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Renal hyperfiltration (RHF) is a prevalent phenomenon in critically ill patients characterized by augmented renal clearance (ARC) and increased of elimination of renally eliminated medications. Multiple risk factors had been described and potential mechanisms may contribute to the occurrence of this condition. RHF and ARC are associated with the risk of suboptimal exposure to antibiotics increasing the risk of treatment failure and unfavorable patient outcomes. The current review discusses the available evidence related to the RHF phenomenon, including definition, epidemiology, risk factors, pathophysiology, pharmacokinetic variability, and considerations for optimizing the dosage of antibiotics in critically ill patients.

Korsakoff’s syndrome (KS) is an insidious and progressive neuropsychiatric disorder that affects specific neurocognitive functioning, especially in tasks that require sustained attention, memory, executive functions, and visuospatial functioning. Usually, this disease generates neuropsychiatric complications that worsen the quality of life (QOL) of patients in the medium term. We present a case of a 63-year-old male who presented with a diagnosis of advanced Korsakoff’s syndrome and has a clinical history of recurrent memory loss and a history of alcohol abuse. The patient showed difficulty manipulating immediate information, associated with a possible frontal lobe dysfunction, and inability to remember material given through the auditory pathway. The patient showed a psychiatric clinical picture which is constantly worsening his and his immediate caregiver’s QOL. The data obtained demonstrate that the patient presents a progressive cognitive impairment, which in the short term is correlated with Korsakoff-type dementia. It is suggested to carry out functional neurorehabilitation plans aimed at improving the QOL of the patient, his immediate caregiver, and future people with this type of diagnosis.

Garlic peel, a low-cost agro-waste, was explored as an adsorbent for the remediation of wastewater containing the crystal violet (CV) cationic dye. The garlic peel was treated with NaOH at 1 : 1.5 ratios in order to modify the surface and increase its porosity. The surface-modified garlic peel was ground to a smaller size in order to increase its surface area and used as an adsorbent in the continuous column investigations. Column parameters such as bed height, flow rate, and initial concentration were optimised and found that optimal removal efficiency was achieved at 3 ml rate of flow, 3 cm column depth, and 100 mg l-1 initial concentration. The surface-modified garlic peel exhibited a higher loading capacity of 99.9 mg g-1 towards CV at optimised conditions. SEM investigations confirmed the surface modification and increase in porosity of the garlic peel. The column data was tending to fit well with Thomas and Yoon-Nelson’s models suggesting the scalability to an industrial level. Regeneration of MGP was successful with 0.01 M HCl solution. These results conclude that garlic peel is a potential agro-waste material that can be used to mitigate water pollution.

Background. Lung neuroendocrine tumors account for approximately 15% of all lung cancer cases. LNET are subdivided into typical carcinoid (TC), atypical carcinoid (AC), large cell neuroendocrine carcinoma (LCNEC), and small-cell lung cancer (SCLC). The Ki-67 index has been used for decades to evaluate mitotic counts however, the role of Ki-67 as a biomarker for assessing prognosis and guiding therapy in metastatic LNET still lacks feasible clinical validation. Recent clinical trials have indicated that inhibition of CD47 with anti-CD47 antibodies exerts a promising antitumor effect against several human malignancies, including NSCLC, melanoma, and hematologic malignancies. However, the clinical relevance of CD47 expression in LNET has remained unclear. Methods. We performed a retrospective study in which we analyzed tumor biopsies from 51 patients with a confirmed diagnosis of LNET that received treatment at our hospital. Then, we analyzed if there was any correlation between CD47 expression with any clinical or pathological characteristic. We also analyzed the prognostic significance of CD47, assessed as progression-free survival and overall survival. Results. A total of 51 patients with LNET were enrolled in our study. The mean age at diagnosis was 57.6 (±11.6) years; 30 patients were women (59%). 27.5% of patients were positive for CD47 expression, and 72.5% of patients showed a CD47 expression of less than 1% and were considered as negatives. In patients with high-grade tumors (this time defined as Ki ‐ 67 > 40 % ), the positive expression of CD47 was strongly associated with an increased PFS. Albeit, these differences did not reach statistical significance when analyzing OS. Conclusion. Contrary to what happens in a wide range of hematologic and solid tumors, a higher expression of CD47 in patients with LNET is associated with a better progression-free survival, especially in patients with a Ki ‐ 67 ≥ 40 % . This “paradox” remains to be confirmed and explained by larger studies.

