In modeling cell culture growth using unstructured model, two types of equations are normally used: logistic and Monod. However, these two equations are known for their limitations to model death phase of cell culture growth and to account for dead cells accumulation data. In this paper, we present a modeling framework whereby both Logistic and Monod equations can be used in a single set of equations system to overcome these limitations. First, it can be shown that the increase of total cell population that consists of viable and dead cells follows a logistic growth pattern with its own intrinsic growth rate and total carrying capacity. Furthermore, a hybrid Logistic-Monod equation with first-order decay kinetics can be used to model viable cell growth data with decline phase effectively. With this paradigm, a pseudo-rate equation can be written to account for dead cells accumulation data using population balancing with a simple understanding that dead cell population is simply the difference between total and viable cells. These equations can be adjoined with substrate consumption and product generation rate equations to depict complete batch growth data that covers exponential growth and death phases. This modeling framework has been fitted successfully to fit batch growth data of two cell lines from published literature with complete depictions of dead cell accumulation and cell viability profiles. The implication of this modeling framework for chemostat culture performance analysis is further investigated. 

    Yapay zeka ile ilgilenen kişilerin duymuş olabileceğini düşündüğümüz, Cahit Arf'ın makinelerin düşünmesi ile ilgili verdiği bir halk konferansını MMMT olarak inceledik ve bunu yazıya döktük. Ünlü bilim insanı ve matematikçi Cahit Arf'ın hayatını ve bilinmeyen detaylarını işlediğimiz yazıya buraya tıklayarak ulaşabilirsiniz: #İzBırakanlar 001: Matematiğin Arf Halkası Cahit Arf

A 39-year-old parturient contracted COVID-19 at 28 weeks of gestation and later developed ARDS requiring emergent caesarean section, intubation and 11 days of invasive ventilation. Her infant also required intubation due to hyaline membrane disease, he was not infected by COVID-19. Both evolved well and could return home.

Primary tuberculosis of the parotid gland is rare even in endemic countries. the clinical manifestations are polymorphic and non-specific. it is important for clinicians to be aware of this pathology.

In December 2019, the novel coronavirus disease pandemic (COVID-19) that began in China had infected more than 56 million individuals worldwide and accounted for more than 1.344.000 fatalities. With the dawn of this novel coronavirus (SARS-CoV-2), there was a requirement to select potential therapies that might effectively kill the virus, accelerate the recovery, or decrease the case fatality rate. Besides the currently available antiviral medications for HIV and HCV, the chloroquine/hydroxychloroquine (CQ/HCQ) regimen with or without azithromycin has been repurposed in China and was recommended by the National Health Commission, China in mid-February 2020. By this time, the selection of this regimen was based on its efficacy against the previous SARS-CoV-1 virus and its potential to inhibit viral replication of the SARS-CoV-2 in vitro. There was a shortage of robust clinical proof about the effectiveness of this regimen against the novel SARS-CoV-2. Therefore, extensive research effort has been made by several researchers worldwide to investigate whether this regimen is safe and effective for the management of COVID-19. This review article provides a comprehensive overview of the CQ/HCQ regimen. It summarizes the evaluating data from in vitro studies and clinical studies either for the protection or the treatment against SARS-CoV-2. There is a sharp difference of opinion about the role of CQ/HCQ regimen in treatment of COVID-19. The literature data are controversial and contradictory due to the diverse study design, population selection, dosage, regimen, and outcome measures. Current evidence from the two largest randomized-controlled trials (recovery and solidarity) suggests that the HCQ regimen does not decrease COVID-19 patients’ mortality. However, conflicting data were published from observational studies showing that the drug might be sufficient. Therefore, more investigations are needed to emphasize these findings.

To elucidate the genetic mechanisms of recurrence and metastasis in clear cell sarcoma of the kidney (CCSK), a dismal pediatric renal cancer, we performed targeted-capture sequencing by pediatric solid tumors panel (381 genes) for multi-sampled tumors including autopsy samples of metastasis extracted from a single case that underwent four relapses. Internal tandem duplication of BCOR (BCOR-ITD) was the only truncal mutation, indicating a strong association with tumorigenesis. Acquisition of additional mutations along tumor relapses and detection of metastasis-specific mutations were reminiscent of the tumor progression and therapeutic resistance of this case, leading to clonal selection and a dismal fate.

