Congenital Extrahepatic Portosystemic Shunt Complicated by the Development of Hepatoblastoma: A Case Report and Review of Literature.

Congenital portosystemic shunts (CPSS) or congenital extrahepatic portosystemic shunts (CEPS) is a rare malformation. This congenital anomaly presents with a diverse array of clinical manifestations, ranging from asymptomatic to severe complications such as cardiac failure, pronounced pulmonary hypertension, and widespread pulmonary arteriovenous malformations. CPSS increases the risk of developing benign or malignant liver tumors, including nodular regenerative hyperplasia, focal nodular hyperplasia, hepatic adenoma, hepatocellular carcinoma, and hepatoblastoma. We report a case of a 15-month-old boy, identified with Abernethy's malformation type Ib, who presented with an abdominal mass during a follow-up. A comprehensive assessment established a diagnosis of hepatoblastoma. The patient was transferred to a specialized liver transplant center for further treatment and management. This is a review of literature highlighting the complexity of Abernethy malformation and its associated risk of liver tumors.

Off-label use of muscular VSD device for closure of a rare congenital portosystemic shunt.

BACKGROUND: Congenital portosystemic shunt (CPSS) is a vascular malformation in which portal blood drains toward the systemic circulation, leading to pulmonary hypertension. CASE PRESENTATION: A 10-year-old patient was brought for evaluation because of dyspnea on exertion. Echocardiography revealed a pulmonary hypertension of 75 mmHg, and multi-slice CT angiography revealed the presence of a CPSS. Closure was finally implemented using a muscular ventricular septal defect device. Follow-up of the patient revealed a gradual decline in pulmonary hypertension. CONCLUSIONS: CPSS is an overlooked cause of reversible pulmonary hypertension (PH). Closure of such lesions and reversal pulmonary hypertension are possible via catheterization. The preferred device type depends largely on the intervening team. Plugs are the first choice for interventional radiologists, while ventricular and atrial septal occluder devices and duct occluders are preferred by pediatric cardiologists.

QsvR and OpaR coordinately regulate the transcription of cpsS and cpsR in Vibrio parahaemolyticus.

Vibrio parahaemolyticus, the leading cause of seafood-associated gastroenteritis, has a strong capacity to form biofilms on surfaces, which is strictly regulated by the CpsS-CpsR-CpsQ regulatory cascade. OpaR, a master regulator of quorum sensing, is a global regulator that controls multiple cellular pathways including biofilm formation and virulence. QsvR is an AraC-type regulator that works coordinately with OpaR to control biofilm formation and virulence gene expression of V. parahaemolyticus. QsvR and OpaR activate cpsQ transcription. OpaR also activates cpsR transcription, but lacks the detailed regulatory mechanisms. Furthermore, it is still unknown whether QsvR regulates cpsR transcription, as well as whether QsvR and OpaR regulate cpsS transcription. In this study, the results of quantitative real-time PCR and LacZ fusion assays demonstrated that deletion of qsvR and/or opaR significantly decreased the expression levels of cpsS and cpsR compared to the wild-type strain. However, the results of two-plasmid lacZ reporter and electrophoretic mobility-shift assays showed that both QsvR and OpaR were unable to bind the regulatory DNA regions of cpsS and cpsR. Therefore, transcription of cpsS and cpsR was coordinately and indirectly activated by QsvR and OpaR. This work enriched our knowledge on the regulatory network of biofilm formation in V. parahaemolyticus.

Cyber-WISE: A Cyber-Physical Deep Wireless Indoor Positioning System and Digital Twin Approach.