Out of all the changes to our daily life brought by the COVID-19 pandemic, one of the most significant ones has been the limited access to health services that we used to take for granted. Thus, in order to prevent temporary injuries from having lingering or permanent effects, the need for home rehabilitation device is urgent. For this reason, this paper proposes a cable-driven device for limb rehabilitation, CUBE2, with a novel end-effector (EE) design and autotuning capabilities to enable autonomous use. The proposed design is presented as an evolution of the previous CUBE design. In this paper, the proposed device is modelled and analyzed with finite element analysis. Then, a novel vision-based control strategy is described. Furthermore, a prototype has been manufactured and validated experimentally. Preliminary test to estimate home position repeatability has been carried out.

Background. A functional interplay between BAs and microbial composition in gut is a well-documented phenomenon. In bile, this phenomenon is far less studied, and with this report, we describe the interactions between the BAs and microbiota in this complex biological matrix. Methodology. Thirty-seven gallstone disease patients of which twenty-one with Opisthorchis felineus infection were enrolled in the study. The bile samples were obtained during laparoscopic cholecystectomy for gallstone disease operative treatment. Common bile acid composition was measured by LC-MS/MS. Gallbladder microbiota were previously analyzed with 16S rRNA gene sequencing on Illumina MiSeq platform. The associations between bile acid composition and microbiota were analyzed. Results. Bile acid signature and Opisthorchis felineus infection status exert influence on beta-diversity of bile microbial community. Direct correlations were found between taurocholic acid, taurochenodeoxycholic acid concentrations, and alpha-diversity of bile microbiota. Taurocholic acid and taurochenodeoxycholic acid both show positive associations with the presence of Chitinophagaceae family, Microbacterium and Lutibacterium genera, and Prevotella intermedia. Also, direct associations were identified for taurocholic acid concentration and the presence of Actinomycetales and Bacteroidales orders, Lautropia genus, Jeotgalicoccus psychrophilus, and Haemophilus parainfluenzae as well as for taurochenodeoxycholic acid and Acetobacteraceae family and Sphingomonas genus. There were no differences in bile acid concentrations between O. felineus-infected and noninfected patients. Conclusions/Significance. Associations between diversity, taxonomic profile of bile microbiota, and bile acid levels were evidenced in patients with cholelithiasis. Increase of taurochenodeoxycholic acid and taurocholic acid concentration correlates with bile microbiota alpha-diversity and appearance of opportunistic pathogens.

Food insecurity would influence children's health and development through its effects on nutrition and household stress in the context of broader poverty-related problems. This study contributes to research regarding the characterisation of food-insecure households with children under the age of 18. In particular, it highlights the social and institutional aspects which influence and interact with parents' attempts to protect their children from hunger and destitution. In this study, we document some aspects of the harsh realities faced by mothers and fathers with children under the age of 18 living in poverty who attended a self-organised foodbank in the city of Madrid in 2015. We used a qualitative methodology consisting of 7 months of participant observation and the conduction of 15 in-depth interviews. This study shows how the possibilities for the meaningful protection of children in food-insecure households can be influenced by parental coping strategies, community resources and availability and accessibility to public help. Foodbanks can help reduce both household hunger (although not meeting all nutritional requirements) and parental psychosocial distress, which might support parents to better protect their children. In particular, self-managed foodbanks appear to help parents cope with emotional distress by reducing feelings of powerlessness and self-blame through their active involvement, and thanks to the collective caring that occurs between members. Public services are of special relevance, since their absence or an active institutional discrimination has been shown to further damage impoverished households with children. We suggest that public policies in Spain are revised and reinforced to enable a more genuine protection of children and their families living under severe deprivation, and to prevent life-long damage. Public institutions could assume that people attending a foodbank are living in severe poverty and need access to adequate and supportive public resources to address it.

A 47-year-old male was diagnosed with chronic kidney disease (CKD) in 2011; idiopathic thrombocytopenic purpura (ITP) was also diagnosed in 2011 refractory to medical treatment and finally treated with splenectomy (2017) without relapses since that date, 5 blood transfusions, and 4 platelet apheresis in 2017. Renal transplant from a living related donor (brother), ABO compatible, crossmatch were negative, sharing 1 haplotype. Donor-specific anti-HLA antibody was negative. Graft function was stable until the 5th day and graft biopsy on the 6th day; thrombotic microangiopathy (TMA), C4D negative and inflammatory infiltration of polymorphonuclear leukocytes inside peritubular capillary, and anti-MICA antibodies were positive. The treatment used were plasmapheresis, intravenous immunoglobulin, and rituximab. Serum creatinine began to decrease since the 14th day, and by day 33, post-RT graft function was restored.