Severe coronary calcification predicts stent under-expansion, malapposition, and poor outcomes in percutaneous coronary intervention. Rotational atherectomy permits debulking of coronary calcium allowing for stent expansion. More recently, intravascular lithotripsy has been used to fracture calcium and aid revascularization. Here we report two cases where both strategies were required for revascularization.

Sickle cell disease (SCD) patients are immunocompromised with multiple comorbidities and a hypercoagulation state. On the other hand COVID-19 is associated with cytokine storm and hypercoagulability. To find the susceptibility and the clinical course of COVID-19 in SCD patients we surveyed related published papers from USA, Europe, Middle East, few African patients and international SCD registry. The COVID-19 presentation was mild in children and moderate in many SCD adults. To explain these findings, possible benefits of high HbF level, and hydroxyurea therapy could be considered. The obtained results should be interpreted considering low cases from sub-Saharan people, younger age of SCD patients compared to general population, a bias toward registry of more severe form of the disease, the influence of preexisting comorbidities with multisystem organ damage in exacerbation of the COVID-19 and the fatality rate in SCD patients and the role of health socio-economic determinants.

Background. The changes and general alarm of the current COVID-19 pandemic have amplified the sense of precariousness and vulnerability for family members who, in addition to the emotional trauma of the cancer diagnosis, add the distress and fear of the risks associated with infection. The primary objectives of the present study was to investigate the psychological impact of the COVID-19 pandemic on the parents of pediatric cancer patients, and to investigate the level of stress, anxiety, and the child’s quality of life perceived by the parents during the Covid-19 epidemic. Methods. The parents of 45 consecutive children with solid and haematological tumors were enrolled. Four questionnaires (Impact of Event Scale-Revised - IES-R ; Perceived Stress Scale - PSS; Spielberger State - Trait Anxiety Inventory - STAI-Y ; Pediatric Quality of Life Inventory - PedsQL) were administered to the parents at the beginning of the pandemic lockdown. Results. 75% of parents exhibited remarkable levels of anxiety, with 60 subjects in state scale and 45 subjects in trait scale having scores that reached and exceeded the STAI-Y cut off. The bivariate matrix of correlation (Figure 1) found a strong significant positive correlation between the IES-R and PSS scores (r = 0.55, P < 0.001). There was a positive correlations between the PSS and PedsQL (emotional needs) scale (P < 0.001) and a negative correlation between IES-R and STAI-Y (P < 0.001). Conclusion. The results confirm that parents of pediatric cancer patients have a high psychological risk for post-traumatic symptoms, high stress levels, and the presence of clinically significant levels of anxiety.

Background: Central venous catheters (CVCs) have been essential devices for the treatment of children with hematological and oncological disorders. Only few studies investigated the complications and selections of different types of CVCs in these pediatric patients. This study aimed to compare risk factors for unplanned removal of two commonly used CVCs, i.e., peripherally inserted central catheters (PICCs) and tunneled CVCs, and propose better device selection for the patient. Procedure: This retrospective, single center cohort analysis was conducted on pediatric patients with hematological and oncological disorders inserted with either a PICC or a tunneled CVC. Results: Between January 1, 2013, and December 31, 2015, 89 patients inserted with tunneled CVCs (total 21,395 catheter-days) and 84 with PICCs (total 9,177 catheter-days) were followed up until the catheter removal. The median duration of catheterization was 88 days in PICCs and 186 days in tunneled CVCs (p = 1.24×10-9). PICCs at the 3-month cumulative incidence of catheter occlusion (5.2% vs. 0%, p = 4.08×10-3) and total unplanned removal (29.0% vs 7.0%, p = 0.0316) were significantly higher, whereas no significant difference was observed in the cumulative incidence of central line-associated bloodstream infection (11.8% vs. 2.3%, p = 0.664). Multivariable analysis identified younger age (<2 years) (subdistribution hazard ratio [SHR], 2.29; 95% confidence interval [CI], 1.27–4.14) and PICCs (SHR, 2.73; 95% CI, 1.48–5.02) were independent risk factors for unplanned removal. Conclusion: Our results suggest that tunnel CVCs would be a preferred device for children with hematological and oncological disorders requiring long-term, intensive treatment.

