Tricalcium neutralization process (TNP) is one of the key recover process in citric acid production process. In this process, the amount of calcium carbonate added needs to be controlled to ensure the pH of the reactants within the target range at the end-point of every batch. But the random initial pH of the fermentation broth impacts a lot on the stability of the end point pH. In this work, an ILC-based control strategy is proposed to optimize the addition of calcium carbonate. First, the ILC is performed and the optimal input of the process can be obtained after several batches. Second, an initial disturbance compensation controller optimized by ILC is proposed. An experimental platform for TNP is designed, and the results demonstrate the proposed control strategy can achieve the end point pH control and suppress the disturbance by the indeterminate initial pH value.

Rupture of ovarian dermoid-cyst is rare case. We report the case of a woman admitted for acute post-traumatic abdominal pain due to ruptured ovarian cyst. The patient was operated and we found a very abundant peritoneal effusion with left ovarian cyst which was broken. we performed a left adnexectomy.

Studies have shown that left bundle branch area pacing (LBBaP) is not inferior to biventricular-cardiac resynchronization therapy (BIV-CRT) in the treatment of heart failure with cardiac electromechanical activity asynchrony. The patient in this report was a 72-year-old heart failure patient needing cardiac resynchronization therapy (CRT). The LBBaP approach was attempted firstly, but it failed to achieve cardiac electromechanical activity synchronization. Then, the BIV-CRT strategy was selected and performed successfully. The patient’s heart function has greatly improved at the postoperative follow-up. Therefore, BIV-CRT remains an irreplaceable treatment for certain patients.

Most instances of Guillain-Barré syndrome (GBS) are caused by immunological stimulation and are discovered after vaccinations for tetanus toxoid, oral polio, and swine influenza. This systematic study investigated GBS cases reported after receiving the COVID-19 vaccination.

Sneddon syndrome (SS) is a clinical entity corresponding to a non-inflammatory thrombotic vasculopathy that includes livedo reticularis (typical skin lesions) and cerebrovascular lesions. We present here a case of autoimmune SS with dementia and psychosis as the main features that revealed the disease, in a 45-year-old Tunisian man

Background Optimal occlusion of pulmonary vein (PV) is essential for atrial fibrillation (AF) cryoballoon ablation (CBA). The aim of the study was to investigate the performance of two different tools for the assessment of PV occlusion with a novel navigation system in CBA procedure. Methods In consecutive patients with paroxysmal AF who underwent CBA procedure with the guidance of the novel 3-dimentional mapping system, the baseline tool, injection tool and pulmonary venography were all employed to assess the degree of PV occlusion, and the corresponding cryoablation parameters were recorded. Results In 23 patients (mean age 60.0 + 13.9 years, 56.5% male), a total of 149 attempts of occlusion and 122 cryoablations in 92 PVs were performed. Using pulmonary venography as the gold standard, the overall sensitivity, specificity of the baseline tool was 96.7% (95% CI 90.0% - 99.1%), and 40.5% (95% CI 26.0% - 56.7%), respectively, while the corresponding value of the injection tool was 69.6% (95% CI 59.7% - 78.1%), and 100.0% (95% CI 90.6% - 100.0%), respectively. Cryoablation with optimal occlusion showed lower nadir temperature (baseline tool: -44.3 + 8.4 ℃ vs -35.1 + 6.5 ℃, p < 0.001; injection tool: -46.7 + 6.4 ℃ vs -38.3 + 9.2 ℃, p < 0.001) and longer total thaw time (baseline tool: 53.3 + 17.0 s vs 38.2 + 14.9 s, p = 0.003; injection tool: 58.5 + 15.5 s vs 41.7 + 15.2 s, p < 0.001) compared with those without. Conclusions Both tools were able to accurately assess the degree of PV occlusion and predict the acute cryoablation effect, with the baseline tool being more sensitive and the injection tool more specific.

Previous reports of clinical course of Angelman syndrome (AS) described typical histories of choking, dysphagia, and severe pneumonia, but there were few bedridden cases or none requiring laryngotracheal separation surgery (LTS) were existed. We report a severe bedridden case of AS requiring LTS involving a 19.3 Mb deletion on 15q11.2–q14.

