Notes

An uncommon case of breast cancers in the transgender girl.
Active disturbance rejection control (ADRC) is considered to be a common control method in the presence of external disturbances and uncertainties. This work proposes a modified ADRC control strategy to further enhance robustness to uncertainties. First, the cascade structure of modified ADRC composed by two control loops is introduced. Two extended state observers that can be tuned independently are arranged in a cascade structure. The outer loop observer provides system state estimation to build the feedback controller, and the inner loop observer deals with the generalized disturbance. Then, the enhanced robustness is verified by the improved sensitivity in the intermediate frequency range. Finally, for the axial magnetic bearing system with unstable system dynamics, the variation trend in maximum sensitivity with different control parameters is explained in the simulation. The experiments are conducted under varying disturbances and parameter uncertainty to verify the enhanced control performance.
Incisional hernia (IH) is a complex, costly and difficult to manage surgical complication. We aim to create an accurate and parsimonious model to assess IH risk, pared down for practicality and translation in the clinical environment.

Institutional abdominal surgical patients from 2002 to 2019 were identified (N=102,281); primary outcome of IH, demographic factors, and comorbidities were extracted. A 32-variable Cox proportional hazards model was generated. Reduced-variable models were created by systematic removal of variables 1-4 and 23-25at a time.

The c-statistic of the full 32-variable model was 0.7232. Four comorbidities decreased accuracy of the model COPD, paralysis, cancer and combined autoimmune/hereditary collagenopathy or AAA diagnosis. The model with those 4 comorbidities removed had the highest c-statistic (0.7291). The most reduced model included 7 variables and had a c-statistic of 0.7127.

Accuracy of an IH predictive model is only marginally affected by a vast reduction in end-user inputs.
Accuracy of an IH predictive model is only marginally affected by a vast reduction in end-user inputs.Hyperpolarized nuclear magnetic resonance and lab-on-a-chip microfluidics are two dynamic, but until recently quite distinct, fields of research. Recent developments in both areas increased their synergistic overlap. By microfluidic integration, many complex experimental steps can be brought together onto a single platform. Microfluidic devices are therefore increasingly finding applications in medical diagnostics, forensic analysis, and biomedical research. In particular, they provide novel and powerful ways to culture cells, cell aggregates, and even functional models of entire organs. Nuclear magnetic resonance is a non-invasive, high-resolution spectroscopic technique which allows real-time process monitoring with chemical specificity. It is ideally suited for observing metabolic and other biological and chemical processes in microfluidic systems. However, its intrinsically low sensitivity has limited its application. Recent advances in nuclear hyperpolarization techniques may change this under special circumstances, it is possible to enhance NMR signals by up to 5 orders of magnitude, which dramatically extends the utility of NMR in the context of microfluidic systems. Hyperpolarization requires complex chemical and/or physical manipulations, which in turn may benefit from microfluidic implementation. In fact, many hyperpolarization methodologies rely on processes that are more efficient at the micro-scale, such as molecular diffusion, penetration of electromagnetic radiation into a sample, or restricted molecular mobility on a surface. In this review we examine the confluence between the fields of hyperpolarization-enhanced NMR and microfluidics, and assess how these areas of research have mutually benefited one another, and will continue to do so.G protein-coupled receptors (GPCRs) have a simple seven transmembrane helix architecture which has evolved to recognize a diverse number of chemical signals. The more than 800 GPCRs encoded in the human genome function as receptors for vision, smell and taste, and mediate key physiological processes. Consequently, these receptors are a major target for pharmaceuticals. Protein crystallography and electron cryo-microscopy have provided high resolution structures of many GPCRs in both active and inactive conformations. However, these structures have not sparked a surge in rational drug design, in part because GPCRs are inherently dynamic and the structural changes induced by ligand or drug binding to stabilize inactive or active conformations are often subtle rearrangements in packing or hydrogen-bonding interactions. NMR spectroscopy provides a sensitive probe of local structure and dynamics at specific sites within these receptors as well as global changes in receptor structure and dynamics. These methods can also capture intermediate states and conformations with low populations that provide insights into the activation pathways. We review the use of solid-state magic angle spinning NMR to address the structure and activation mechanisms of GPCRs. The focus is on the large and diverse class A family of receptors. We highlight three specific class A GPCRs in order to illustrate how solid-state, as well as solution-state, NMR spectroscopy can answer questions in the field involving how different GPCR classes and subfamilies are activated by their associated ligands, and how small molecule drugs can modulate GPCR activation.A survey, primarily based on work in the authors' laboratory during the last 10 years, is provided of recent developments in NMR studies of exchange processes involving protein-ligand and protein-protein interactions. We start with a brief overview of the theoretical background of Dark state Exchange Saturation Transfer (DEST) and lifetime line-broadening (ΔR2) NMR methodology. Some limitations of the DEST/ΔR2 methodology in applications to molecular systems with intermediate molecular weights are discussed, along with the means of overcoming these limitations with the help of closely related exchange NMR techniques, such as the measurements of Carr-Purcell-Meiboom-Gill (CPMG) relaxation dispersion, exchange-induced chemical shifts or rapidly-relaxing components of relaxation decays. Some theoretical underpinnings of the quantitative description of global dynamics of proteins on the surface of very high molecular weight particles (nanoparticles) are discussed. Subsequently, several applications of DEST/ΔR2 methodology are described from a methodological perspective with an emphasis on providing examples of how kinetic and relaxation parameters for exchanging systems can be reliably extracted from NMR data for each particular model of exchange. Among exchanging systems that are not associated with high molecular weight species, we describe several exchange NMR-based studies that focus on kinetic modelling of transient pre-nucleation oligomerization of huntingtin peptides that precedes aggregation and fibril formation.
Continuous vital sign monitoring may potentially be improved through the use of wearable monitors linked wirelessly to hospital electronic patient records. By improving early detection of physiological deterioration this approach may save lives.

