An understanding of how infected-susceptible populations interact is critical to identify underlying causal factors and disease transmission patterns of infectious diseases. Disease transmission patterns are dynamic, non-linear, and spatially complex. This anisotropic characteristic of disease spread necessitates the ideal solution to be sensitive to the geographic context. A Spatial Diffusion Model (SDM) to predict interaction potential and COVID-19 risk probability is developed by adapting the Newtonian gravity model. This novel approach overcomes the limitations of existing epidemiological studies by characterizing the behavioral patterns of the infected population to model the spatiotemporal transmission of disease across the geographic space. The proposed model is robust as it couples a multicriteria behavioral pattern to enhance predictive capability. The model shows an 83.74% correlation with the observational COVID-19 case data. The highest risk patterns for COVID-19 are predicted in the neighborhoods of New York City (NYC), exhibiting clustered socioeconomic disparities along with racial and ethnic heterogeneity. Policymakers can use these results to identify neighborhoods at high risk for becoming hot spots; efficiently match community resources with needs, and ensure that the most vulnerable have access to equipment, personnel, and medical interventions. This study emphasizes the need for improved spatial epidemiological models including enhanced depictions of human activity patterns and the need to integrate spatial data with advanced mathematical models.

Given the emergence of SARS-CoV-2 virus as a life-threatening pandemic, identification of immunodominant epitopes of the viral structural proteins, particularly the nucleocapsid (NP) protein and receptor binding domain (RBD) of spike protein, is important to determine targets for immunotherapy and diagnosis. In this study, epitope screening was performed using a panel of overlapping peptides spanning the entire sequences of the RBD and NP proteins of SARS-CoV-2 in the sera from 66 COVID-19 patients and 23 healthy subjects by enzyme-linked immunosorbent assay (ELISA). Also, three non-overlapping peptides belonging to the S2 domain of spike protein were assessed. Our results showed that while reactivity of patients’ sera with reduced recombinant RBD protein was significantly lower than the native form of RBD (p<0.001), no significant differences were observed for reactivity of patients’ sera with reduced and non-reduced NP protein. Pepscan analysis revealed weak to moderate reactivity towards different RBD peptide pools, which was more focused on peptides encompassing aa 181-223 of RBD. NP peptides, however, displayed strong reactivity with a single peptide covering aa 151-170. These findings were confirmed by peptide depletion experiments using both ELISA and Western blotting. Altogether, our data suggest the involvement of mostly conformational disulfide bond-dependent immunodominant epitopes in RBD-specific antibody response, while the IgG response to NP is dominated by linear epitopes. Identification of antigenic epitope in NP and RBD of SARS-CoV-2 could provide important advances for the development of passive and active immunotherapy as well as diagnostic tools for the control of COVID-19 infection.

Background: The endoscopic ablation system (EAS) is an established ablation device for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). The novel X3 EAS is now equipped with a contiguous circumferential ablation mode (RAPID mode). Aim: To determine the feasibility of single-sweep ablation using X3. Methods: Consecutive patients who underwent AF ablation using X3 were enrolled. We assessed the acute procedural data focusing on “Single-sweep PVI” defined as PVI with a single energy application using RAPID mode to complete the circular lesion set, and on “first-pass isolation” defined as successful visually guided PVI after initial circular lesion set. Results: One-hundred AF patients (56% male, age 68±10 years, 66% paroxysmal AF) were analyzed. A total of 379 of 383 PVs (99%) were isolated with X3. Single-sweep isolation and first-pass-isolation were achieved in 214 PVs (56%) and in 362 PVs (95%), respectively. Single-sweep isolation rates varied across PVs with higher rates at the superior PVs (61.2% vs. inferior PVs:49.5%, P=0.0239) and at PVs with maximal ostial diameter <24mm (57.6% vs. >24mm: 36.8%, P=0.0151). The mean total procedure and fluoroscopy times were 43.0±10 and 4.0±2 mins, respectively. In none of the patients an acute thromboembolic event (stroke or transient ischemic attack) or a pericardial effusion/tamponade occurred. A single transient phrenic nerve palsy was observed. Conclusion: The new X3 EAS allows for single-sweep PVI in 56% of PVs. The new RAPID ablation mode leads to an improved rate of first-pass isolation associated with very short procedure times without compromising safety.