Warner and Wilson-Jones syndrome (WWS), is a rare entity. We report a pediatric case of 6-year-old patient, referred to our department for recurrent nodules of the scalp following removal of capillary hemangioma. Intralesional corticosteroids infiltration was decided without recurrence until today.

Clinician perspectives may inform health service strategies to meet optimal nutrition needs for infants with cystic fibrosis (CF). We conducted a qualitative study with CF-specialized dietitians (RDs) and physicians between July to December 2020 to characterize the current state of infant nutrition care delivery and organize input into a conceptual model to inform CF care program strategies. Among 42 participants, 36 completed survey responses and 6 completed interviews; 93% were RDs. Three global themes emerged in the current care model: nutrition management, family-centered connections, and collaborative care delivery. Within nutrition management clinicians emphasized providing education, setting goals, and maintaining adequate follow-up with families. Under family-centered connections clinicians expressed the need to foster relationships with families and link families to resources for assistance to social stressors such as food insecurity. Collaborative care delivery for clinicians interviewed was defined by sharing expertise from across the interdisciplinary team. Based on the timing of this study, clinicians reported compelling examples for various modes of telehealth and home weight monitoring to facilitate and support these domains of nutrition care, including potential advantages for education, supporting family needs, and communication. We integrate these themes to propose a conceptual model for integration of in-person and telehealth activities to enhance quality infant CF nutrition care delivery. Future implementation can refine this model through testing of practical telehealth interventions to optimize nutrition outcomes for infants with CF.

Objective: Spontaneous preterm birth is the leading global cause of neonatal death, and countless efforts have failed to establish a single effective treatment for preterm labor. Labor dystocia is the major cause of primary cesarean delivery; however, its biological mechanisms during labor are poorly understood. When post-term pregnancy truly exists the cause is usually unknown. The objective of the study tries to identify the possible cause of these obstetric complications Design: Research Study Setting: Portiuncula University Hospital, Ireland Population: N/A Methods: This study investigated the current evidence-based literature that may support the hypothesis. Main Outcome Measures: N/A Results: Obstetric literature is replete with overwhelming evidence that malfunction of any exponential uterine wall tension (EUWT) component (stretch-dependent inhibitory system) terminates the pregnancy. Most of the current therapeutic preterm strategies are focused on preventing premature EUWT failure e.g. the cervical stitch. Progesterone treatment for preterm labor may be working by enhancing the stretch-dependent inhibitory system by modulating uterine wall plasticity and EUWT. Post-term pregnancy is due to the failure of the stimulatory system to transform the cervix into the lower uterine segment and to lose its resistance that terminating the pregnancy at full term. A combined malfunction of the two systems causes labor dystocia e.g rupture of fetal membranes with a long cervix. Conclusion: There is growing evidence to support the hypothesis that malfunction of the inhibitory system causes preterm labor, malfunction of the stimulatory system causes post-term pregnancy and labor dystocia is due to a combined malfunction of the two systems.

Objective: The clock that measures the duration of pregnancy consists of two interacting timers: an interval timer measuring the overall length of gestation, and a circadian timer defining when within a 24-hour cycle birth occurs, and they have not been definitively established or systematically studied and our objectives to study pregnancy interval and circadian timers. Design: Research Study Setting: Portiuncula University Hospital, Ireland Population: N/A Methods: This study investigated the current evidence-based literature and research that may support our proposed hypothesis, accompanied by a 40-second 3D animation. Main Outcome Measures: N/A Results: Gestation is divided into five clinical phases, growth, maturation, transition, parturition, and involution secondary to light-dark cycle modulation of the interactive inhibitory and stimulatory systems. During the maturation phase (30-37 weeks), the inhibitory system transiently wears off due to cortisol modulation. This occurs alongside the modulation of melatonin and oxytocin, and the latter induces contractions of the stimulatory system, resulting in nocturnal synchronization and synergy of the two systems and causing the cervix to lose its strength by transforming it into the lower uterine segment. Pregnancy interval and circadian timers are achieved by a single mechanism, that is, exponential uterine wall tension (EUWT) failure, secondary to the complete loss of cervical resistance nocturnally. Conclusion: The creation, autonomic maintenance, and eventually autonomic termination of the EUWT make gestation an autonomic cycle with constant intervals and circadian timers. There is evidence-based support for the hypothesis which will have an impact on obstetric practice and maternal and family welfare.

