Giant cell myocarditis masquerading as orbital myositis with a rapid, fulminant course necessitating mechanical support and heart transplantation.

Giant cell myocarditis (GCM), a rapidly progressive inflammation of the myocardium, is associated with fulminant heart failure, refractory ventricular arrhythmias, and conduction system abnormalities. Few case reports have noted orbital myositis as the initial clinical presentation. Our case demonstrates a unique presentation of GCM with only ocular symptoms, which unlike prior studies, rapidly progressed to heart failure, tachyarrhythmias, and conduction disease. Our case necessitated quick recognition and treatment with mechanical support making this the first known case of GCM with successful placement of biventricular assist devices and ultimately with heart transplantation

Area optimization algorithms in high-speed digital FIR filter synthesis

Son on yıl içinde, birden fazla katsayının çarpımı (MCM) problemi, bir başka deyişle, bir değişkenin birden fazla katsayı ile çarpımının en az sayıda toplama/çıkarma işlemleri kullanılarak tasarımı, için etkili algoritmalar önerilmiştir. Bu algoritmalarda, toplama/çıkarma işlemi iki girişli bir işlem olarak kabul edilmekte ve genellikle, hesaplama süresi fazla olan elde ötelemeli toplayıcılar ile gerçeklenmektedir. Bunun yanında, elde korumalı toplayıcılar (CSA) çok girişli toplama işlemlerinin yüksek hızlı tasarımında sıklıkla kullanılmaktadır. Yine de, CSA blok sayısının optimizasyonu için önerilen algoritmalar sezgisellerdir ve minimum sonucu garanti edemezler. Bu makalede, MCM işlemi için gereken minimum sayıdaki CSA bloklarını bulan bir kesin ortak alt ifade eliminasyonu (CSE) algoritması önerilmektedir. Önerilen kesin yöntem gerçek boyutlu örnekler üzerinde uygulanabilse de, MCM probleminin bir NP-bütün problem olmasından dolayı, doğal olarak, kesin algoritmanın ele alamayacağı örnekler mevcuttur. Bu yüzden, bu makalede, büyük boyutlu örnekleri ele alabilen bir yaklaşık CSE yöntemi de önerilmekedir. CSE algoritmaları ile elde edilen sonuçlar katsayıların gerçeklenmesi için kullanılan sayı gösterimlerine bağlı olduğundan bu makalede, ayrıca, katsayıların genel sayı gösterimindeki ifadelerini ele alabilen bir yaklaşık yöntem de sunulmaktadır. Önerilen algoritmalar, rastgele üretilmiş örnekler ve FIR filtreleri üzerinde test edilmiş ve daha önceden önerilmiş CSE ve graf tabanlı sezgisel yöntemler ile karşılaştırılmıştır. Deneysel sonuçlardan kesin CSE algoritmanın sezgisel CSE yönteme göre oldukça iyi sonuçlar elde ettiği ve genel sayı gösterimi altında yaklaşık algoritmanın graf tabanlı sezgisel yöntemle rekabet edebilecek düzeyde ve daha iyi sonuçlar bulduğu gözlenmektedir.  Anahtar Kelimeler: Birden fazla katsayının çarpımı problemi, ortak alt ifade eliminasyonu, elde ötelemeli toplama, elde korumalı toplama, 0-1 tamsayı lineer programlama.Digital Finite Impulse Response (FIR) filters are frequently used in Digital Signal Processing (DSP) by virtue of stability and easy implementation. The problem of designing the multiplier block of a digital FIR filter has received a significant amount of attention during the last decade, as the filters require a large number of multiplications, leading to excessive area, delay, and power consumption even if implemented in a full custom integrated circuit. Previous works have focused on the design of filters with minimum area by replacing the multiplication operations with constant coefficients by addition, subtraction, and shifting operations. Since shifts can be implemented with only wires in hardware, the design problem can be defined as the minimization of the number of addition/subtraction operations to implement the coefficient multiplications. This problem is generally known as the MCM problem. In the last decade, many efficient algorithms have been proposed for the MCM problem. These algorithms can be categorized in two classes: Common Subexpression Elimination (CSE) and graph-based algorithms. While the CSE algorithms basically find the common non-zero digit patterns on the representations of the constants, the graph-based algorithms are not restricted to a particular number representation and synthesize the constants iteratively by build-ing a graph.However, in the algorithms proposed for the MCM problem, an addition/subtraction operation is assumed to be a two-input operation that is generally implemented using a Ripple Carry Adder (RCA) block yielding great latency in the implementation of MCM. In high-speed applications, particularly in DSP systems, Carry-Save Adder (CSA) blocks are preferred to RCA blocks taking into account the increase in area.Despite the large number of algorithms designed for the minimization of addition/subtraction operations based on RCAs, there are only a few algorithms proposed for the optimization of the number of CSA blocks. Although these algorithms give good results, they are based on heuristics, i.e., provide no indication on how far from the minimum their solutions are. To the best of our knowledge, there is no exact algorithm proposed for the optimization of the number of CSA blocks in MCM.In this paper, an exact CSE algorithm designed for the minimization of the number of CSA blocks is introduced. In the exact CSE algorithm, initially, all possible implementations of filter coefficients and partial terms using CSAs are found when filter coefficients are defined under a number representation, and a combinational network that represents the implementations of constants is constructed. Then, the minimization of the number of CSA blocks problem is defined as a 0-1 Integer Linear Programming (ILP) problem with a cost function to be minimized and constraints to be satisfied. Finally, a generic 0-1 ILP solver is used to obtain the minimum solution. Due to the NP-completeness of the MCM problem, naturally, there are instances that the exact algorithm cannot handle. Hence, in this paper, we also introduce an approximate CSE algorithm based on the exact CSE algorithm that considers limited implementations of the coefficients reducing the size of the search space to be explored significantly. It is also shown that the approximate CSE algorithm obtains similar results with the exact CSE algorithm. Since the solutions obtained by the proposed CSE algorithms depend on the number representation, in the approximate algorithm, the number of possible implementations of filter coefficients is increased using a general number representation allowing the approximate algorithm to be more effective in area optimization. It is shown that the approximate algorithm under general number representation obtains more promising results than the approximate CSE algorithm. In this paper, the results of the proposed exact and approximate algorithms on a comprehensive set of instances including randomly generated and FIR filter instances are presented. It is shown that the proposed algorithms can be applied on real size instances. Also, the results of the exact and approximate algorithms are compared with those of the previously proposed CSE and graph-based heuristics. As observed from the experimental results, the exact and approximate CSE algorithms find significantly better solutions than the CSE heuristic and the approximate algorithm under general number representation obtains competitive and better results than the graph-based heuristic. Keywords: Multiple constant multiplications, common subexpression elimination, ripple carry adders, carry save adders, 0-1 integer linear programming