In this work, we investigated the invariance analysis of fractional-order Hirota-Satsoma coupled Korteveg-de-Vries (HSC-KdV) system of equations based on Riemann-Liouville (RL) derivatives. The Lie Symmetry analysis is considered to obtain infinitesimal generators; we reduced the system of coupled equations into nonlinear fractional ordinary differential equations (FODEs) with the help of Erdelyi’s-Kober (EK) fractional differential and integral operators. The reduced system of FODEs solved by means of the power series technique with its convergence. The conservation laws of the system constructed by Noether’s theorem.

In this paper, we discuss the split monotone variational inclusion problem and propose two new inertial algorithms in infinite-dimensional Hilbert spaces. As well as, the iterative sequence by the proposed algorithms converges strongly to the solution of a certain variational inequality with the help of the hybrid steepest descent method. Furthermore, an adaptive step size criterion is considered in suggested algorithms to avoid the difficulty of calculating the operator norm. Finally, some numerical experiments show that our algorithms are realistic and summarize the known results.

Aim: We aimed to identify dislocation, myelomalacia, and other congenital pathologies that may cause neurological complications arising from the odontoid process in the craniocervical junction (CVJ) of patients who were performed cervical tomography due to various complaints. Materials and Methods: Patients who were performed cervical CT with various complaints between 2010 and 2018 were retrospectively screened and evaluated, from the hospital registry system. Segmentation and fusion anomalies arising from the odontoid process in the craniovertebral junction area, as well as other accompanying pathologies such as subluxation, dislocation, compression to the spinal cord, and myelomalacia were also recorded. An additional 1.5 Tesla cervical MRI was performed for the 12 patients with os odontoideum. Radiological evaluation was performed on the workstation by an experienced radiologist. Results: 2525 patients with cervical CT were included in the study. 67 of these patients had congenital anomalies at the CVJ. 13 of 67 patients had os odontoideum, 38 had Klippel-Feil syndrome (KFS). Atlanto-occipital assimilation (AOA) and KFS often saw together. Only AOA was observed in 16 cases. Neck pain and limitation of movement were the most common findings in patients with congenital anomalies in the CVJ region. Conclusion: Congenital anomalies at the CVJ region, although rare, can cause mortality or morbidity. Cervical CT and MRI studies on the CVJ region should be evaluated carefully by the clinicians due to the risk of various complications.

Background: Inherited chronic mucocutaneous candidiasis (CMC) is often caused by inborn errors of immunity, impairing the response to, or the production of IL-17A and IL-17F. About half of the cases carry STAT1 gain-of-function (GOF) mutations. Only few patients have been reported with mutations of TRAF3IP2, a gene encoding the adaptor ACT1 essential for IL-17-receptor(R) -signaling. We investigated a 10-year-old girl with CMC, carrying a heterozygous variant of STAT1 and compound heterozygous variants of TRAF3IP2. Methods: By flow cytometry STAT1 levels and phosphorylation (CD14+) as well as IL-17A-, IL-22-, IFN-γ- and IL-4-production (memory CD4+ T cells) were determined. ACT1 expression and binding to IL-17RA by western blot and co-immunoprecipitation in HEK-293T cells transfected with plasmids encoding wild-type or mutant HA-tagged ACT1 and Flag-IL-17RA. We evaluated IL-17A response using an NF-κB-driven luciferase reporter system in HEK-293T cells, and by measuring GRO-α secretion by fibroblasts. Results: A likely non-pathogenic STAT1 variant (c.1363G>A/p.V455I) was identified by next generation sequencing., STAT1 expression and phosphorylation upon IFN- were normal. We also found compound heterozygous variants (c.1325A>G/p.D451G and c.1335delA/p.K454fs11*) of TRAF3IP2. By overexpression, despite normal protein expression, and impaired (K454fs11*) or normal (D451G) interaction with IL-17RA, both mutant alleles resulted in an impaired NF-κB-activation. Patient’s fibroblasts displayed abolished GRO-α secretion upon IL-17A. Finally, ex vivo CD4+ T cells showed increased IL-17A, IL-22, and IL-4, and normal-low IFN-γ expression upon stimulation. Conclusion: We identify novel compound heterozygous variants of TRAFP3IP2 causing autosomal recessive ACT1 deficiency in a child with CMC, and provide a review of the current literature.