Objective: Labor is viewed as the result of a physiologic release from an inhibitory effect of pregnancy on the myometrium, rather than an active process mediated by contractile agonists. The contractile stimulators and relaxation mechanisms have not yet been well defined. The objective of the study is to identify the systems that control uterine function during pregnancy. Design: Research Study Setting: Portiuncula University Hospital, Ireland Population: N/A Methods: This study investigated the current evidence-based literature that may support the hypothesis, accompanied by a 40-second 3D animation. Main Outcome Measures: N/A Results: Uterine mechanotransduction has functional and molecular components, wherein the exponential uterine wall tension (EUWT) is the functional component, and the intrinsic myometrial cell character (IMCC) is the molecular component. IMCC enables the uterus to control its functions both autonomically and intrinsically, secondary to changes in tension. EUWT is measured by Laplace’s Law and is created and maintained by interaction among the gestational sac, uterus, and cervix, for which the primary function is to maintain the EUWT. Directly, EUWT mechanotransduction and progesterone/estrogen stimulation induce the inhibitory system and indirectly, they induce the stimulatory system by inducing myometrial hyperplasia and hypertrophy. The inhibitory system is the main system that maintains pregnancy through a stretch-dependent mechanism. The stimulatory system makes the cervix lose its strength through the YVU pattern formation by transforming it into the lower uterine segment, thus terminating the pregnancy. Conclusion: There is evidence-based support for the hypothesis which might be the first step in uncovering the human parturition’s mystery.

Objective Failures in understanding uterine functions during pregnancy are a major shortcoming of healthcare and can be attributed to many possible causes. Importantly, there might be flaws in the current concept of human parturition, which creates a genuine barrier to a greater understanding of the process. The objective of the study is to challenge the existence of the isthmus in view of the current evidence-based studies. Design: Research Study Setting: Portiuncula University Hospital, Ireland Population: N/A Methods: This study investigated the current evidence-based literature that may support our proposed hypothesis. Main Outcome Measures: N/A Results The isthmus of the cervix, both anatomically and functionally, does not seem to exist. There has been no convincing evidence to support its existence since Aschoff first proposed it in 1905. In fact, the embryological, anatomical, and histological characteristics of the cervix and the radiological evidence for cervical changes during pregnancy challenge its existence. The study makes it clear that there are two opposing and contradicting views about the isthmus. In the first view, the isthmus and its nebulous character must be accepted, and no evidence contradicting this concept in the human being could be found. The other view is that the isthmus, geographically and functionally, does not exist, and we have provided abundant evidence to support this view. Conclusion The anatomical and functional division of the cervix into isthmus and non-isthmus portions may be the main obstacle to understanding cervical function and parturition and they should be revised in light of this hypothesis.

Objective：Discussing the influence of Diastasis Recti Abdominis (DRA) on patients’ social, psychological, and biological experiences, It tries to direct the patients’ attention to DRA. Meanwhile, how patients deal with DRA is summarised to provide effective measures to help them, provide reference for medical staff in managing DRA. Design: An observational and descriptive study design Setting: Zhejiang Province, China Sample：Female diagnosed with DRA. Methods: A purposive sampling method was adopted when selecting female DRA participants for semi-structured interviews based on their disease perception with the Colaizzi seven-step analysis method being used for analysis. Main outcome measure: DRA people’s perception and response to disease Results: In the interviews, three themes, and 10 sub-themes, were extracted 1) Inadequate disease perception (including a lack of aetiology cognition, incomplete prevention knowledge, and insufficient treatment knowledge), 2) The disease as a daily inconvenience (including body image disorder, abdominal muscle weakness, poor pelvic floor strength, backache, and a psychological burden), and 3) Varying attitudes and management responses to DRA (including positive and negative responses). Conclusion: Patients awareness of their DRA should be improved to consider whether any of their physical or mental discomfort experienced in daily life is related to this condition. DRA’s management should be holistic and comprehensive— including a simple symptomatic treatment— along with emotional, psychological, and behavioural coping strategies. Tweetable Abstract: DRA is common among women and has adverse effects on patients. The exploration of DRA helps to promote disease perception of DRA and promote women’s health.

