In this study, the authors present an overview of closed-loop subspace identification methods found in the recent literature. Since a significant number of algorithms has appeared over the last ...decade, the authors highlight some of the key algorithms that can be shown to have a common origin in autoregressive modelling. Many of the algorithms found in the literature are variants on the algorithms that are discussed here. In this study, the aim is to give a clear overview of some of the more successful methods presented throughout the last decade. Furthermore, the authors retrace these methods to a common origin and show how they differ. The methods are compared both on the basis of simulation examples and real data. Although the main focus in the literature has been on the identification of discrete-time models, identification of continuous-time models is also of practical interest. Hence, the authors also provide an overview of the continuous-time formulation of the identification framework.
Macromolecular signals are crucial constituents of short echo‐time 1H MR spectra with potential clinical implications in themselves as well as essential ramifications for the quantification of the ...usually targeted metabolites. Their parameterization, needed for general fitting models, is difficult because of their unknown composition. Here, a macromolecular signal parameterization together with metabolite signal quantification including relaxation properties is investigated by multidimensional modeling of interrelated 2DJ inversion‐recovery (2DJ‐IR) datasets. Simultaneous and iterative procedures for defining the macromolecular background (MMBG) as mono‐exponentially or generally decaying signals over TE are evaluated. Varying prior knowledge and restrictions in the metabolite evaluation are tested to examine their impact on results and fitting stability for two sets of three‐dimensional spectra acquired with metabolite‐cycled PRESS from cerebral gray and white matter locations. One dataset was used for model optimization, and also examining the influence of prior knowledge on estimated parameters. The most promising model was applied to a second dataset. It turned out that the mono‐exponential decay model appears to be inadequate to represent TE‐dependent signal features of the MMBG. TE‐adapted MMBG spectra were therefore determined. For a reliable overall quantification of implicated metabolite concentrations and relaxation times, a general fitting model had to be constrained in terms of the number of fitting variables and the allowed parameter space. With such a model in place, fitting precision for metabolite contents and relaxation times was excellent, while fitting accuracy is difficult to judge and bias was likely influenced by the type of fitting constraints enforced. In summary, the parameterization of metabolite and macromolecule contributions in interrelated MR spectra has been examined by using multidimensional modeling on complex 2DJ‐IR datasets. A tightly restricted model allows fitting of individual subject data with high fitting precision documented in small Cramér‐Rao lower bounds, good repeatability values and a relatively small spread of estimated concentration and relaxation values for a healthy subject cohort.
Complex 2DJ‐IR datasets have been examined using multidimensional fitting in FiTAID for the parameterization of metabolite and macromolecule contributions. TE‐specific models deviating from mono‐exponential decay for the macromolecules were tested, showing little impact on metabolite quantification. A tightly restricted model allows fitting of individual subject data with high fitting precision documented in small Cramér‐Rao lower bounds, good repeatability values and a relatively small spread of estimated concentration and relaxation values for a healthy subject cohort.
Background
Shortening of hospital stay to 1 night has not affected the short-term safety of patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB). Whether the RYGB is feasible in an ...ambulatory setting (same-day discharge) without overnight hospital stay remains to be answered. We aimed to evaluate the feasibility of same-day discharge after laparoscopic Roux-en-Y gastric bypass (RYGB) using additional live video consultation and remote monitoring. Same-day discharge (SDD) was defined as surgery without postoperative overnight hospital stay.
Methods
This was a single-center prospective feasibility study in a selected group of patients undergoing a RYGB. Fifty patients undergoing a primary RYGB were selected and potentially treated following the SDD protocol. After SDD discharge patients were remotely monitored after surgery for 48 h using a medical device measuring vital signs three times a day. Video consultations were performed by a doctor twice a day for 2 postoperative days. Primary outcome was the success rate (%) of SDD. Secondary outcomes were emergency room presentations, readmissions, early complications (<30 days), and patient satisfaction.
Results
A total of 50 patients were selected for the SDD treatment protocol between June 2020 and November 2020. An SDD success rate of 88 % (44/50 patients) was achieved. Five patients (10%) presented at the emergency room, 2 of whom (4%) were readmitted because of a complication within 30 days after surgery. Overall, patients who followed the SDD protocol reported high satisfaction scores.
Conclusion
A RYGB with SDD can be considered feasible using remote monitoring for a selected group of patients.
Graphical abstract
Tourette syndrome (TS) is a neuropsychiatric disorder characterized by motor and vocal tics. Most patients describe uncomfortable premonitory sensations preceding the tics and a subjective experience ...of increased sensitivity to tactile stimuli. These reports indicate that a sensory processing disturbance is an important component of TS together with motor phenomena. Thus, we focused our investigation on the role of the sensorimotor cortex (SMC) in TS using multimodal neuroimaging techniques. We measured the gamma‐aminobutyric acid (GABA)+/Creatine (Cre) ratio in the SMC using GABA 1H magnetic resonance spectroscopy. We recorded the baseline beta activity in the SMC using magnetoencephalography and correlated GABA+/Cre ratio with baseline beta band power. Finally, we examined the resting state functional connectivity (FC) pattern of the SMC using functional magnetic resonance imaging (fMRI). GABA+/Cre ratio in the SMC did not differ between patients and controls. Correlation between the baseline beta band power and GABA+/Cre ratio was abnormal in patients. The anterior insula showed increased FC with the SMC in patients. These findings suggest that altered limbic input to the SMC and abnormal GABA‐mediated beta oscillations in the SMC may underpin some of the sensorimotor processing disturbances in TS and contribute to tic generation. Hum Brain Mapp 35:5834–5846, 2014. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.
X‐linked creatine transporter deficiency (CTD) is one of the three types of cerebral creatine deficiency disorders. CTD arises from pathogenic variants in the X‐linked gene SLC6A8. We report the ...first phosphorus (31P) MRS study of patients with CTD, where both phosphocreatine and total creatine concentrations were found to be markedly reduced. Despite the diminished role of creatine and phosphocreatine in oxidative phosphorylation in CTD, we found no elevation of lactate or lowered pH, indicating that the brain energy supply still largely relied on oxidative metabolism. Our results suggest that mitochondrial function is a potential therapeutic target for CTD.
We report the first phosphorus (31P) MRS study of patients with creatine transporter deficiency. Both phosphocreatine and total creatine concentrations were found to be markedly reduced in the patients. This was accompanied by normal pH values and no elevation of the glycolytic product lactate, indicating that the brain energy supply remains dominated by oxidative phosphorylation in creatine transporter deficiency.
C1-inhibitor is a key inhibitor of the complement and contact activation systems, and mutations in the protein can cause hereditary angioedema. Through an unknown mechanism, polysaccharides can ...increase C1-inhibitor activity against some of its target proteases. Here we present the crystal structures of the serine protease inhibitor (serpin) domain of active C1-inhibitor by itself and in complex with dextran sulfate. Unlike previously described interactions of serpins with polysaccharides, the structures and isothermal titration calorimetry experiments together reveal that dextran sulfate binds to C1-inhibitor's F1 helix with low affinity and does not invoke an allosteric change. Furthermore, one dextran sulfate molecule can bind multiple C1-inhibitor molecules. We propose that in a C1-inhibitor/protease/polysaccharide ternary complex, negatively charged polysaccharides link C1-inhibitor's positively charged F1 helix to positively charged autolysis loops of proteases. The proposed mechanism elegantly explains previous experiments showing that polysaccharide potentiation is increased against proteases with a greater positive charge in their autolysis loop.
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•Crystal structure of active C1-inhibitor by itself and with dextran sulfate•Dextran sulfate binds to C1-inhibitor's F1 helix with no allosteric change•We show low-affinity binding of dextran sulfate to multiple C1-inhibitor molecules•We propose that polyanions link C1-inhibitor to protease's autolysis loop
The interaction between polysaccharides and the plasma protein C1-inhibitor, a serine protease inhibitor (serpin), is important for health. Dijk et al. elucidate the structures of active C1-inhibitor by itself and in complex with dextran sulfate, identifying the polysaccharide binding site and the mechanism of polysaccharide potentiation for serpins.
Facial appearance, whether consciously or subconsciously assessed, may affect clinical assessment and treatment strategies in the Intensive Care Unit (ICU). Nevertheless, the association between ...objective clinical measurement of facial appearance and multi-organ failure is currently unknown. The objective of this study was to examine whether facial appearance at admission is associated with longitudinal evaluation of multi-organ failure.
This was a sub-study of the Simple Intensive Care Studies-II, a prospective observational cohort study. All adult patients acutely admitted to the ICU between March 26, 2019, and July 10, 2019, were included. Facial appearance was assessed within three hours of ICU admission using predefined pictograms. The SOFA score was serially measured each day for the first seven days after ICU admission. The association between the extent of eye-opening and facial skin colour with longitudinal Sequential Organ Failure Assessment (SOFA) scores was investigated using generalized estimation equations.
SOFA scores were measured in 228 patients. Facial appearance scored by the extent of eye-opening was associated with a higher SOFA score at admission and follow-up (unadjusted 0.7 points per step (95%CI 0.5 to 0.9)). There was no association between facial skin colour and a worse SOFA score over time. However, patients with half-open or closed eyes along with flushed skin had a lower SOFA score than patients with a pale or normal facial skin colour (P-interaction < 0.1).
The scoring of patients' facial cues, primarily the extent of eye-opening and facial colour, provided valuable insights into the disease state and progression of the disease of critically ill patients. The utilization of advanced monitoring techniques that incorporate facial appearance holds promise for enhancing future intensive care support.
BACKGROUND Obesity is increasing rapidly among women all over the world. Obesity is a known risk factor for subfertility due to anovulation, but it is unknown whether obesity also affects spontaneous ...pregnancy chances in subfertile, ovulatory women. METHODS We evaluated whether obesity affected the chance of a spontaneous pregnancy in a prospectively assembled cohort of 3029 consecutive subfertile couples. Women had to be ovulatory and had to have at least one patent tube, whereas men had to have a normal semen analysis. Time to spontaneous ongoing pregnancy within 12 months was the primary endpoint. RESULTS The probability of a spontaneous pregnancy declined linearly with a body mass index (BMI) over 29 kg/m2. Corrected for possible related factors, women with a high BMI had a 4% lower pregnancy rate per kg/m2 increase hazard ratio: 0.96 (95% CI 0.91–0.99). CONCLUSIONS These results indicate that obesity is associated with lower pregnancy rates in subfertile ovulatory women.
GABA levels can be measured using proton MRS with a two‐step editing sequence. However due to the low concentration of GABA, long acquisition time is usually needed to achieve sufficient SNR to ...detect small differences in many psychiatric disorders. During this long scan time the frequency offset of the measured voxel can change because of magnetic field drift and patient movement. This drift will change the frequency of the editing pulse relative to that of metabolites, leading to errors in quantification. In this article we describe a retrospective method to correct for frequency drift in spectral editing. A series of reference signals for each metabolite was generated for a range of frequency offsets and then averaged together based on the history of frequency changes over the scan. These customized basis sets were used to fit the in vivo data. Our results demonstrate the effectiveness of the correction method and the remarkable robustness of a GABA editing technique with a top hat editing profile in the presence of frequency drift.
Frequency drifts during a long spectral editing experiment change the frequency of the editing pulse relative to that of metabolites, leading to errors in quantification. In this article, we describe a retrospective method to correct for frequency drifts in spectral editing. Our results demonstrate the effectiveness of the correction method and also the remarkable robustness of a γ‐aminobutyric acid (GABA) editing technique with a top hat editing profile in the presence of frequency drifts.
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