Syndecan-1 (CD138) is a transmembrane proteoglycan expressed in various normal and malignant tissues. It is of interest due to a possible prognostic effect in tumors and its role as a target for the antibody-drug conjugate indatuximab ravtansine. Here, we analyzed 17,747 prostate cancers by immunohistochemistry. Membranous and cytoplasmic CD138 staining was separately recorded. In normal prostate glands, CD138 staining was limited to basal cells. In cancers, membranous CD138 positivity was seen in 19.6% and cytoplasmic CD138 staining in 11.2% of 12,851 interpretable cases. A comparison with clinico-pathological features showed that cytoplasmic CD138 staining was more linked to unfavorable tumor features than membranous staining. Cytoplasmic CD138 immunostaining was associated with high tumor stage ( p < 0.0001 ), high Gleason grade ( p < 0.0001 ), nodal metastases ( p < 0.0001 ), positive surgical margin ( p < 0.0001 ), and biochemical recurrence ( p < 0.0001 ). This also holds true for both V-ets avian erythroblastosis virus E26 oncogene homolog (ERG) fusion positive and ERG fusion negative tumors although the cytoplasmic CD138 expression was markedly more frequent in ERG positive than in ERG negative tumors ( p < 0.0001 ). Comparison with 11 previously analyzed chromosomal deletions identified a conspicuous association between cytoplasmic CD138 expression and 8p deletions ( p < 0.0001 ) suggesting a possible functional interaction of CD138 with one or several 8p genes. Multivariate analysis revealed the cytoplasmic CD138 expression as an independent prognostic parameter in all cancers and in the ERG positive subgroup. In summary, our study indicates the cytoplasmic CD138 expression as a strong and independent predictor of poor prognosis in prostate cancer. Immunohistochemical measurement of CD138 protein may thus—perhaps in combination with other parameters—become clinically useful in the future.

This paper presents a feedback control solution that achieves robust stability and disturbance rejection in systems with multiple manipulated inputs and a single measurable output. The uncertain plant models may exhibit either nonminimum phase, or delay, or unstable phenomena, which makes it not easy to take full advantage of the frequency response of each plant. In the framework of quantitative feedback theory (QFT), a methodology is proposed to decide the best control bandwidth distribution among inputs and to design the set of parallel controllers with as small as possible gain at each frequency. The temperature regulation in a continuous stirred-tank reactor (CSTR) illustrates the benefits of a quantitative frequency distribution of the dynamic controllability between the jacket flow and the feed flow. The main challenge is that the feed flow exhibits a higher temperature regulation capacity and also produces a temporary decrease in the reactor temperature (nonminimum phase behaviour).

Cell dwell time (DT) and unencumbered interruption time (IT) are fundamental time interval variables in the teletraffic analysis for the performance evaluation of mobile cellular networks. Although a diverse set of general distributions has been proposed to model these time interval variables, the effect of their moments higher than the expected value on system performance has not been reported in the literature. In this paper, sensitivity of teletraffic performance metrics of mobile cellular networks to the first three standardized moments of both DT and IT is investigated in a comprehensive manner. Mathematical analysis is developed considering that both DT and IT are phase-type distributed random variables. This work includes substantial numerical results for quantifying the dependence of system level performance metrics to the values of the first three standardized moments of both DT and IT. For instance, for a high mobility scenario where DT is modeled by a hyper-Erlang distribution, we found that call forced termination probability decreases around 60% as the coefficient of variation (CoV) and skewness of DT simultaneously change from 1 to 20 and from 60 to 2, respectively. Also, numerical results confirm that as link unreliability increases the forced termination probability increases while both new call blocking and handoff failure probabilities decrease. Numerical results also indicate that for low values of skewness, performance metrics are highly sensitive to changes in the CoV of either the IT or DT. In general, it is observed that system performance is more sensitive to the statistics of the IT than to those of the DT. Such understanding of teletraffic engineering issues is vital for planning, designing, dimensioning, and optimizing mobile cellular networks.

Fried snacks are highly appreciated in the consumer's diet because of their unique flavor and texture. However, it is difficult to combine fried foods with the current consumer trends toward healthier and low‐fat products. Vacuum frying is a healthier option to develop snacks with differentiated nutritional and organoleptic properties. However, pretreatments are required to obtain products with better properties. This study investigated the effect of processing (whole, peeled, peeled, and sliced) and pressurization (100, 200 and 300 MPa) prior to vacuum frying. The study showed that peeling and slicing, prior to pressurization, produced microstructural stress which affected significantly moisture and oil uptake; meanwhile, pressurization pretreatment in whole apples did not produce any negative effects, thus enhancing the textural properties of the vacuum‐fried product. PRACTICAL APPLICATIONS: Vacuum frying has a potential to produce healthy snacks. In order to obtain fried fruits, pretreatments are required, which enable the production of products with adequate sensory qualities. The use of HPP in fruits has not been investigated as a pretreatment prior to vacuum frying. This study investigates structural and mechanical effects of processing (whole, peeled and peeled and sliced) and pressurization (100, 200 and 300 MPa) prior to vacuum frying. These factors play an important role in the snack microstructure and oil uptake. Results showed that HPP applied on whole or peeled apples at low pressures (100 and 200 MPa) enhanced the textural properties before frying. HPP can be a feasible alternative to osmotic pretreatments, considering additional advantages, such as improving the nutritional composition of the final product.