Diabetes is a chronic metabolic disorder associated with the accelerated development of macrovascular (atherosclerosis, coronary artery disease) and microvascular complications (nephropathy, retinopathy and neuropathy), which remain the principal cause of mortality and morbidity in this population. Current understanding of cellular and molecular pathways of diabetes-driven vascular complications as well as therapeutic interventions have arisen from studying disease pathogenesis in animal models. Diabetes-associated vascular complications are multi-faceted, involving the interaction between various cellular and molecular pathways. Thus, the choice of an appropriate animal model to study vascular pathogenesis is important in our quest to identify innovative and mechanism-based targeted therapies to reduce the burden of diabetic complications. Herein, we provide up-to-date information on available mouse models of both Type 1 and Type 2 diabetic vascular complications as well as experimental analysis and research outputs.

Introduction: There is an increasing amount of data relating the dietetic pattern to health variables, although data concerning the child population are scarce. The aim of the study is to assess the effects of affinity to the Traditional Mediterranean Diet (TMD) pattern, together with breastfeeding, on the incidence of childhood asthma and inflammatory and recurrent diseases in children under two years of age. Methods: Quasi-experimental intervention study, where breastfeeding was promoted and following the TMD pattern was offered. The incidence of morbidity was evaluated and correlated with the dietary patterns which were followed. According to their adhesion to the TMD-Breastfed Test patients were classified into two groups: Group-1 (greater affinity) and Group-2 (lower affinity). Results: The score of the TMD-Breastfed Test was optimal in group-1 and good in group-2. It shows a marked reduction in both consultation groups “on request” compared with “planned”, with low morbidity and low use of antibiotics. The incidence of infectious diseases and bacterial complications shows a clinically relevant difference between both groups. The incidence of childhood asthma was greater in group-2, with less adherence to breastfeeding. Conclusions: In these cohorts of breastfed patients with good adherence to TMD patterns, there was evidence of a low incidence of infectious diseases and childhood asthma, more pronounced in the breastfed group. Adapted milk and other foodstuffs of animal origin have been linked to being able to cause inflammatory and recurrent diseases, as their dietary limitations have contributed to decreasing morbidity.

Background and Purpose: The Covid-19 is a viral infection classified as a pandemic by the World Health Organization. There is not currently therapy against the Sars-cov-2. We aimed to assess the best drug therapy approach for the management of Covid-19. Experimental Approach: We did a systematic review and meta-analysis of randomized controlled trials of drugs used in patients with Covid-19. We performed research in the PubMed and the Medrxiv. The trials were included if the patients were over 12 years old, diagnosed through the rt-PCR test and who assessed as primary outcomes or decreased mortality, or time to clinical improvement, or hospitalization time. Random-effects meta-analysis was used to pool individual studies. Heterogeneity was assessed using I². The review has been registered on PROSPERO, number 179879. Key Results: Nine trials were included for analysis. Remdesivir, mainly early after the onset of symptoms, led to a reduction in mortality (OR, 0·85; 95% CI, 0·05 to 0·98; P=0·045). Although this meta-analysis did not observe a reduction using dexamethasone, the Recovery Trial indicates that it can be an option for a patient that needs oxygen support. Our study did not demonstrate the efficacy of any treatment to minimize the effects of Covid-19 related to large hospital stay or time to clinical improvement. Conclusion and Implications: Remdesivir is the only drug that can change the course of Covid-19, reducing mortality rates. Despite this result, other studies must evaluate the effectiveness of this and other drugs in the management of Covid-19 mainly studies with robust methods.

The geometries of monocharged and neutral octafluoro-spirobi[triphosphazene] in singlet, doublet and/or triplet ground spin states were optimized. Their electronic structures are investigated in terms of Quantum Theory of Atoms-in-Molecules and compared with neutral hexafluorocyclotriphosphazene. The change of the total molecular charge implies mainly the change of the properties of the nitrogen atoms which are bonded to the central spiro-phosphorus atom. The charged systems in singlet spin states have stable structures of D2d symmetry only unlike the remaining ones of C2 symmetry within two geometry types. The existence of the less symmetric structures can be fully explained as a consequence of the (pseudo-) Jahn-Teller effect.

