The development of a glucose prediction model in critically ill patients

Purpose: The aim of the current study is to develop a prediction model for glucose levels applicable for all patients admitted to the ICU with an expected ICU stay of at least 24 h. This model will be incorporated in a closed-loop glucose system to continuously and automatically control glucose values. Methods: Data from a previous single-center randomized controlled study was used. All patients received a FreeStyle Navigator II subcutaneous CGM system from Abbott during their ICU stay. The total dataset was randomly divided into a training set and a validation set. A glucose prediction model was developed based on historical glucose data. Accuracy of the prediction model was determined using the Mean Squared Difference (MSD), the Mean Absolute Difference (MAD) and a Clarke Error Grid (CEG). Results: The dataset included 94 ICU patients with a total of 134,673 glucose measurements points that were used for modelling. MSD was 0.410 +/- 0.495 for the model, the MAD was 5.19 +/- 2.63 and in the CEG 99.8% of the data points were in the clinically acceptable regions. Conclusion: In this study a glucose prediction model for ICU patients is developed. This study shows that it is possible to accurately predict a patient's glucose 30 min ahead based on historical glucose data. This is the first step in the development of a closed-loop glucose system. (C) 2021 Elsevier B.V. All rights reserved

Water supply of ancient Egyptian settlements: the role of the state. Overview of a relatively equitable scheme from the Old to New Kingdom (ca. 2543-1077 BC).

This is the final version of the article. It first appeared from Springer via http://dx.doi.org/10.1007/s12685-015-0150-xThe study of the textual and archaeological evidence shows that the water supply of the settlements of ancient Egypt seems to have worked on a simple and a relatively equitable scheme, at least from the Old Kingdom until the New Kingdom (ca. 2543-1077). The water supply of the inhabitants was completely managed by the state, through the local administration which was charged to bring the water, in general from a rural area, into towns and cities and to redistribute it to the inhabitants. The method of supply is illustrated by several sources of evidence, in particular by the well known case of the "water-carriers" of the village of Deir el-Medina. Thus, drawing together text and archaeology, this paper will demonstrate that over an extended period, even when the city was far from a water source, the state did not set up complex installations such as pipe networks or wells to bring water, but preferred a simpler system using the manpower available

No effect of thermal maturity on the Mo-, U-, Cd- and Zn-isotope compositions of Lower Jurassic organic-rich sediments

The isotope ratios of redox-sensitive metals in organic-rich rocks are critical tools for quantifying the timing and severity of deoxygenation and nutrient cycling in Earth’s past. The resilience of isotopic data to thermal alteration of the host sediments over millions of years of burial is, however, largely unknown. We present molybdenum, uranium, cadmium, and zinc stable-isotope data from two stratigraphic successions of the same Lower Jurassic Posidonienschiefer unit in the Lower Saxony Basin of northern Germany that were affected by different burial histories. We show that thermal maturity had no effect on the isotopic compositions of these elements but does appear to have increased their concentrations in the rock. The data corroborate the results of laboratory-based maturation studies and provide constraints on the Mo, U, Cd, and Zn isotopic compositions of ca. 182 Ma seawater in the Lower Saxony Basin

Effective Melanoma Immunotherapy in Mice by the Skin-Depigmenting Agent Monobenzone and the Adjuvants Imiquimod and CpG

Background: Presently melanoma still lacks adequate treatment options for metastatic disease. While melanoma is exceptionally challenging to standard regimens, it is suited for treatment with immunotherapy based on its immunogenicity. Since treatment-related skin depigmentation is considered a favourable prognostic sign during melanoma intervention, we here aimed at the reverse approach of directly inducing vitiligo as a shortcut to effective anti-melanoma immunity. Methodology and Principal Findings: We developed an effective and simple to use form of immunotherapy by combining the topical skin-bleaching agent monobenzone with immune-stimulatory imiquimod cream and cytosine-guanine oligodeoxynucleotides (CpG) injections (MIC therapy). This powerful new approach promptly induced a melanoma antigen-specific immune response, which abolished subcutaneous B16. F10 melanoma growth in up to 85% of C57BL/6 mice. Importantly, this regimen induced over 100 days of tumor-free survival in up to 60% of the mice, and forcefully suppressed tumor growth upon re-challenge either 65- or 165 days after MIC treatment cessation. Conclusions: MIC therapy is effective in eradicating melanoma, by vigilantly incorporating NK-, B-and T cells in its therapeutic effect. Based on these results, the MIC regimen presents a high-yield, low-cost and simple therapy, readily applicable in the clini

Prognostic value of patient-reported quality of life for survival in oesophagogastric cancer:Analysis from the population-based POCOP study