Background: This study evaluated short-term (1-month) and long-term (1-year) mortality risks associated with kidney function measured by estimated glomerular filtration rate (eGFR) levels at admission for patients with intracerebral hemorrhage. Methods: From the Taiwan Stroke Registry data, we identified and stratified patients with intracerebral hemorrhage into 5 subgroups by the eGFR levels at admission: ≥ 90, 60-89, 30-59, 15-29, and < 15 mL/min/1.73m2 or on dialysis from April 2006 to December 2016. Risks of 1-month mortality and 1-year mortality rates after intracerebral hemorrhage were investigated by the eGFR levels. Results: Both the 1-month mortality and 1-year mortality rates increased as the eGFR level decreased. The 1-month mortality rate was over 5-fold greater in patients with eGFR < 15 mL/min/1.73m2 or on dialysis than in patients with eGFR levels ≥ 90 mL/min/1.73m2 (8.31 versus 1.50 per 1000 person-days), with an adjusted hazard ratio (HR) of 4.59 [95% confidence interval (CI) = 2.71-7.78]. Similarly, the 1-year mortality rate was 7.5-fold greater in patients with eGFR < 15 mL/min/1.73m2 or on dialysis than in patients with eGFR ≥ 90 mL/min/1.73m2, with an adjusted HR of 4.54 (95% CI 2.95-6.98). Conclusion: The eGFR level can be an indicator of prognosis for patients with intracerebral hemorrhage.

This paper introduces the fractal Kraenkel-Manna-Merle (KMM) system, that explains nonlinear short wave propagation with zero conductivity for saturated ferromagnetic materials in an external field. The semi inverse technique and the new auxiliary equation method (NAEM) are used to generate a new set of solutions. The proposed methods are more straightforward, succinct, accurate, and simple to calculate dual mode solitary wave solutions. A collection of exact soliton solutions specifically bright, dark, singular-shaped and singular-periodic are generated. The estimated solutions are obtained using constraint conditions and are displayed through 2D, 3D and contour plots with appropriate parametric values. The arbitrary functions in the solutions are chosen as unique functions to generate some novel soliton structures.

Background: Community-acquired pneumonia (CAP) is an important public health problem because of its high morbidity, mortality, and health care costs. Many biomarkers have been used to determine the severity and prognosis of pneumonia. Ischemia-modified albumin (IMA) is a marker of the recently used oxidant-antioxidant mechanism and has been found to increase in many inflammatory conditions. Objectives: To investigate the role of the levels of IMA in CAP and to evaluate its relationship with pneumonia severity. Methods: A total of 150 patients with a diagnosis of CAP and 150 healthy individuals were included in the study. IMA levels were evaluated in both groups. The patients with CAP were divided into ambulatory, ward and intensive care groups, and their IMA levels were compared. Results: There was no significant difference between the two groups in terms of age or gender (p > 0.05 for both). No significant difference was observed in the IMA levels of the patient and control groups (p ˃ 0.05). The lowest IMA level was observed in the ambulatory group (p = 0.001). When the patients in the ambulatory and hospitalized (ward and intensive care together) groups were evaluated, the cut-off value of IMA was 77.60 ABSU, sensitivity was 64.9%, specificity was 75.0%, positive predictive value was 89.2%, and negative predictive value was 40.3%. Conclusion: In the management of patients with CAP, IMA seems to be a useful marker for CAP severity and hospitalization decision. Keywords: Community-acquired pneumonia, ischemia-modified albumin, biomarker

