    S1=10Λ(t)f(c+d(tx+(1t)y))dt=Λ(1)f(c+dx)yx1yx[GRLI(c+dx)f(c+dy)].

    By making use of S1 and S2 in (3.2), we get the identity (3.1).

    Remark 3.1. Let the assumptions of Lemma 3.1 be satisfied.

    If (t)=t, then Lemma 3.1 reduces to [43,Corollary 1].

    If (t)=tνΓ(ν), then Lemma 3.1 reduces to [43,Lemma 1].

    If (t)=tνkkΓk(ν) in Lemma 3.1, we get

    f(c+dx)+f(c+dy)2Γk(ν+k)2(yx)νk[RLI(c+dy)+,kf(c+dx)+RLI(c+dx),kf(c+dy)]=yx210[tνk(1t)νk]f(c+d(tx+(1t)y))dt. (3.3)

    If x=c and y=d, then Lemma 3.1 reduces to [47,Lemma 2.1].

    Corollary 3.1. Let the assumptions of Lemma 3.1 be satisfied, then the following equality holds for the conformable fractional integrals:

    f(c+dy)+f(c+dx)2νyνxνc+dxc+dyf(t)dνt=(yx)2Λ1(1)10[Λ1(t)Λ1(1t)]f(c+d(tx+(1t)y))dt=(yx)2Λ1(1)10Λ1(t)[f(c+d(tx+(1t)y))f(c+d(ty+(1t)x))]dt, (3.4)

    where

    Λ1(t)=yν(tx+(1t)y)νν.

    Proof. By setting (t)=t(yt)ν1 in Lemma 3.1, then we have proof of Corollary 3.1.

    Remark 3.2. By setting x=c and y=d in (3.4), we get

    f(c)+f(d)2νdνcνdcf(t)dνt=(dc)2Λ2(1)10[Λ2(t)Λ2(1t)]f(td+(1t)c)dt=(dc)2Λ2(1)10Λ2(t)[f(td+(1t)c)f(tc+(1t)d)]dt,

    where

    Λ2(t)=yν(tc+(1t)d)νν.

    Corollary 3.2. Let the assumptions of Lemma 3.1 be satisfied, then the following equality holds for the fractional integrals with exponential kernel:

    f(c+dy)+f(c+dx)2(ν1)2[exp(1νν(yx))1]×[expIν(c+dy)+f(c+dx)+expIν(c+dx)f(c+dy)]=(yx)2Λ3(1)10[Λ3(t)Λ3(1t)]f(c+d(tx+(1t)y))dt=(yx)2Λ3(1)10Λ3(t)[f(c+d(tx+(1t)y))f(c+d(ty+(1t)x))]dt, (3.5)

    where

    Λ3(t)=exp(1νν(yx)t)1ν1.

    Proof. By setting (t)=tνexp(1ννt) in Lemma 3.1, we get proof of Corollary 3.2.

    Remark 3.3. If we set x=c and y=d in (3.5), we get

    f(c)+f(d)2(ν1)2[exp(1νν(dc))1][expIνc+f(d)+expIνdf(c)]=(dc)2Λ4(1)10[Λ4(t)Λ4(1t)]f(td+(1t)c)dt=(dc)2Λ4(1)10Λ4(t)[f(td+(1t)c)f(tc+(1t)d)]dt,

    where

    Λ4(t)=exp(1νν(dc)t)1ν1.

    Lemma 3.2. Let f:[c,d]R be a differentiable function on (c,d) such that fL[c,d]. Then, the following equality holds for GRL:

    12Δ(1)[GRLI(c+dx+y2)+f(c+dx)+GRLI(c+dx+y2)f(c+dy)]f(c+dx+y2)=(yx)4Δ(1)10Δ(t)[f(c+d(2t2x+t2y))f(c+d(t2x+2t2y))]dt. (3.6)

    Proof. The proof of Lemma 3.2 is similar to Lemma 3.1, so we omit it.