In recent decades, there have been significant research efforts focusing on wireless indoor localization systems, with fingerprinting techniques based on received signal strength leading the way. The majority of the suggested approaches require challenging and laborious Wi-Fi site surveys to construct a radio map, which is then utilized to match radio signatures with particular locations. In this paper, a novel next-generation cyber-physical wireless indoor positioning system is presented that addresses the challenges of fingerprinting techniques associated with data collection. The proposed approach not only facilitates an interactive digital representation that fosters informed decision-making through a digital twin interface but also ensures adaptability to new scenarios, scalability, and suitability for large environments and evolving conditions during the process of constructing the radio map. Additionally, it reduces the labor cost and laborious data collection process while helping to increase the efficiency of fingerprint-based positioning methods through accurate ground-truth data collection. This is also convenient for working in remote environments to improve human safety in locations where human access is limited or hazardous and to address issues related to radio map obsolescence. The feasibility of the cyber-physical system design is successfully verified and evaluated with real-world experiments in which a ground robot is utilized to obtain a radio map autonomously in real-time in a challenging environment through an informed decision process. With the proposed setup, the results demonstrate the success of RSSI-based indoor positioning using deep learning models, including MLP, LSTM Model 1, and LSTM Model 2, achieving an average localization error of ≤2.16 m in individual areas. Specifically, LSTM Model 2 achieves an average localization error as low as 1.55 m and 1.97 m with 83.33% and 81.05% of the errors within 2 m for individual and combined areas, respectively. These outcomes demonstrate that the proposed cyber-physical wireless indoor positioning approach, which is based on the application of dynamic Wi-Fi RSS surveying through human feedback using autonomous mobile robots, effectively leverages the precision of deep learning models, resulting in localization performance comparable to the literature. Furthermore, they highlight its potential for suitability for deployment in real-world scenarios and practical applicability.

Microstructural Changes in the Spinothalamic Tract of CPSS Patients: Preliminary Results from a Single-Center Diffusion-Weighted Magnetic Resonance Imaging Study.

INTRODUCTION: Chronic pain after spinal surgery (CPSS), formerly known as failed back surgery syndrome, encompasses a variety of highly incapacitating chronic pain syndromes emerging after spinal surgery. The intractability of CPSS makes objective parameters that could aid classification and treatment essential. In this study, we investigated the use of cerebral diffusion-weighted magnetic resonance imaging. METHODS: Cerebral 3T diffusion-weighted (DW-) MRI data from adult CPSS patients were assessed and compared with those of healthy controls matched by age and gender. Only imaging data without relevant artefacts or significant pathologies were included. Apparent diffusion coefficient (ADC) maps were calculated from the b0 and b1000 values using nonlinear regression. After skull stripping and affine registration of all imaging data, ADC values for fifteen anatomical regions were calculated and analyzed with independent samples T-tests. RESULTS: A total of 32 subjects were included (sixteen CPSS patients and sixteen controls). The mean ADC value of the spinothalamic tract was found to be significantly higher in CPSS patients compared with in healthy controls (p = 0.013). The other anatomical regions did not show statistically different ADC values between the two groups. CONCLUSION: Our results suggest that patients suffering from CPSS are subject to microstructural changes, predominantly within the cerebral spinothalamic tract. Additional research could possibly lead to imaging biomarkers derived from ADC values in CPSS patients.

A Holistic Review of Cyber-Physical-Social Systems: New Directions and Opportunities.

A Cyber-Physical-Social System (CPSS) is an evolving subset of Cyber-Physical Systems (CPS), which involve the interlinking of the cyber, physical, and social domains within a system-of-systems mindset. CPSS is in a growing state, which combines secure digital technologies with physical systems (e.g., sensors and actuators) and incorporates social aspects (e.g., human interactions and behaviors, and societal norms) to facilitate automated and secure services to end-users and organisations. This paper reviews the field of CPSS, especially in the scope of complexity theory and cyber security to determine its impact on CPS and social media's influence activities. The significance of CPSS lies in its potential to provide solutions to complex societal problems that are difficult to address through traditional approaches. With the integration of physical, social, and cyber components, CPSS can realize the full potential of IoT, big data analytics, and machine learning, leading to increased efficiency, improved sustainability and better decision making. CPSS presents exciting opportunities for innovation and advancement in multiple domains, improving the quality of life for people around the world. Research challenges to CPSS include the integration of hard and soft system components within all three domains, in addition to sociological metrics, data security, processing optimization and ethical implications. The findings of this paper note key research trends in the fields of CPSS, and recent novel contributions, followed by identified research gaps and future work.

Fusion and detection for multi-sensor systems under false data injection attacks.

This article investigates a security problem in cyber-physical systems under multisensory framework. