Monsters begat by quantifiers?

It is common practice in formal semantics to assume that the context specifies an assignment of values to variables and that the same variables that receive contextually salient values when they occur free may also be bound by quantifiers and λs. These assumptions are at work to provide a unified account of indexical and bound uses of third person pronouns, namely an account by which the same lexical item is involved in both uses. One apparent consequence of this approach is that quantifiers and λs are monsters in Kaplan's sense. We argue that this consequence can, and should, be avoided. We explore an alternative unified account based on the idea that variable assignments occur both as coordinates of the context and as coordinates of the circumstance of evaluation. The outcome is a non indexical account of free third person pronouns and a new conception of the role and structure of assignment functions

Cardiometabolic burden and biomarkers of autonomous cortisol secretion

The overwhelming majority of incidentally discovered adrenal tumours are benign adrenocortical tumours. These can be non-functioning (NFAT) or associated with autonomous cortisol secretion on a spectrum ranging from rare clinically overt adrenal Cushing’s syndrome (CS) to much more prevalent mild autonomous cortisol secretion (MACS) without signs of CS. Here I present the characteristics of a large cohort of persons with newly diagnosed benign adrenocortical tumours. In 1305 prospectively recruited cases, almost every second person with benign adrenocortical tumours was diagnosed with MACS. Persons with MACS had rates of cardiometabolic disease similar to CS, particularly increased prevalence and severity of hypertension and type 2 diabetes. Urine multi-steroid profiling of these persons revealed a gradual increase in glucocorticoid excretion from NFAT over MACS to CS, whilst androgen excretion decreased. Increased glucocorticoid and 11-oxygenated androgen metabolite excretion predicted clinical outcomes including hypertension, type 2 diabetes, and the presence of bilateral adrenal tumours. A representative group of 291 persons underwent untargeted serum metabolome profiling. Prototype-based supervised machine learning identified progressive metabolic changes in MACS and CS suggestive of lipotoxicity, dysfunctional lipid β-oxidation, and oxidative stress across the spectrum of autonomous cortisol secretion. These results show that MACS is a prevalent cardiometabolic risk condition associated with distinct changes in the steroid and untargeted metabolome. Observed changes offer the prospect of risk stratification of affected individuals

I tempi della tiroidectomia nella MEN2

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BIM And GIS Data Integration: A Novel Approach Of Technical/Environmental Decision-Making Process In Transport Infrastructure Design

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Modelling oral adrenal cortisol support

A simplified mathematical model of oral hydrocortisone delivery in adrenal insufficiency is described; the model is based on three components (gastric hydrocortisone, free serum cortisol and bound serum cortisol) and is formulated in terms of linear kinetics, taking into account the dynamics of glucocorticoid-protein binding. Motivated by the need to optimise cortisol replacement in the situations of COVID-19 infection, the model is fitted to recently-published data on 50 mg dosing and earlier data on 10 mg dosing. The fitted model is used to predict typical responses to standard dosing regimes, which involve a larger dose in the morning and 1 or 2 smaller doses later in the day, and the same regimes with doses doubled. In all cases there is a circadian-like response, with early morning nadir. The model is also used to consider an alternative dosing strategy based on four equal and equally-spaced doses of 10, 20 or 30 mg per 24 h, resulting in a more even response resembling a response to sustained inflammatory stress.Comment: 8 pages, 2 figures 1 tabl

Current best practice in the management of patients after pituitary surgery

Sellar and parasellar masses are a common finding, and most of them are treated surgically via transsphenoidal approach. This type of surgery has revolutionized the approach to several hypothalamic-pituitary diseases and is usually effective, and well-tolerated by the patient. However, given the complex anatomy and high density of glandular, neurological and vascular structures in a confined space, transsphenoidal surgery harbors a substantial risk of complications. Hypopituitarism is one of the most frequent sequelae, with central adrenal insufficiency being the deficit that requires a timely diagnosis and treatment. The perioperative management of AI is influenced by the preoperative status of the hypothalamic\u2013pituitary\u2013adrenal axis. Disorders of water metabolism are another common complication, and they can span from diabetes insipidus, to the syndrome of inappropriate antidiuretic hormone secretion, up to the rare cerebral salt-wasting syndrome. These abnormalities are often transient, but require careful monitoring and management in order to avoid abrupt variations of blood sodium levels. Cerebrospinal fluid leaks, damage to neurological structures such as the optic chiasm, and vascular complications can worsen the postoperative course after transsphenoidal surgery as well. Finally, long-term follow up after surgery varies depending on the underlying pathology, and is most challenging in patients with acromegaly and Cushing disease, in whom failure of primary pituitary surgery is a major concern. When these pituitary functioning adenomas persist or relapse after neurosurgery other treatment options are considered, including repeated surgery, radiotherapy, and medical therapy

Replica symmetric evaluation of the information transfer in a two-layer network in presence of continuous+discrete stimuli

In a previous report we have evaluated analytically the mutual information between the firing rates of N independent units and a set of multi-dimensional continuous+discrete stimuli, for a finite population size and in the limit of large noise. Here, we extend the analysis to the case of two interconnected populations, where input units activate output ones via gaussian weights and a threshold linear transfer function. We evaluate the information carried by a population of M output units, again about continuous+discrete correlates. The mutual information is evaluated solving saddle point equations under the assumption of replica symmetry, a method which, by taking into account only the term linear in N of the input information, is equivalent to assuming the noise to be large. Within this limitation, we analyze the dependence of the information on the ratio M/N, on the selectivity of the input units and on the level of the output noise. We show analytically, and confirm numerically, that in the limit of a linear transfer function and of a small ratio between output and input noise, the output information approaches asymptotically the information carried in input. Finally, we show that the information loss in output does not depend much on the structure of the stimulus, whether purely continuous, purely discrete or mixed, but only on the position of the threshold nonlinearity, and on the ratio between input and output noise.Comment: 19 pages, 4 figure