    Remark 3.4. Let the assumptions of Lemma 3.2 be satisfied.

    If (t)=tνΓ(ν), then Lemma 3.2 reduces to [43,Lemma 2].

    If (t)=tνkkΓk(ν) in Lemma 3.2, we get

    2νk1Γk(ν+k)(yx)νk[RLI(c+dx+y2),kf(c+dy)+RLI(c+dx+y2)+,kf(c+dx)]f(c+dx+y2)=yx410tνk[f(c+d(2t2x+t2y))f(c+d(t2x+2t2y))]dt. (3.7)

    If x=c and y=d, then Lemma 3.2 becomes

    12Δ(1)[GRLI(c+d2)f(c)+GRLI(c+d2)+f(d)]f(c+d2)=dc4Δ(1)10Δ(t)[f(t2c+2t2d)f(2t2c+t2d)]dt.

    Corollary 3.3. Let the assumptions of Lemma 3.2 be satisfied, then the following equality holds for the conformable fractional integrals:

    ν[yν(x+y2)ν]c+dxc+dyf(t)dνt=(yx)4Δ1(1)10Δ1(t)[f(c+d(2t2x+t2y))f(c+d(t2x+2t2y))]dt, (3.8)

    where

    Δ1(t)=yν(y(yx2)t)νν.

    Proof. By setting (t)=t(yt)ν1 in Lemma 3.2, we have proof of Corollary 3.3.

    Remark 3.5. If we set x=c and y=d in (3.8), we get

    ν[dν(d+c2)ν]dcf(t)dνt=(dc)4Δ2(1)10Δ2(t)[f(2t2d+t2c)f(t2d+2t2c)]dt,

    where

    Δ2(t)=dν(d(dc2)t)νν.

    Corollary 3.4. Let the assumptions of Lemma 3.2 be satisfied, then the following equality holds for the fractional integrals with exponential kernel:

    (ν1)2[exp(1νν(yx)2)1][expIν(c+dx+y2)+f(c+dx)+expIν(c+dx+y2)f(c+dy)]f(c+dx+y2)=(yx)4Δ3(1)10Δ3(t)[f(c+d(2t2x+t2y))f(c+d(t2x+2t2y))]dt, (3.9)

    where

    Δ3(t)=exp(1νν(yx)t2)1ν1.

    Proof. By setting (t)=tνexp(1ννt) in Lemma 3.2, we get proof of Corollary 3.4.

    Remark 3.6. If we put x=c and y=d in (3.9), we get

    (ν1)2[exp(1νν(dc)2)1][expIν(c+d2)+f(d)+expIν(c+d2)f(c)]f(c+d2)=(dc)4Δ4(1)10Δ4(t)[f(2t2d+t2c)f(t2d+2t2c)]dt,

    where

    Δ4(t)=exp(1νν(dc)t2)1ν1.

    Theorem 3.1. Let f:[c,d]R be a differentiable function on (c,d) such that |f| is convex on [c,d]. Then, the following inequality holds for GRL:

    |GRLF(c,d;x,y)|(yx)2Λ(1)[[|f(c)|+|f(d)|]10|Λ(t)Λ(1t)|dt[|f(x)|+|f(y)|]10t|Λ(t)Λ(1t)|dt], (3.10)

    where

    |GRLF(c,d;x,y)|:=|f(c+dy)+f(c+dx)212Λ(1)[GRLI(c+dy)+f(c+dx)+GRLI(c+dx)f(c+dy)]|.

    Proof. In view of Lemma 3.1, we have

    |GRLF(c,d;x,y)|(yx)2Λ(1)10|Λ(t)Λ(1t)||f(c+d(tx+(1t)y))|dt.