Investigation of the blastocystis hominis frequency in patients with irritable bowel syndrome

AimIn this study, it was aimed to investigate the relationship between Blastocystis hominis infection and inflammatory bowel syndrome (IBS). Methods: In this study, the frequency of B. hominis in the stool samples of 52 patients applied to Microbiology laboratory and pre-diagnosed with irritable bowel syndrome in January 2013-June 2013 was investigated, retrospectively. Microscopic investigations were evaluated after macroscopic examination. For this purpose, the stool samples of the diarrheal cases were investigated by trichrome staining after they were prepared by native-lugol and formol ethyl acetate concentration method. The results were compared with the examination of 2160 stool samples sent to our laboratory during the same period. Results: Stool samples of 52 patients pre-diagnosed with IBS were accepted to our laboratory in January 2013-June 2013. 13 of the patients were found as B. hominis positive. Weight loss and anorexia was identified only in one patient while abdominal pain, diarrhea and gas complaints were identified in all of the IBH and B. hominis positive patients. During the same period, parasites were detected in 96 (4.4%) of 2160 stool samples sent to our laboratory and the most common was B. hominis 48 (2.2%). 452 of these patients applied with diarrhea symptoms and B. hominis was detected in 36 samples (7.96%). Conclusion: The limited studies investigating the presence of B. hominis in patients with irritable bowel syndrome are far from illuminating the role of this agent in disease pathogenesis. We believe that further investigations should be performed. In this study, 25% of the patients were found as positive. J Clin Exp Invest 2014; 5 (2): 242-24

Improved costs and outcomes with conscious sedation vs general anesthesia in TAVR patients: Time to wake up?