Plastid retrograde signaling plays a key role in coordinating the expression of plastid genes and photosynthesis-associated nuclear genes ( PhANGs). Although plastid retrograde signaling can be substantially compromised by mitochondrial dysfunction, it is not yet clear whether specific mitochondrial factors are required to regulate plastid retrograde signaling. Here, we show that mitochondrial ATP synthase β-subunit mutants with decreased ATP synthase activity are impaired in plastid retrograde signaling. Transcriptome analysis revealed that the expression levels of PhANGs were significantly higher in seedlings affected in AT5G08670, the gene of the β-subunit of mitochondrial ATP synthase than in wild-type (WT) seedlings upon treatment with lincomycin (LIN) and norflurazon (NF). Further studies showed that the expression of nuclear genes involved in chloroplast and mitochondrial retrograde signaling was affected in AT5G08670 mutant seedlings treated with LIN. These changes might be associated with the repression of some transcriptional factors (TFs), such as ARF3/ETTIN ( ETT), PLASTID TRANSCRIPTION FACTOR 1 ( PTF1), CYCLOIDEA AND PCF TRANSCRIPTION FACTOR 2 ( TCP2), and KOW DOMAIN-CONTAINING TRANSCRIPTION FACTOR 1 ( KTF1). These findings indicate that the activity of mitochondrial ATP synthase affects plastid retrograde signaling.

The fusion of multiple monitoring sensors is crucial to improve the accuracy and robustness of machinery fault diagnosis. However, existing fault diagnosis methods may underestimate the interference of noise in the multi-sensor fusion process, leading to unsatisfied performance. To handle this problem, this paper proposes a deep model based on the frequency adaptive wavelet pyramid. First, an adaptive frequency selection strategy is designed to prune the seriously polluted frequencies and only retain some key frequencies. Then, the self-attention mechanism is used to perform information fusion on the selected frequency bands of different sensors. Finally, a wavelet fusion pyramid is adopted by repeating the fusion process at multiple wavelet decomposition levels. In this way, different sensors can be fused in a more fine-grained manner. The experimental results on two multi-sensor-based fault diagnosis datasets demonstrate the anti-noise capability of our proposed method.

Abstract Questions: Most clustering methods assume data are structured as discrete hyper-spheroidal clusters to be evaluated by measures of central-tendency. If vegetation data do not conform to this model, then vegetation data may be clustered incorrectly. What are the implications for cluster stability and evaluation if clusters are of irregular shape or density? Location: Southeast Australia Methods: We define misplacement as the placement of a sample in a cluster other than (distinct from) its nearest neighbour and hypothesise that optimising homogeneity incurs the cost of higher rates of misplacement. The Chameleon algorithm emphasises interconnectivity and thus is sensitive to the shape and distribution of clusters. We contrasted its solutions with those of traditional non-hierarchical and hierarchical (agglomerative and divisive) approaches. Results: Chameleon-derived solutions had lower rates of misplacement and only marginally higher heterogeneity than those of k-means in the range 15–60 clusters, but their metrics converged with larger numbers of clusters. Solutions derived by agglomerative clustering had the best metrics (and divisive clustering the worst) but both produced inferior high-level solutions clusters to those of Chameleon by merging distantly-related clusters. Conclusions: Our results suggest that Chameleon may have an advantage over traditional algorithms at when data exhibit discontinuities and variable structure, potentially producing more stable solutions (due to lower rates of misplacement), but scoring lower on traditional metrics of central-tendency. Chameleon’s advantages are less obvious in the partitioning of data from continuous gradients, however its graph-based partitioning protocol facilitates hierarchical integration of solutions.

The transmission capacity of gas pipeline networks should be calculated and allocated to deal with the capacity booking with shippers. Technical capacities, which depend on the gas flow distribution at routes or interchange points, are calculated with a multiobjective optimization model and form a Pareto solution set in the entry/exit or point-to-point regime. Then, the commercial capacities, which can be directly applied in capacity booking, are calculated with single-objective optimization models that are transformed from the above multiobjective model based on three allocation rules and the demand of shippers. Next, peak-shaving capacities, which are daily oversupply or overdelivery amounts at inlets or deliveries, are calculated with two-stage transient optimization models. Considering the hydraulic process of a pipeline network and operating schemes of compressor stations, all the above models are mixed-integer nonlinear programming problems (MINLPs). Finally, a case study is made to demonstrate the ability of the models.