    Then, by using the Jensen–Mercer inequality, we obtain

    |GRLF(c,d;x,y)|(yx)2Λ(1)10|Λ(t)Λ(1t)|[|f(c)|+|f(d)|t|f(x)|(1t)|f(y)|]dt=(yx)2Λ(1)[10|Λ(t)Λ(1t)|[|f(c)|+|f(d)|]dt|f(x)|10t|Λ(t)Λ(1t)|dt|f(y)|10(1t)|Λ(t)Λ(1t)|dt]=(yx)2Λ(1)[[|f(c)|+|f(d)|]10|Λ(t)Λ(1t)|dt[|f(x)|+|f(y)|]10t|Λ(t)Λ(1t)|dt],

    which completes the proof of Theorem 3.1.

    Remark 3.7. Let the assumptions of Theorem 3.1 be satisfied. Then,

    If (t)=tνΓ(ν), then Theorem 3.1 reduces to [43,Theorem 4].

    If (t)=tνkkΓk(ν) in Theorem 3.1, we get

    |f(c+dx)+f(c+dy)2Γk(ν+k)2(yx)νk[RLI(c+dy)+,kf(c+dx)+RLI(c+dx),kf(c+dy)]|yxν+k(kk2νk)[|f(c)|+|f(d)||f(x)|+|f(y)|2]. (3.11)

    If x=c and y=d, then Theorem 3.1 reduces to [21,Theorem 6].

    Corollary 3.5. Let the assumptions of Theorem 3.1 be satisfied. Then, we have

    |f(c+dy)+f(c+dx)21yxc+dxc+dyf(x)dx|14[|f(c)|+|f(d)||f(x)|+|f(y)|2]. (3.12)

    Proof. If we set (t)=t in Theorem 3.1, then we have proof of Corollary 3.5.

    Remark 3.8. If we use x=c and y=d in Corollary 3.5, then Corollary 3.5 reduces to [47,Theorem 2.2].

    Corollary 3.6. Let the assumptions of Theorem 3.1 be satisfied. Then, we have the following inequality holds for conformable fractional integrals:

    |f(c+dy)+f(c+dx)2νyνxνc+dxc+dyf(t)dνt|ν(yx)2(yνxν)×[[|f(c)|+|f(d)|]10|Λ1(t)Λ1(1t)|dt[|f(x)|+|f(y)|]10t|Λ1(t)Λ1(1t)|dt]. (3.13)

    Proof. By setting (t)=t(yt)ν1 in Theorem 3.1, we have proof of Corollary 3.6.

    Remark 3.9. If we set x=c and y=d, then we have

    |f(c)+f(d)2νdνcνdcf(t)dνt|ν(dc)2(dνcν)[[|f(c)|+|f(d)|]10t|Λ2(t)Λ2(1t)|dt].

    Corollary 3.7. Let the assumptions of Theorem 3.1 be satisfied. Then, we have the following inequality for fractional integrals with exponential kernel:

    |f(c+dy)+f(c+dx)2(ν1)2[exp(1νν(yx))1]×[expIν(c+dy)+f(c+dx)+expIν(c+dx)f(c+dy)]|(ν1)(yx)2[exp(1νν(yx))1][[|f(c)|+|f(d)|]10|Λ3(t)Λ3(1t)|dt[|f(x)|+|f(y)|]10t|Λ3(t)Λ3(1t)|dt]. (3.14)

    Proof. By setting (t)=tνexp(1ννt) in Theorem 3.1, we get proof of Corollary 3.7.

    Remark 3.10. If we set x=c and y=d in (3.14), then we have

    |f(c)+f(d)2(ν1)2[exp(1νν(dc))1][expIνc+f(d)+expIνdf(c)]|(ν1)(dc)2[exp(1νν(dc))1][[|f(c)|+|f(d)|]10t|Λ4(t)Λ4(1t)|dt].

    Theorem 3.2. Let f:[c,d]R be a differentiable function on (c,d) such that |f|q is convex on [c,d] for some q>1. Then, the following inequality holds for GRL:

    |GRLF(c,d;x,y)|(yx)2Λ(1)(10|Λ(t)Λ(1t)|pdt)1p×(|f(c)|q+|f(d)|q|f(x)|q+|f(y)|q2)1q, (3.15)

    where 1p+1q=1.