BackgroundTranscatheter aortic valve replacement (TAVR) has become a commonplace procedure for the treatment of aortic stenosis in higher risk surgical patients. With the high cost and steadily increasing number of patients receiving TAVR, emphasis has been placed on optimizing outcomes as well as resource utilization. Recently, studies have demonstrated the feasibility of conscious sedation in lieu of general anesthesia for TAVR. This study aimed to investigate the clinical as well as cost outcomes associated with conscious sedation in comparison to general anesthesia in TAVR.MethodsRecords for all adult patients undergoing TAVR at our institution between August 2012 and June 2016 were included using our institutional Society of Thoracic Surgeons (STS) and American College of Cardiology (ACC) registries. Cost data was gathered using the BIOME database. Patients were stratified into two groups according to whether they received general anesthesia (GA) or conscious sedation (CS) during the procedure. No-replacement propensity score matching was done using the validated STS predicted risk of mortality (PROM) as a propensity score. Primary outcome measure with survival to discharge and several secondary outcome measures were also included in analysis. According to our institution's data reporting guidelines, all cost data is presented as a percentage of the general anesthesia control group cost.ResultsOf the 231 patients initially identified, 225 (157 GA, 68 CS) were included for analysis. After no-replacement propensity score matching, 196 patients (147 GA, 49 CS) remained. Overall mortality was 1.5% in the matched population with a trend towards lower mortality in the CS group. Conscious sedation was associated with significantly fewer ICU hours (30 vs 96 hours, p = <0.001) and total hospital days (4.9 vs 10.4, p<0.001). Additionally, there was a 28% decrease in direct cost (p<0.001) as well as significant decreases in all individual all cost categories associated with the use of conscious sedation. There was no difference in composite major adverse events between groups. These trends remained on all subsequent subgroup analyses.ConclusionConscious sedation is emerging as a safe and viable option for anesthesia in patients undergoing transcatheter aortic valve replacement. The use of conscious sedation was not only associated with similar rates of adverse events, but also shortened ICU and overall hospital stays. Finally, there were significant decreases in all cost categories when compared to a propensity matched cohort receiving general anesthesia

The genetic profile of childhood neuromuscular disorders: A single center experience

Neuromuscular Diseases are a heterogeneous group of childhood disorders, and differential diagnosis can be challenging. Although there is no definitive treatment for the most of this group of diseases, early diagnosis is important with the development of new treatment methods. In this study, we aimed to draw attention to the importance of new generation genetic tests in diagnosing neuromuscular diseases. In this retrospective study, we reviewed the records of 800 patients with suspected neuromuscular diseases followed in the Neuromuscular Clinic of Marmara University Pendik Training and Research Hospital between December 2011 and January 2023 according to their demographic, clinical and genetic characteristics. Patients who were diagnosed with Duchenne muscular dystrophy and spinal muscular atrophy with targeted gene testing were excluded from the study. The results of targeted gene testing, clinical exome sequencing (CES), whole exome sequencing (WES) and mitochondrial genome analysis were analysed

Türk Psikiyatri Dergisi 2005; 16(4) Turkish Journal of Psychiatry Development and Reliability Study of the Adolescent Inhalant Use Severity Scale

Results: The correlation between the questionnaire scores and the Visual Analog Scale scores was adequate (0.72). The mean scores of addicts were higher than those of nonaddicts (p<0.001). The Cronbach alpha value was 0.84. Three items had no internal consistency and the same items' interrater and test re-test reliability correlations were low. Conclusion: It is thought that when the 3 inconsistent items are removed the 18-item Yeniden Inhalant Use Severity Scale (YUKUD) is a reliable and valid measure to evaluate the severity of inhalant use in adolescents and that it can be used in related research

3-D Electrochemical Impedance Spectroscopy Mapping of Arteries to Detect Metabolically Active but Angiographically Invisible Atherosclerotic Lesions

We designed a novel 6-point electrochemical impedance spectroscopy (EIS) sensor with 15 combinations of permutations for the 3-D mapping and detection of metabolically active atherosclerotic lesions. Two rows of 3 stretchable electrodes circumferentially separated by 120° were mounted on an inflatable balloon for intravascular deployment and endoluminal interrogation. The configuration and 15 permutations of 2-point EIS electrodes allowed for deep arterial penetration via alternating current (AC) to detect varying degrees of lipid burden with distinct impedance profiles (Ω). By virtue of the distinctive impedimetric signature of metabolically active atherosclerotic lesions, a detailed impedance map was acquired, with the 15 EIS permutations uncovering early stages of disease characterized by fatty streak lipid accumulation in the New Zealand White rabbit model of atherosclerosis. Both the equivalent circuit and statistical analyses corroborated the 3-D EIS permutations to detect small, angiographically invisible, lipid-rich lesions, with translational implications for early atherosclerotic disease detection and prevention of acute coronary syndromes or strokes