Intro Allergic rhinitis（AR） is a common condition which can significantly impair quality of life. This study aimed to illustrate the efficacy and safety of sublingual immunotherapy (SLIT) on pollen AR patients. Methods Four electronic databases (PubMed, EMBASE, Cochrane Library, and Web of Science) were searched from their inception until September 2019. Two reviewers （FLF and CLJ） independently extracted the data. The Cochrane’s Risk of Bias tool was used to assess the quality of included studies. The outcomes of study were calculated by MD or SMD with 95%CI. A meta-analysis was performed using RevMan 5.3 software. Results In this systematic review, a total of 8 articles were included, involving 785 participants. The quality of the included studies ranged from low to moderate. The results of the meta-analysis showed that compared with placebo, a significant reduction of nasal symptoms were observed on SLIT (MD = −0.84, 95% CI = −1.47 to −0.22, P < 0.05), IgE (SMD =0.46, 95% CI = 0.16 to 0.76, P < 0.05); No significant effect on medication scores (MD = −0.41, 95% CI = −0.89 to 0.07, P =0.10). No serious adverse events were reported, and symptoms of adverse events were reported more frequently in the gastrointestinal symptoms. Conclusion SLIT can effectively relieve rhinitis symptoms and decrease the level of specific-IgE for pollen allergic rhinitis patients and the safety was verified. But due to the low quality of studies, more high-quality randomized trials are needed to provide stronger evidence of the conclusion.

Cystic fibrosis (CF) was historically a disease largely afflicting children. Due to therapeutic advancement, there are now more adults with CF than children. In the past decade, medications became available that treat the underlying cause of CF and are dramatically improving lung function as well as quality and quantity of life for people with CF. As a result, more women with CF are having babies. We gathered a panel of experts in CF care, family planning, high risk obstetrics, nutrition, genetics and women with CF to review current literature on pregnancies and to provide care recommendations for this unique population.

Objective: to describe the impact of COVID-19 on the management of patients with ectopic pregnancy. Design: a multicentre study comparing outcomes from a prospective cohort during the pandemic [Covid-ectopic pregnancy registry (CEPR)] compared to an historical pre-pandemic cohort [non-Covid ectopic pregnancy registry (NCEPR)]. Setting: five London university hospitals. Population and Methods: consecutive patients diagnosed clinically and/or radiologically with ectopic pregnancy (March/2020-Aug/2020) were entered into the CEPR and an exploratory matched analysis was performed comparing results to NCEPR patients (January/2019-June/2019). Main outcome measures: patient demographics, management (expectant, medical and surgical), length of treatment, number of hospital visits (non-surgical management), length of stay (surgical management) and 30-day complications. Results: 341 patients met inclusion: 162 CEPR and 179 NCEPR. A significantly higher percentage of women underwent non-surgical management versus surgical management in the CEPR versus NCEPR (58.6% [95/162] vs 72.6% [130/179]; p= 0.0084]. Amongst patients managed with expectant management the CEPR had a significantly lower mean number of hospital visits compared to NCEPR [3.6 [SD 1.4] vs 13.7 [SD 13.4], p= 0.0053]. Amongst patients managed with medical management, the CEPR had a significantly lower mean number of hospital visits [NCEPR 6.4 [SD 2.3] vs 8.8 [SD 3.9], p= 0.0014]. There was no observed difference in complication rates between cohorts. Conclusion: women were found to undergo significantly higher rates of non-surgical management during COVID-19 first wave vs NCEPR cohort. Women managed non-surgically in CPER cohort were also managed with fewer hospital attendances. This did not lead to an increase in observed complications rates.

This study aims to introduce Suzuki type Σcontraction mappings with simulation functions in the frame of modular b-metric spaces. Also, some coincidence and common fixed point results are obtained for four mappings using the weakly compatibility property that these results are the extensions and improvements of the existing literature. Finally, we also present two applications on graph theory and homotopy theory, which show applicability and validity of our results.