    Proof. In view of Lemma 3.1 and the well–known Hölder's inequality, one can obtain

    |GRLF(c,d;x,y)|(yx)2Λ(1)(10|Λ(t)Λ(1t)|pdt)1p(10|f(c+d(tx+(1t)y))|qdt)1q.

    We can apply the Jensen–Mercer inequality due to the convexity of |f|q, to get

    |GRLF(c,d;x,y)|(yx)2Λ(1)(10|Λ(t)Λ(1t)|pdt)1p×(10[|f(c)|q+|f(d)|q(t|f(x)|q+(1t)|f(y)|q)]dt)1q=(yx)2Λ(1)(10|Λ(t)Λ(1t)|pdt)1p(|f(c)|q+|f(d)|q|f(x)|q+|f(y)|q2)1q,

    which completes the proof of Theorem 3.2.

    Corollary 3.8. Let the assumptions of Theorem 3.2 be satisfied, then we have

    |f(c+dy)+f(c+dx)21yxc+dxc+dyf(x)dx|(yx)2(1+p)1p×(|f(c)|q+|f(d)|q|f(x)|q+|f(y)|q2)1q. (3.16)

    Remark 3.11. If we use x=c and y=d in Corollary 3.8, then Corollary 3.8 reduces to [47,Theorem 2.3].

    Proof. By using (t)=t in inequality (3.15), we can obtain inequality (3.16).

    Corollary 3.9. Let the assumptions of Theorem 3.2 be satisfied, then we have the following inequality holds for RL:

    |f(c+dy)+f(c+dx)2Γ(ν+1)2(yx)ν[RLIν(c+dy)+f(c+dx)+RLIν(c+dx)f(c+dy)]|(yx)2(νp+1)1p(|f(c)|q+|f(d)|q|f(x)|q+|f(y)|q2)1q. (3.17)

    Proof. By setting (t)=tνΓ(ν) in inequality (3.15), we obtain inequality (3.17).

    Remark 3.12. If we set x=c and y=d in Corollary 3.9, then we have

    |f(c)+f(d)2Γ(ν+1)2(dc)ν[RLIνc+f(d)+RLIνdf(c)]|(dc)2(νp+1)1p(|f(c)|q+|f(d)|q2)1q.

    Corollary 3.10. Let the assumptions of Theorem 3.2 be satisfied, then we have for k–RL:

    |f(c+dy)+f(c+dx)2Γk(ν+k)2(yx)νk[RLIν(c+dy)+,kf(c+dx)+RLIν(c+dx),kf(c+dy)]|(yx)2(νkp+1)1p(|f(c)|q+|f(d)|q|f(x)|q+|f(y)|q2)1q. (3.18)

    Proof. By setting (t)=tνkkΓk(ν) in inequality (3.15), we can obtain inequality (3.18).

    Remark 3.13. If we set x=c and y=d in Corollary 3.10, then we obtain

    |f(c)+f(d)2Γk(ν+k)2(dc)νk[RLIνc+,kf(d)+RLIνd,kf(c)]|(dc)2(νkp+1)1p(|f(c)|q+|f(d)|q2)1q.

    Corollary 3.11. Let the assumptions of Theorem 3.2 be satisfied, then we have the following inequality for the conformable fractional integrals:

    |f(c+dy)+f(c+dx)2νyνxνc+dxc+dyf(t)dνt|ν(yx)2(yνxν)×(10|Λ1(t)Λ1(1t)|pdt)1p(|f(c)|q+|f(d)|q|f(x)|q+|f(y)|q2)1q. (3.19)

    Proof. By setting (t)=t(yt)ν1 in Theorem 3.2, we get proof of Corollary 3.11.