In this work, a flexible and reconfigurable feeding network design for a nonuniform aperture on circular concentric ring arrays is proposed and analyzed. The network subsystem delivers coherent in-phase outputs with a Gaussian-like amplitude distribution, in a modular and basic topology based on sets of alternated power combiners and dividers. A complete antenna system in a monobeam configuration with a coherent network based on grouped inputs (blocks) per ring for an aperiodic concentric ring array with beam scanning and beam shaping properties is synthesized and analyzed. Additionally, a comparative analysis based on nonuniform and uniform concentric ring arrays fed by the proposed coherent network configuration is conducted and assessed. The optimization of the aperiodic layout on the antenna aperture (radii and interelement antenna spacings) is done by the differential evolution algorithm. Numeric experimentation demonstrates the performance advantages and capabilities of the proposed coherent network configuration with a nonuniform aperture over its uniform counterpart, with an improvement in average equal to −8.7 dB of side lobe level and 3.9 dB of directivity. Furthermore, the numeric examples show a complexity reduction on the coherent feeding network configuration based on the number of control signal inputs compared with a conventional phased antenna array; in the proposed configuration, the main beam is steered and shaped with N-1 control feeding ports per ring in this antenna system.

Objective. The aim of this study was to investigate tear film optical quality dynamics for four types of silicone hydrogel contact lenses (SHCLs) for daily wear over a 15-day period and for different blink rate (BR) patterns. Methods. A prospective randomized, double-blind, cross-over pilot study including four SHCLs (A: lotrafilcon B (Air Optix plus HydraGlyde, Alcon Laboratories); B: samfilcon A (Ultra, Bausch & Lomb); C: comfilcon A (Biofinity, CooperVision); and D: filcom V3 (Blu:gen, Mark’Ennovy)). Serial measurements of Objective Scatter Index (OSI) using the HD Analyzer (Visiometrics S.L., Terrassa, Spain) were taken at different blinking patterns: blinking every 2.5 seconds (high BRs) and every 9 seconds (low BRs). They were performed during the first visit before CL insertion (baseline), after 20 minutes of CL wear (Day 1), and during the last visit after 8 hours of CL wear on day 15 of use (Day 15). Results. Normal young healthy subjects were recruited and fitted with the four lenses. For low BRs, the mean OSI value increased over time for all CLs and the slope of the curve also increased for all CLs, except for CL D. However, for high BRs, the mean OSI value increased only for CLs B and C and the slope of the curve did not change over time for any of them. Conclusions. These results suggest that the tear film optical quality dynamics after wearing SCHLs for 15 days seems to undergo a slight deterioration only for lowest BR.

Delivery of bioactive factors is a very valuable strategy for articular cartilage repair. Nevertheless, the direct supply of such biomolecules is limited by several factors including rapid degradation, the need for supraphysiological doses, the occurrence of immune and inflammatory responses, and the possibility of dissemination to nontarget sites that may impair their therapeutic action and raise undesired effects. The use of controlled delivery systems has the potential of overcoming these hurdles by promoting the temporal and spatial presentation of such factors in a defined target. Hydrogels are promising materials to develop delivery systems for cartilage repair as they can be easily loaded with bioactive molecules controlling their release only where required. This review exposes the most recent technologies on the design of hydrogels as controlled delivery platforms of bioactive molecules for cartilage repair.

The regulation of a disturbed output can be improved when several manipulated inputs are available. A popular choice in these cases is the series control scheme, characterized by (1) a sequential intervention of loops and (2) faster loops being reset by slower loops, to keep their control action around convenient values. This paper tackles the problem from the frequency-domain perspective. First, the working frequencies for each loop are determined and closed-loop specifications are defined. Then, Quantitative Feedback Theory (QFT) bounds are computed for each loop, and a sequential loop-shaping of controllers takes place. The obtained controllers are placed in a new series architecture, which unlike the classical series architecture only requires one controller with integral action. The benefits of the method are greater as the number of control inputs grow. A continuous stirred tank reactor (CSTR) is presented as an application example.