We performed a single-centre before-and-after study including surgical and medical patients at a university hospital in The Netherlands. The study intervention was continuous vital sign monitoring using wearable monitors linked wirelessly to hospital systems. The co-primary outcomes were unplanned ICU admission and rapid response team calls. Secondary outcomes were length of hospital stay and in-patient death.

Our baseline cohort included 2466 admissions and our intervention cohort included 2303 admissions recruited from August 2017 to July 2019. Patients in the intervention cohort experienced fewer unplanned ICU admissions (84 [3.4%] vs 54 [2.3%]; P=0.03) and fewer rapid response team calls (107 [4.3%] vs 71 [3.1%]; P=0.02). The number of rapid response team calls that did not result in ICU admission also declined (70 [2.8%] vs 45 [2.0%]; P=0.05). The number of rapid response team calls that did result in ICU admission was not significantly different (52 [2.1%] vs 36 [1.6%]; P=0.16). There were no differences in hospital stay or in-patient deaths between the two study periods.

Continuous monitoring of patient vital signs using wearable monitoring technology linked wirelessly to hospital systems was associated with a reduction in unplanned ICU admissions and rapid response team calls. Further research is necessary to confirm the impact of this approach on patient survival.
Continuous monitoring of patient vital signs using wearable monitoring technology linked wirelessly to hospital systems was associated with a reduction in unplanned ICU admissions and rapid response team calls. Further research is necessary to confirm the impact of this approach on patient survival.
Severe coronavirus disease 2019 (COVID-19) can cause acute respiratory failure requiring mechanical ventilation. Venovenous (VV) extracorporeal membrane oxygenation (ECMO) has been used in patients in whom conventional mechanical ventilatory support has failed. To date, published data have focused on survival from ECMO and survival to discharge. In addition to survival to discharge, this study reports 1-year follow-up data for patients who were successfully discharged from the hospital.

A single-institution, retrospective review of all patients with severe COVID-19 who were cannulated for VV-ECMO between March 10, 2020 and May 1, 2020 was performed. A multidisciplinary ECMO team evaluated, selected, and managed patients with ECMO support. The primary outcome of this study was survival to discharge. Available 1-year follow-up data are also reported.

A total of 30 patients were supported with VV-ECMO, and 27 patients (90%) survived to discharge. selleck chemicals All patients were discharged home or to acute rehabilitation on room air, except for 1 patient (3.7%), who required supplemental oxygen therapy. At a median follow-up of 10.8 months (interquartile range [IQR], 8.9-14.4 months) since ECMO cannulation, survival was 86.7%, including 1 patient who underwent lung transplantation. Of the patients discharged from the hospital, 44.4% (12/27) had pulmonary function testing, with a median percent predicted forced expiratory volume of 100% (IQR, 91%-110%). For survivors, a 6-minute walk test was performed in 59.3% (16/27), with a median value of 350 m (IQR, 286-379 m).

A well-defined patient selection and management strategy of VV-ECMO support in patients with severe COVID-19 resulted in exceptional survival to discharge that was sustained at 1-year after ECMO cannulation.
A well-defined patient selection and management strategy of VV-ECMO support in patients with severe COVID-19 resulted in exceptional survival to discharge that was sustained at 1-year after ECMO cannulation.
Prurigo nodularis (PN) as an extremely pruritic and hyperplastic chronic dermatosis induces psychologically and physiologically stressful responses. PN-induced responses in the hypothalamic-pituitary-adrenal (HPA), hypothalamic-pituitary-gonadal (HPG) axes and endocannabinoid system (ECS) are abnormal. Extant studies on the PN's pathogenesis mostly focused on the PN's psychological responses. To date, the PN's physiological responses remain not been fully uncovered yet.

To investigate the PN-induced physiological responses via the levels of five steroids and two endocannabinoids combined with their ratios in plasma and examine the association between the psychological and physiological responses.

Thirty-six patients with PN, 36 age- and gender-matched healthy controls were recruited. The PN's psychological symptoms including pruritus severity, pain and life quality were measured with the visual analog scale, the prurigo score index, numerical rating scale, verbal rating scale and dermatology life quality index.
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