    Remark 3.14. If we set x=c and y=d in (3.19), then we have

    |f(c)+f(d)2νdνcνdcf(t)dνt|ν(dc)2(dνcν)(10|Λ2(t)Λ2(1t)|pdt)1p×(|f(c)|q+|f(d)|q2)1q.

    Corollary 3.12. Let the assumptions of Theorem 3.2 be satisfied, then we have the following inequality for the fractional integrals with exponential kernel:

    |f(c+dy)+f(c+dx)2(ν1)2[exp(1νν(yx))1]×[expIν(c+dy)+f(c+dx)+expIν(c+dx)f(c+dy)]|(ν1)(yx)2[exp(1νν(yx))1](10|Λ3(t)Λ3(1t)|pdt)1p×(|f(c)|q+|f(d)|q|f(x)|q+|f(y)|q2)1q. (3.20)

    Proof. By setting (t)=tνexp(1ννt) in Theorem 3.2, we have proof of Corollary 3.12.

    Remark 3.15. If we set x=c and y=d in (3.20), then we have

    |f(c)+f(d)2(ν1)2[exp(1νν(dc))1][expIνc+f(d)+expIνdf(c)]|(ν1)(dc)2[exp(1νν(dc))1](10|Λ4(t)Λ4(1t)|pdt)1p(|f(c)|q+|f(d)|q2)1q.

    Theorem 3.3. Let f:[c,d]R be a differentiable function on (c,d) such that |f| is convex on [c,d]. Then, the following inequality holds for GRL:

    |GRLG(c,d;x,y)|(yx)2Δ(1)[|f(c)|+|f(d)||f(x)|+|f(y)|2]10|Δ(t)|dt, (3.21)

    where

    |GRLG(c,d;x,y)|:=|12Δ(1)[GRLI(c+dx+y2)+f(c+dx)+GRLI(c+dx+y2)f(c+dy)]f(c+dx+y2)|.

    Proof. From Lemma 3.2, we have

    |GRLG(c,d;x,y)|(yx)4Δ(1)[10|Δ(t)||f(c+d(2t2x+t2y))|dt+10|Δ(t)||f(c+d(t2x+2t2y))|dt]

    Then, by using the Jensen–Mercer inequality, we get

    |GRLG(c,d;x,y)|(yx)4Δ(1)[10|Δ(t)|(|fc|+|f(d)|(2t2|f(x)|+t2|f(y)|))dt+10|Δ(t)|(|f(c)|+|f(d)|(t2|f(x)|+2t2|f(y)|))dt]=(yx)4Δ(1)[10|Δ(t)|[2|f(c)|+2|f(d)|(|f(x)|+|f(y)|)]dt]=(yx)2Δ(1)[|f(c)|+|f(d)||f(x)|+|f(y)|2]10|Δ(t)|dt,

    which completes the proof of Theorem 3.3.

    Remark 3.16. Let the assumptions of Theorem 3.3 be satisfied. Then, the following special cases can be considered.

    If (t)=t, then Theorem 3.3 reduces to [43,Corollary 2].

    If (t)=t, x=c and y=d, then Theorem 3.3 reduces to [48,Theorem 2.2].

    If (t)=tνΓ(ν), then Theorem 3.3 reduces to [43,Theorem 5].

    If (t)=tνΓ(ν),x=c and y=d, then Theorem 3.3 reduces to [26,Theorem 5] with q=1.

    If (t)=tνkkΓk(ν) in Theorem 3.3, we get

    |2νk1Γk(ν+k)(yx)νk[RLI(c+dx+y2),kf(c+dy)+RLI(c+dx+y2)+,kf(c+dx)]f(c+dx+y2)|k(yx)2(ν+k)[|f(c)|+|f(d)||f(x)|+|f(y)|2]. (3.22)

    If we set (t)=tνkkΓk(ν),x=c and y=d in Theorem 3.3, then we have

    |2νkkΓk(ν+k)(dc)νk[RLIν(c+d2)+,kf(d)+RLIν(c+d2),kf(c)]f(c+d2)|k(dc)2(ν+k)[|f(c)|+|f(d)|2].