BACKGROUND: Accumulating evidence of trials demonstrates that patient-reported health-related quality of life (HRQoL) at diagnosis is prognostic for overall survival (OS) in oesophagogastric cancer. However, real-world data are lacking. Moreover, differences in disease stages and tumour-specific symptoms are usually not taken into consideration. The aim of this population-based study was to assess the prognostic value of HRQoL, including tumour-specific scales, on OS in patients with potentially curable and advanced oesophagogastric cancer. METHODS: Data were derived from the Netherlands Cancer Registry and the patient reported outcome registry (POCOP). Patients included in POCOP between 2016 and 2018 were stratified for potentially curable (cT1-4aNallM0) or advanced (cT4b or cM1) disease. HRQoL was measured with the EORTC QLQ-C30 and the tumour-specific OG25 module. Cox proportional hazards models assessed the impact of HRQoL, sociodemographic and clinical factors (including treatment) on OS. RESULTS: In total, 924 patients were included. Median OS was 38.9 months in potentially curable patients (n = 795) and 10.6 months in patients with advanced disease (n = 129). Global Health Status was independently associated with OS in potentially curable patients (HR 0.89, 99%CI 0.82-0.97), together with several other HRQoL items: appetite loss, dysphagia, eating restrictions, odynophagia, and body image. In advanced disease, the Summary Score was the strongest independent prognostic factor (HR 0.75, 99%CI 0.59-0.94), followed by fatigue, pain, insomnia and role functioning. CONCLUSION: In a real-world setting, HRQoL was prognostic for OS in patients with potentially curable and advanced oesophagogastric cancer. Several HRQoL domains, including the Summary Score and several OG25 items, could be used to develop or update prognostic models

Testing the survival of microfossils in artificial martian sedimentary meteorites during entry into Earth's atmosphere: the STONE 6 experiment

If life ever appeared on Mars, could we find traces of primitive life embedded in sedimentary meteorites? To answer this question, a 3.5 billion-year-old volcanic sediment containing microfossils was embedded in the heat shield of a space capsule in order to test survival of the rock and the microfossils during entry into the Earth's atmosphere (the STONE 6 experiment). The silicified volcanic sediment from the Kitty's Gap Chert (Pilbara, Australia) is considered to be an excellent analogue for Noachian-age volcanic sediments. The microfossils in the chert are also analogues for potential martian life. An additional goal was to investigate the survival of living microorganisms (Chroococcidiopsis) protected by a 2 cm thick layer of rock in order to test whether living endolithic organisms could survive atmospheric entry when protected by a rocky coating. Mineralogical alteration of the sediment due to shock heating was manifested by the formation of a fusion crust, cracks in the chert due to prograde and retrograde changes of ? quartz to ? quartz, increase in the size of the fluid inclusions, and dewatering of the hydromuscovite-replaced volcanic protoliths. The carbonaceous microfossils embedded in the chert matrix survived in the rock away from the fusion crust but there was an increase in the maturity index of the kerogen towards the crust. We conclude that this kind of sediment can survive atmospheric entry and, if it contains microfossils, they could also survive. The living microorganisms were, however, completely carbonised by flame leakage to the back of the sample and therefore non-viable. However, using an analytical model to estimate the temperature reached within the sample thickness, we conclude that, even without flame leakage, the living organisms probably need to be protected by at least 5 cm of rock in order to be shielded from the intense heat of entry

Th17 Cells and Activated Dendritic Cells Are Increased in Vitiligo Lesions

Vitiligo is a common skin disorder, characterized by progressive skin de-pigmentation due to the loss of cutaneous melanocytes. The exact cause of melanocyte loss remains unclear, but a large number of observations have pointed to the important role of cellular immunity in vitiligo pathogenesis.In this study, we characterized T cell and inflammation-related dermal dendritic cell (DC) subsets in pigmented non-lesional, leading edge and depigmented lesional vitiligo skin. By immunohistochemistry staining, we observed enhanced populations of CD11c+ myeloid dermal DCs and CD207+ Langerhans cells in leading edge vitiligo biopsies. DC-LAMP+ and CD1c+ sub-populations of dermal DCs expanded significantly in leading edge and lesional vitiligo skin. We also detected elevated tissue mRNA levels of IL-17A in leading edge skin biopsies of vitiligo patients, as well as IL-17A positive T cells by immunohistochemistry and immunofluorescence. Langerhans cells with activated inflammasomes were also noted in lesional vitiligo skin, along with increased IL-1ß mRNA, which suggest the potential of Langerhans cells to drive Th17 activation in vitiligo.These studies provided direct tissue evidence that implicates active Th17 cells in vitiligo skin lesions. We characterized new cellular immune elements, in the active margins of vitiligo lesions (e.g. populations of epidermal and dermal dendritic cells subsets), which could potentially drive the inflammatory responses