ABSTRACT Purpose: Recently, there is an increased number of reports being published on catheter-induced spinal epidural abscess (SEA). This review aims to identify and critically evaluate all the descriptive studies that report the SEA due to catheterization and its presentation, diagnosis, management, and outcomes. Methodology: A literature search was performed in the PubMed database using MeSH terms “epidural abscess” AND “renal dialysis” from inception to January 2021 without any language restriction. Google Scholar, grey literature databases (GreyNet. OpenGrey, Grey literature Report, BIOSIS Previews), and the bibliographic search of included studies were carried out to find the additional studies. Descriptive studies describing the SEA induced by catheter usage were included in the review. Study selection, data extraction, and quality assessment were conducted by two independent reviewers any disagreement was resolved by discussing with the third reviewer. Results: Data of 6 studies were retrieved for this review which includes 11 patients (5 females and 6 males) aged from 26 to 79 years old. The most common patient’s presentation was back pain, high-grade fever, quadriparesis, neck pain, drowsy, and altered mental status. The most common isolated microorganism from the blood and catheter tip was Methicillin-resistant Staphylococcus aureus. The most common findings in all the patients were elevated erythrocyte sedimentation rate and leucocyte count. Conclusion: Clinicians must be aware of the possibilities of SEA initiated by catheter usage to prevent further consequences. Aggressive antibiotic therapy along with surgical intervention are the cornerstones in the management of SEA. Early diagnosis and initiation of treatment are important factors that decide the mortality and morbidity in patients with SEA. Keywords: Catheter; Dialysis; Spinal epidural abscess; Systematic review; Case report Protocol registration: International Prospective Register for Systematic Reviews (PROSPERO) ID: CRD42021233375

Aim: Although prostate adenocarcinoma is the most common cancer in men, survival is quite high and with the help of histopathological examination using the updated classification, patient management strategies are developing. We aimed to evaluate the correlation between the histopathological features and biochemical recurrence (BCR) in patients who underwent radical prostatectomy (RP) using the new classification. Methods: A total of 285 prostate adenocarcinoma cases that underwent RP between January 2009 and December 2017 and followed up for at least 3 months were included in the study. The cases were re-evaluated according to WHO-ISUP 2016 classification and the findings were recorded. Results: The mean age was 63,4 years. Gleason scores of the cases were as follows: 3+3 144 cases (50.5%), 3+4 81 cases (28.4%), 4+3 28 cases (9.8%), 4+4 7 cases (2.5%) , 3+5 6 cases (2.1%), 5+3 2 cases (0.7%), 4+5 17 cases (6%). There were 198 (69,5%) pT2, 54 (18,9%) pT3a and 33 (11,6%) pT3b cases. The mean follow-up time was 44,1 months and BCR was detected in 97 cases (34%). The relationship between the Group Grades and BCR was statistically significant. BCR rate increased as the tumor volume and the percentage of pattern 4 increased (p<0.001).There was a significant correlation between preoperative PSA value, extraprostatic extension, seminal vesicle invasion, surgical margin positivity, tumor volume, pattern 4 percentage, presence of cribriform glands and BCR and recurrence-free survival in both univariate and multivariate analysis and recurrence-free survival was also affected by these parameters. Among the morphological subtypes of Pattern 4, recurrence-free survival decreased as the incidence of cribriform glands increased (p <0.001). Conclusion: Histopathological evaluation is important in predicting BCR in prostate adenocarcinoma, the Group Grade system seems to be helpful in this regard. More studies are needed to prove the relatively worse prognostic effect of cribriform glands.

Meticulous transfer of coronary arteries is of crucial importance in transposition of great arteries and determines the success of the switch procedure. This report describes a coronary anatomy consisting of four separate ostia from the two facing sinuses in a six-month-old infant presenting with d-transposition of great arteries and ventricular septal defect. Being a rare coronary arterial pattern not described in previous coding systems, the surgeon would do well to be aware of this possibility while performing the switch procedure.