Introduction: After thyroid diseases, hyperparathyroidism is one of the most common endocrine surgical disease. The increasing diagnosis of thyroid pathologies in early stages and a societal emphasis on physical appearances, especially in young women, have been led to development of new surgical techniques alternative to conventional transcervical incision consistently. Here, we describe our anaesthesia experience for parathyroidectomy with Transoral Endoscopic Parathyroidectomy by Vestibular Approach (TOEPVA). Material-method: Patients undergo TOEPVA at the Health Sciences University Izmir Bozyaka Training and Research Hospital between November 2018 and April 2019 were reviewed. Demographic data and hemodynamic parameters were reported. Seven patients were operated successfully by this technique none of which required conversion to conventional open surgery. Two patient required atropine and one patient required ephedrine during insufflation. Conclusion: After induction of anaesthesia with propofol, remifentanil and rocuronium; anaesthesia managed by desflurane co-administered with continous infusion of remifentanil, provide feasible and safe anaesthesia for TOEPVA. However, especially during hydrodissection and insufflation, a close cooperation between surgeon and anaesthetist have a great value to improve patient management.

Background: The global cases of Covid-19 increasing day by day. On Nov. 25, 2020, a total of 59,850,910 cases reported globally with a 1,411,216 global death. In India, total cases in the country now stand at 91,77,841 including 86,04,955 recoveries and 4,38,667 active cases as of Nov. 24, 2020, as per data issued by ICMR. A new generation of voice/audio analysis application which can tell whether the person is suffering from COVID-19 or not. Aims: To describe how to establish a new generation of voice/audio analysis applications to identify the suspected covid-19 hidden cases in hotspot areas with the help of an audio sample of the general public. Materials & Methods: The different patents and data available as literature on the internet are evaluated to make a new generation of voice/audio analysis application with the help of an audio sample of the general public. Results: The collection of the audio sample will be done from the already suffered covid-19 patients in (.Wave files) personally or through phone calls. The audio samples like the sound of the cough, the pattern of breathing, respiration rate, and way of speech will be recorded. The parameters will be evaluated for loudness, articulation, tempo, rhythm, melody, and timbre. The analysis and interpretation of the parameters can be made through machine learning and artificial intelligence to detect corona cases with an audio sample. Discussion: The voice/audio application current project can be merged with a mobile App called “Aarogya Setu” by Govt. of India. The project can be implemented in the high-risk area of Covid-19 in the country. Conclusion: This new method of detecting cases will decrease the workload in the covid-19 laboratory.

Introduction: The coexistence of diabetes mellitus (DM) and hypertension (HTN) worsen clinical outcomes and contribute to increased morbidity and mortality. Objective: This study aims to analyze the length of stay and healthcare costs by calculating the direct and indirect costs of diabetes with co-existing hypertension in North India. Methods: A prospective observational study was conducted at the medicine department of the three different hospitals. Results: The patients’ mean age was found to be (M=53.8, SD=11.5) years. Out of 1914 patients, 53.65% were found female. Our study revealed that the median cost of medical supplies and equipment was found to be 21.2 $. The median cost of dialysis was found at 47.5 $; the median cost of hospitalization was found to be 142.6 $. The treatment’s median direct cost was 188.5 $, followed by the overall median cost of 295.6 $. The maximum overall cost of treatment was observed at 603.9 $. It was observed that that maximum LOS was found to be 14 days for patients having BPS between 140 to 159 mmHg and BPD between 110- 119 mmHg, and minimum LOS was found to be 3.5 days. Conclusion: The present study highlighted that diabetes co-existing hypertension poses a high economic burden on patients. This study explored that highly significant result for BPS, BPD, FBS, and HbA1c, whereas the significant results were obtained when RBS is compared with LOS and treatment costs. Our study concluded that mean difference of 9.24 $ in patients having FBS: 261-290 mg/dl and > 290 mg/dL. The LOS increases 6.57 days for patients with BPS between 140-159 mmHg compared to BPS between 180 -above 209 mmHg, which lower treatment costs by -21.31$. Keywords: Diabetes, Hypertension, length of stay, cost of treatment, direct medical cost, indirect medical cost