Background and Purpose: Triptolide (TP) is the major active and toxic component of Tripterygium wilfordii Hook. F. Previous studies reported that a toxic pretreatment dose of triptolide leads to hepatic intolerance to exogenous lipopolysaccharide stimulation in mice and liver failure rather than damaging the liver directly. However, the immune mechanisms involved have not been elucidated. Experimental Approach: Flow cytometry analysis, LDH release measurement, blood biochemical analysis, ELISA, qPCR, magnetic beads sorting, plasmid transfection and AAV-DNA transduction were performed to investigate the immune mechanism in TP- and LPS-induced fulminant hepatitis. Key Results: The results show that IFN-γ-mediated necroptosis occurred in C57BL/6N mice treated with 500 μg/kg TP and 0.1 mg/kg LPS to induce fulminant hepatitis. Intracellular IFN-γ levels of natural killer cells increased significantly in mice administered TP and LPS, indicating primary source of IFN-γ in innate lymphocytes in the liver. Flow-cytometry analysis and in vivo depletion of NK cells showed that NK cells in the liver were activated and exhibited potent cytotoxicity. In vivo and in vitro TP administration significantly inhibited hepatocyte major histocompatibility complex class I molecules, H-2Kb, in mice. Further in vitro analysis confirmed that TP-pretreated hepatocytes were susceptible to NK-cell-mediated cytotoxicity, and the induction of hepatocyte H-2Kb significantly decreased NK-cell-mediated cytotoxicity. In vivo induction or of overexpression of hepatocyte H-2Kb also protected against TP- and LPS-induced liver injury. Conclusion and Implications: In conclusion, inhibiting hepatocyte H-2Kb accounted for TP-induced hepatic intolerance to exogenous LPS stimulation and was directly related to NK-cell-mediated cytotoxicity against self-hepatocytes.

Cylindrical elements made of concrete or metal are found in buildings and bridges for supporting other building elements. These building elements are often exposed to environmental conditions and strength-weakening agents that may compromise their vigor and their bearing capacity. A technique or a method is therefore often desirable for controlling the health condition and integrity of these elements. Such a method is expected to be easy to implement, using light-weighted equipment, affordable and most importantly of non-destructive character. The aim of this paper is to present such a method, which is based on vibrations, and which may be used in a circular cylinder for tracking a range of vibrational modes, namely the radial ones with a prior specific emphasis on the so-called ovalling mode. This mode may be extracted from the response of the cylinder as a result of its excitation by a mechanical stress applied in the radial direction. This method uses a single concentrated source of excitation and two vibration sensors diametrically positioned and fastened onto the surface of the cylinder. The ovalling mode may then be extracted from the frequency response through adding the signals recorded by the two sensors. These two signals are in phase in the case of a test object with a circular cross-section. This study is a preliminary investigation into the feasibility and the extent of reliability of this non-destructive method when applied to the identification of corrosion or other strength-weakening agents hosted by concrete or steel pillars or columns. The degree of severity in strength loss in such elements may be assessed through an evaluation of the change in value of the resonance frequency of the ovalling mode.

Olanzapine pamoate is an intramuscular depot injection for the treatment of schizophrenia. Approximately 1.4% of patients develop a serious adverse event called Post Injection Delirium/Sedation Syndrome (PDSS); characterised by drowsiness, anticholinergic and extrapyramidal symptoms. The objective is to investigate olanzapine PDSS presentations including clinical features and treatment approach. This is a retrospective review of olanzapine PDSS patients from three toxicology units and the NSW Poisons Information between 2017 and 2022. Adult patients were included if they had intramuscular olanzapine then developed PDSS criteria. Clinical symptoms, treatment, timing and length of symptoms were extracted into a preformatted Excel database. There were 18 patients included in the series, with a median age of 49 years (IQR: 38-58) and male predominance (89%). Median onset time post injection was 30 minutes (IQR: 11-38). PDSS symptoms predominate with drowsiness, confusion and dysarthria. Median length of symptoms was 24 hours (IQR: 20-54). Most common treatment included supportive care without any pharmacological intervention (n=10), benzodiazepine (n=4) and benztropine (n=3). In one case, bromocriptine and physostigmine followed by oral rivastigmine were given to manage anti-dopaminergic and anti-cholinergic symptoms respectively. This proposed treatment combination could alleviate some of the symptoms. In conclusion, this case series supports the characterisation of PDSS symptomology predominantly being anti-cholinergic with similar onset (<1 hour) and duration (<72hours). A combination of bromocriptine and physostigmine followed by rivastigmine is proposed to manage PDSS if patients develop severe dopamine blockade or anti-cholinergic delirium.