Background: TYK2 deficiency is a rare Primary immunodeficiency disease caused by loss of function mutations of TYK2 gene, which is initially proposed as a subset of Hyper IgE syndrome (HIES). However, accumulating evidence suggest TYK2 deficient patients do not necessarily present with HIES characteristics, indicating a vacuum of knowledge on the exact roles of TYK2 in human immune system. Method: Pathogenic effects of patients were confirmed by qRT-PCR, western blot and protein stability assays. The responses to cytokines including IFN-α/β/γ, IL-6, IL-10, IL12 and IL-23 of peripheral blood mononuclear cells (PBMCs) from these patients were detected by western blot, qRT-PCR and flow cytometry. The differentiation of T and B cells were detected by flow cytometry. Results: We describe five more TYK2 deficient cases presenting with or without hyper IgE levels, atopy and distinct pathogen infection profile, which are caused by novel TYK2 mutations. These mutations were all found by high throughout sequencing and confirmed by Sanger sequencing. The patients showed heterogenous responses to various cytokine treatments, including IFN-α/β/γ, IL-6, IL-10, IL12 and IL-23. The homeostasis of lymphocytes is also disrupted. Conclusion: Based on our findings, we propose that TYK2 works as a multi-tasker in orchestrating various cytokines signaling pathways, differentially combined defects of which account for the expressed clinical manifestations.

The bifurcation, stability and stabilization analysis of permanent magnet synchronous motor (PMSM) systems are investigated in this paper. To begin, a new class of delay-dependent sufficient conditions is suggested with respect to the information of the membership function, a relevant Lyapunov-Krasovskii functional (LKF), and the overall information connected with the real sampling pattern, so that the fuzzy system is ensured to be stable with a weighted dissipativity efficiency. Second, sampled-data control is intended to stabilize the Takagi-Sugeno (T-S) fuzzy system with specified integral inequalities based on the obtained results. The required conditions are stated in terms of the feasibility of linear matrix inequalities (LMIs) under the dissipativity output index, and can readily be verified by MATLAB toolbox. Finally, verification examples are contributed to demonstrated the efficacy of the techniques established in this paper.

We consider a new class of semiparametric spatio-temporal models with unknown and banded autoregressive coefficient matrices. The setting represents a type of sparse structure in order to include as many panels as possible. We apply the local linear method and least squares method for Yule-Walker equation to estimate trend function and spatio-temporal autoregressive coefficient matrices respectively. We also balance the over-determined and under-determined phenomena in part by adjusting the order of extracting sample information. Both the asymptotic normality and convergence rates of the proposed estimators are established. The proposed methods are further illustrated using both simulation and case studies, the results also show that our estimator is stable among different sample size, and it performs better than the traditional method with known spatial weight matrices.

Most of the bone metastasis origination from Follicular Thyroid Carcinoma (FTC) will present as non-solitary and non-isolated. We present an extremely unique case of an isolated and solitary lesion in an unusual site, scapula, originated from FTC presenting incredibly about ten years after the initial successful treatment.

Additive manufacturing (AM) enables the cost-effective production of complex components, many of which are traditionally manufactured using costly production steps among other processes. One widely applied AM process is Laser-based Powder Bed Fusion of Metals (PBF-LB/M); however, internal pores and rough surfaces are typically inevitable with PBF-LB/M, reducing fatigue and corrosion resistance compared to traditional processes involving turning and milling. Additionally, large defects often occur near to or just at the surfaces. Thus, this study investigates the effect of hybrid additive and subtractive manufacturing on the fatigue strength of AISI 316L. For this purpose, different post treatment routes are compared with wrought material. Additionally, computer tomography is used to determine the necessary machining depth of the surface layer. In this study, heat-treatment and machining are both found to significantly increase fatigue strength. Finally, cyclic mean stresses affect wrought and AM specimens differently.

Anatomical anomalies of the jugular bulb include a high jugular bulb and deficiency of the cortical bone. Most cases are asymptomatic; however, they may present with tinnitus, hearing loss, dizziness. We encountered a rare case of jugular bulb diverticulum with deficiency of the cortical bone that caused objective tinnitus.

Bastomycosis-like pyoderma is a rare skin disorder most commonly caused by bacterial infection. It is usually diagnosed in immunocompromised patients. We report a case of BLP in an immunocompetent woman, who presented with a 6-week history of verrucous cutaneous plaque of the left wrist.