    Corollary 3.13. Let the assumptions of Theorem 3.3 be satisfied. Then, the following inequality holds for the conformable fractional integrals:

    |ν[yν(x+y2)ν]c+dxc+dyf(t)dνt|ν(yx)2[yν(x+y2)ν]×[|f(c)|+|f(d)||f(x)|+|f(y)|2]10|Δ1(t)|dt. (3.23)

    Proof. By setting (t)=t(yt)ν1 in Theorem 3.3, we can get proof of Corollary 3.13.

    Remark 3.17. If we set x=c and y=d in (3.23), then we have

    |ν[dν(c+d2)ν]dcf(t)dνt|ν(dc)2[dν(c+d2)ν][|f(c)|+|f(d)|2]10|Δ2(t)|dt.

    Corollary 3.14. Let the assumptions of Theorem 3.3 be satisfied. Then, the following inequality holds for the fractional integrals with exponential kernel:

    |(ν1)2[exp(1νν(yx)2)1][[expIν(c+dx+y2)+f(c+dx)+expIν(c+dx+y2)f(c+dy)]]f(c+dx+y2)|(ν1)(yx)2[exp(1νν(yx)2)1][|f(c)|+|f(d)||f(x)|+|f(y)|2]10|Δ3(t)|dt. (3.24)

    Proof. By setting (t)=tνexp(1ννt) in Theorem 3.3, we can obtain proof of Corollary 3.14.

    Remark 3.18. If we set x=c and y=d in (3.24), then we have

    |(ν1)2[exp(1νν(dc)2)1][[expIν(c+d2)+f(d)+expIν(c+d2)f(c)]]f(c+d2)|(ν1)(dc)2[exp(1νν(dc)2)1][|f(c)|+|f(d)|2]10|Δ4(t)|dt.

    Theorem 3.4. Let f:[c,d]R be a differentiable function on (c,d) such that |f|q is convex on [c,d] for some q>1. Then, the following inequality holds for GRL:

    |GRLG(c,d;x,y)|(yx)4Δ(1)(10|Δ(t)|pdt)1p[(|f(c)|q+|f(d)|q3|f(x)|q+|f(y)|q4)1q+(|f(c)|q+|f(d)|q(|f(x)|q+3|f(y)|q4))1q], (3.25)

    where 1p+1q=1.

    Proof. From Lemma 3.2 and well-known Hölder's inequality, we obtain

    |GRLG(c,d;x,y)|(yx)4Δ(1)(10|Δ(t)|pdt)1p[(10|f(c+d(2t2x+t2y))|qdt)1q+(10|f(c+d(t2x+2t2y))|qdt)1q].

    By applying the Jensen–Mercer inequality due to convexity of |f|q, we can obtain

    |GRLG(c,d;x,y)|(yx)4Δ(1)(10|Δ(t)|pdt)1p[(10[|f(c)|q+|f(d)|q(2t2|f(x)|q+t2|f(y)|q)]dt)1q+(10[|f(c)|q+|f(d)|q(t2|f(x)|q+2t2|f(y)|q)]dt)1q]=(yx)4Δ(1)(10|Δ(t)|pdt)1p[(|f(c)|q+|f(d)|q3|f(x)|q+|f(y)|q4)1q+(|f(c)|q+|f(d)|q(|f(x)|q+3|f(y)|q4))1q],

    and this completes proof of the Theorem 3.4.

    Remark 3.19. Let the assumptions of Theorem 3.4 be satisfied. Then, the following special cases can be considered.

    If (t)=t, then Theorem 3.4 reduces to [43,Corollary 3].

    If (t)=t,x=c and y=d, then Theorem 3.4 reduces to [48,Theorem 2.3].

    If (t)=tνΓ(ν), then Theorem 3.4 reduces to [43,Theorem 6].

