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青少年起病的成人型糖尿病(MODY)5型在中国人群中较为罕见, 且临床表现不典型, 临床医师对其认识不足, 极易误诊, 漏诊。该文报道了1例MODY5型患者, 具有多发性肾囊肿和胰腺 发育不全, 低钾血症等临床特征。患者为18岁男性, 因“口干, 多饮, 多食伴乏力9个月”入院。入院后 行外周血遗传性糖尿病相关基因测序, 检测到肝细胞核因子1β基因c.810‑1G>C杂合突变, 是一种特 殊的自发基因变异, 国内外均尚未见报道, 其父母及姐姐均未携带该突变, 结合患者临床表现与辅助 检查, 诊断为MODY5。通过对该例患者诊疗经过的回顾及相关文献的复习, 对青少年起病的糖尿病 合并肾脏, 胰腺损害的患者, 应尽早行基因检测明确诊断, 防止漏诊及误诊。 [ABSTRACT FROM AUTHOR]

Objective To evaluate the value of N-terminal pro brain natriuretic peptide (NT-proBNP) and hydroxybutyrate dehydrogenase (HBDH) in diagnosing secondary heart failure in elderly patients with sepsis. Methods A case control study was conducted, with 80 elderly patients with sepsis from January 2020 to December 2021 as the study subjects. Patients were divided into a heart failure group (36 cases) and a non heart failure group (44 cases) based on whether they had concurrent heart failure. The echocardiographic indicators, NT-proBNP, HBDH, and levels of inflammatory factors between the two groups were compared. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value of echocardiographic indicators, NT-proBNP, and HBDH in sepsis with concurrent heart failure. Results The left ventricular ejection fractions (LVEF), stroke volume variation (SVV), cardiac output (CO), fraction shortening (FS), and mitral early diastolic inflow velocity/mitral late diastolic inflow velocity (E/A) values of the heart failure group were significantly lower than those of the non heart failure group, with statistically significant differences (P<0.05). The NT-proBNP, HBDH, interleukin (IL-6), tumor necrosis factor (TNF-a), procalcitonin (PCT) values, APACHE II scores, and Sofa scores of the heart failure group were significantly higher than those of the non-heart failure group, with statistically significant differences (P<0.05). There was no statistically significant difference in C-reactive protein (CRP) levels between the two groups (P>0.05). For the 36 patients with sepsis and concurrent heart function damage, the NT-proBNP values were negatively correlated with LVEF, SVV, CO, FS, and E/A (P<0.05); and HBDH values were negatively correlated with LVEF and FS (P<0.05). The sensitivities of NT-proBNP, HBDH, and NT-proBNP + HBDH in diagnosing sepsis with concurrent heart failure were 76. 17%, 48.52%, and 92.41%, respectively, and the specificities were 91. 90%, 89. 20%, and 84.58%, respectively. The area under the ROC curve (AUC) were 0.893, 0.757, and 0.944, respectively. Conclusion The diagnostic efficacy of NT-proBNP and HBDH alone for predicting heart failure in patients with sepsis is limited. The combined use of NT proBNP and HBDH has high clinical value in diagnosing sepsis with concurrent heart failure and is significantly correlated with cardiac function indicators. In clinical practice, NT-proBNP and HBDH results may be considered in conjunction with ultrasound diagnosis to determine whether patients with sepsis have concurrent heart failure. [ABSTRACT FROM AUTHOR]

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The adaptive fuzzy finite-time output tracking control is addressed for a class of non-strict feedback high-order nonlinear systems with state constraints.The fuzzy logic systems are utilized to identify the unknown nonlinearities of the controlled systems,based on which the problem of state constraints is tackled by adopting barrier Lyapunov function.An adaptive finite-time control approach is developed combining backstepping control algorithm with adding a barrier power integrator.According to the finite-time Lyapunov stability theory,the proposed adaptive finite-time control scheme could guarantee the closed-loop system to be semi-globally practically finite-time stable and the states are ensured not to transgress their constrained sets. Moreover,the goal of finite-time tracking control is achieved.Finally,a numerical simulation is given to verify the effectiveness of the proposed adaptive finite-time control approach. [ABSTRACT FROM AUTHOR]

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