Abstract Background: Propofol may result in hypotension, bradycardia, and loss of protective reflexes, especially in elderly patients, while esketamine, a N-methyl-D-aspartate receptor antagonists, has analgesic, anaesthetic and sympathomimetic properties and is known to cause less cardiorespiratory depression. We hypothesized that esketamine may reduce the median effective concentration (EC50) of propofol and cause more stable haemodynamic responses during gastrointestinal endoscopy in elderly patients. Methods: Ninety elderly patients, aged 65-89 years, undergoing gastrointestinal endoscopy were randomly assigned into three groups: SK0.25 group (0.25 mg/kg esketamine), SK0.5 group (0.5 mg/kg esketamine) and saline control group. Anaesthesia was achieved by target-controlled infusion of propofol with an initial plasma concentration of 2.5 μg/ml with different bolus doses of esketamine during gastrointestinal endoscopy. The EC50 of propofol for gastrointestinal endoscopy was determined by using an up-and-down method of Dixon with an adjacent concentration gradient at 0.5μg/mL to prohibit purposeful movements. Cardiovascular parameters were also measured and recorded. Results: Propofol EC50 and its 95% confidence interval for gastrointestinal endoscopy in elderly patients were 1.71 (1.15-2.27) μg/mL in SK0.5 group, 2.45 (1.85-3.05) μg/mL in SK0.25 group and 3.69 (2.59-4.78) μg/mL in control group respectively (P < 0.05). The average percent change to baseline mean arterial pressure (MBP) was -19.7 (7.55), -15.2 (7.14) and -10.1 (6.73) with P＜0.001, in the control group, the SK0.25 group and the SK0.5 group, respectively. Conclusions: Combination medication of propofol with esketamine reduced the propofol EC50 during gastrointestinal endoscopy in elderly patients and caused more stable haemodynamic responses compared with single administration of propofol.

Quantifying hydrologic exchange fluxes (HEF) and subsurface water residence times (RT) are important for managing the water quality and ecosystem health in dynamic river corridor systems. Laboratory-scale experiments and models have shown that hydrodynamic pressure variations on the riverbed induced by dynamic river flows can strongly impact HEFs and RTs. In this study, the impacts of hydrodynamic pressure on HEFs and RT for a 30 km section of the Columbia River in Washington State over a three-year period were quantitatively evaluated using a coupled transient three-dimensional (3D) multi-phase surface and subsurface water flow transport approach. Based on comparisons between model simulations with and without considering hydrodynamic pressure, we found that hydrodynamic pressure increase the net HEFs by 7% of flowing into river from subsurface domain, and also leads to a reduction of the area with long RT, and increase of area with short RT.

Climate change and other global change drivers threaten plant diversity in mountains worldwide. A widely documented response to such environmental modifications is for plant species to change their elevational ranges. Range shifts are often idiosyncratic and difficult to generalize, partly due to variation in sampling methods. There is thus a need for a standardized monitoring strategy that can be applied across mountain regions to assess distribution changes and community turnover of native and non-native plant species over space and time. Here, we present a conceptually intuitive and standardized protocol developed by the Mountain Invasion Research Network (MIREN) to systematically quantify global patterns of native and non-native species distributions along elevation gradients and shifts arising from interactive effects of climate change and human disturbance. Usually repeated every five years, surveys consist of 20 sample sites located at equal elevation increments along three replicate roads per sampling region. At each site, three plots extend from the side of a mountain road into surrounding natural vegetation. The protocol has been successfully used in 18 regions worldwide from 2007 to present. Analyses of one point in time already generated some salient results, and revealed region-specific elevational patterns of native plant species richness, but a globally consistent elevational decline in non-native species richness. Non-native plants were also more abundant directly adjacent to road edges, suggesting that disturbed roadsides serve as a vector for invasions into mountains. From the upcoming analyses of time series even more exciting results especially about range shifts can be expected. Implementing the protocol in more mountain regions globally would help to generate a more complete picture of how global change alters species distributions. This would inform conservation policy in mountain ecosystems, where some conservation policies remain poorly implemented.

Authors: Morrison Miranda1, Kerkeni Hassen2, Korda Athanasia1, Räss Simone3, Caversaccio Marco D. 1, Abegg Mathias3, Erich Schneider4, Mantokoudis Georgios1.1 Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.2 Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.3 Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.4 Brandenburg University of Technology Cottbus – Senftenberg, Germany.