As a general rule in pharmacotherapy, ineffective pharmacological treatment should be discontinued. Ineffective pharmacotherapy should not be administered for a long time. The first problem is the appropriate duration to determine that the pharmacological treatment is ineffective. The second problem is the criterion for determining the efficacy (or ineffectiveness) of the pharmacological treatment. As far as I know, there is no evidence regarding the duration. Nevertheless, it is necessary to determine the duration. Standards by academic organizations are necessary, even provisional standards are acceptable. Long-term administration of ineffective medicine causes the problem of adverse effects. It loses the opportunity to receive effective treatment. In case that HT is ineffective for menopause, the treatment of fibromyalgia may relieve symptoms of menopause. Patients do not get medical attention for the improvement of abnormal hormone levels but do for the improvement of subjective symptoms such as widespread pain, numbness, insomnia, and fatigue. Some people are almost asymptomatic even if their hormone levels are abnormal. I believe that the efficacy (or ineffectiveness) should be determined with the improvement of the above-mentioned subjective symptoms rather than the improvement of the abnormal hormone levels.

Chronic lesion has become a major biological burden for individual patients and health organizations. Using nanoparticles as drug delivery systems is remarkable nowadays. The unique properties of chitosan without any toxicity for living creations make it a suitable option for drug delivery. Epidermal growth factor (EGF) is one of the important agents for wound healing, cellular proliferation, extracellular matrix formation, and skin remodeling. A combination of these properties can accelerate the wound healing process. In this study, rh-EGF is embedded into the chitosan nanoparticles by the Ion-gelation method. Nanoparticles are characterized by TEM microscopy and the DLS method and conjugation efficacy is measured by FT-IR radiation. The antibacterial effect of manipulated nanoparticles was estimated by MIC/MBC methods. The cytotoxicity and proliferation were measured by MTT assay on the HFF-1 human fibroblast cell line. Migration assay was accomplished by in vitro scratch model and the gene expression analysis for TGF-β, VEGF, and PDGF were manipulated by the real time-PCR method. The obtained results were considered statistically significant with P < 0.05. Obtained results illustrated no toxic effect on the HFF-1 cell line treated with Chitosan-EGF (CS-EGF). In cellular proliferation and migration assays, CS-EGF nanoparticles demonstrated a better effect than free rh-EGF. For the duration of 72h of the experiment, the whole scratch was covered by fibroblasts. The real time-PCR analysis also showed upregulation of all TGF-β, VEGF, and PDGF genes. As CS-EGF nanoparticles in the acceleration of the skin remodeling process showed promising results, subsequent studies might be useful.

Abstract Background: We report a 62-year-old patient who received redo-orthotopic Heart transplantation due to worsening severe aortic regurgitation after 19 months of continuous flow LVAD (cf-LVAD) and temporary RVAD support for one month. Case Report: The patient received a heartware LVAD (HVAD) and annuloplasty of the tricuspid valve due to end-stage heart failure (as a consequence of dilated cardiomyopathy) and severe tricuspid regurgitation in addition to right-sided ECMO implantation. Postoperatively due to the inability to wean the implanted ECMO, a temporary RVAD was implanted after which the patient’s condition improved so that it had been explanted later and the patient was discharged after nine-month. In immediate post-operative echo, minimal aortic regurgitation was noted but in the follow-up transthoracic echocardiograms, there was a gradual increase in the severity of aortic regurgitation with worsening both right and left ventricular functions. TAVI was not an option due to unfavourable anatomical issues. That’s why the patient was listed for urgent heart transplantation, performed 19 months after the LVAD implantation. The postoperative course was complicated due to acute renal failure. After recompensation, dialysis, and intensive physiotherapy, the patient could be discharged home after three months. Conclusion: severe aortic regurgitation is a recognizable complication after cf-LVAD implantation which in our case was managed successfully with orthotopic heart transplantation in this high-risk patient.