Background: Right ventricular (RV) pacing causes delayed activation of remote ventricular segments. We used the UHF-ECG to describe ventricular depolarization when pacing different RV locations. Methods: In 51 consecutive patients, temporary pacing was performed at the RV apex, anterior and lateral wall, and at the RV septum with (cSp) and without direct conductive tissue engagement (mSp) (further subclassified as RVIT and RVOT for septal inflow and outflow positions). The timing of UHF-ECG electrical activations were quantified as: left ventricular lateral wall delay (LVLWd; V8 activation delay), RV lateral wall delay (RVLWd; V1 activation delay), and LV lateral wall depolarization duration (V5-8d). Results: The LVLWd was shortest for cSp (11 ms (95% CI; 5;17), followed by the RVIT (19 ms (11;26) and the RVOT (33 ms (27;40), (p<0.01 between all of them), although the QRSd for the latter two were the same (153 ms (148;158) vs. 153 ms (148; 158); p=0.99). The RVOT caused longer V5-8d (9 ms (3;14) compared to the RVIT (1 ms (−5;8), p<0.05. RV apical capture not only had a worse LVLWd (34 ms (26;43) compared to mSp (27 ms (20;34), p<0.05), but its RVLWd (17 ms (9;25) was also the longest compared to other RV pacing sites (mean values for cSp, mSp, anterior and lateral wall captures being below 6 ms), p<0.001 compared to each of them. Conclusions: UHF-ECG ventricular dyssynchrony parameters show that cSp offers the best ventricular synchrony followed by RVIT pacing, which should be preferred over RVOT and other RV myocardial pacing locations.

Introduction: The implantable cardioverter defibrillator (ICD) reduces mortality in patients at risk for potentially life-threatening arrhythmias. Access and distribution of ICDs in rural or economically disadvantaged populations is suspected to be low. This study examined Out of Hospital Premature Natural Death data (OHPND) and electronic medical record (EMR) data to identify rates of non-implantation of ICDs in a sample of decedents in eastern North Carolina. Methods and Results: Death certificate information on 1,316 decedents were matched with EMR data (N = 967, 73.4%). Chart review identified 70 (7.2%) potential ICD candidates with a left ventricular ejection fraction (LVEF) ≤35%. Of the 70 identified patients, 5 (7.1%) did not meet criteria because LVEF subsequently improved. Of the remaining 65 patients, 32 (49.2%) already received an ICD or a wearable cardioverter-defibrillator (WCD), and 33 patients (50.7%) met ICD implantation criteria but had not received one. The reasons identified for non-implantation of ICDs included: limited life expectancy secondary to comorbidities, principally chronic kidney disease (CKD) (N=11, 17%), lack of physician adherence to guidelines (N=9, 14%), lost to follow-up (N=7, 11%), patient refusal (N=5, 8%), and patients yet to commence guideline-directed medical therapy (N=1, 2%). Among our cohort of 967 individuals who died unexpectedly at home, 9 (0.9%) patients may have avoided unexpected death with an ICD/WCD. Conclusion: This study using decedent data shows low rates of ICD-underutilization in a rural population, but also emphasizes the role that advanced comorbidities such as CKD play in ICD-underutilization.

Background: Combination of endocardial and epicardial approach has improved the overall success rate of ventricular tachycardia (VT) ablation in patients with cardiomyopathy. However, the origins of some VTs are truly intramural or close to coronary arteries, which make this combined strategy either prone to failure or too risky. Objectives: This observational study aimed to explore the feasibility and efficacy of direct epicardial ablation combined with intramural ethanol injection via surgical approach for such VTs. Methods: Six consecutive patients with recurrent sustained VT refractory to combined endocardial and epicardial radiofrequency ablation were included. Direct epicardial access was achieved through limited left thoracotomy in 3 patients and median sternotomy in other 3 patients. Ablation was performed using irrigation catheter guided by electroanatomic mapping. Ethanol was injected in all patients to reinforce transmural lesions. The primary outcome was freedom of sustained VT determined by device interrogation and periodical 24h-holter recordings subsequently. Results: Over a median follow-up of 22 months (range, 6~65), all patients remained free of sustained VT. One patient died of pulmonary infection one year after the procedure. Conclusions: A hybrid strategy of surgical ablation combined with intramural ethanol injection is feasible and effective in patients with multiple failed percutaneous ablation attempts.