    If (t)=tνΓ(ν),x=c and y=d, then Theorem 3.4 reduces to [26,Theorem 6].

    If (t)=tνkkΓk(ν) in Theorem 3.4, we get

    |2νk1Γk(ν+k)(yx)νk[RLI(c+dx+y2),kf(c+dy)+RLI(c+dx+y2)+,kf(c+dx)]f(c+dx+y2)|yx4(kνp+k)1p[(|f(c)|q+|f(d)|q3|f(x)|q+|f(y)|q4)1q+(|f(c)|q+|f(d)|q|f(x)|q+3|f(y)|q4)1q]. (3.26)

    If (t)=tνkkΓk(ν),x=c and y=d, then we have

    |2νkkΓk(ν+k)(dc)νk[RLIν(c+d2)+,kf(d)+RLIν(c+d2),kf(c)]f(c+d2)|(dc)4(kνp+k)1p[(|f(c)|q+3|f(d)|q4)1q+(3|f(c)|q+|f(d)|q4)1q].

    Corollary 3.15. Let the assumptions of Theorem 3.4 be satisfied. Then, the following inequality holds for the conformable fractional integrals:

    |ν[yν(x+y2)ν]c+dxc+dyf(t)dνt|ν(yx)4(yν(x+y2)ν)(10|Δ1(t)|pdt)1p×[(|f(c)|q+|f(d)|q3|f(x)|q+|f(y)|q4)1q+(|f(c)|q+|f(d)|q(|f(x)|q+3|f(y)|q4))1q]. (3.27)

    Proof. By setting (t)=t(yt)ν1 in Theorem 3.4, we can obtain proof of Corollary 3.15.

    Remark 3.20. If we set x=c and y=d in (3.27), then we have

    |ν[dν(c+d2)ν]dcf(t)dνt|ν(dc)4(dν(c+d2)ν)(10|Δ2(t)|pdt)1p[(|f(c)|q+3|f(d)|q4)1q+(3|f(c)|q+|f(d)|q4)1q].

    Corollary 3.16. Let the assumptions of Theorem 3.4 be satisfied. Then, the following inequality holds for the fractional integrals with exponential kernel:

    |(ν1)2[exp(1νν(yx)2)1][[expIν(c+dx+y2)+f(c+dx)+expIν(c+dx+y2)f(c+dy)]]f(c+dx+y2)|(ν1)(yx)4[exp(1νν(yx)2)1](10|Δ3(t)|pdt)1p[(|f(c)|q+|f(d)|q3|f(x)|q+|f(y)|q4)1q+(|f(c)|q+|f(d)|q(|f(x)|q+3|f(y)|q4))1q]. (3.28)

    Proof. By setting (t)=tνexp(1ννt) in Theorem 3.4, we can obtain proof of Corollary 3.16.

    Remark 3.21. If we set x=c and y=d in (3.28), then we have

    |(ν1)2[exp(1νν(dc)2)1][[expIν(c+d2)+f(d)+expIν(c+d2)f(c)]]f(c+d2)|(ν1)(dc)4[exp(1νν(dc)2)1](10|Δ4(t)|pdt)1p[(|f(c)|q+3|f(d)|q4)1q+(3|f(c)|q+|f(d)|q4)1q].

    In this work inequalities of Hermite-Hadamard-Mercer type via generalized fractional integrals are obtained. It is also proved that the results in this paper are generalization of the several existing comparable results in literature. As future direction, one may finds some new interesting inequalities through different types of convexities. Our results may stimulate further research in different areas of pure and applied sciences.

    We want to give thanks to the Dirección de investigación from Pontificia Universidad Católica del Ecuador for technical support to our research project entitled: "Algunas desigualdades integrales para funciones convexas generalizadas y aplicaciones". This work is partially supported by National Natural Sciences Foundation of China (Grant No. 11971241).

    The authors declare that they have no conflict of interest.



    Conflict of interest



    The authors declare no conflict of interest.

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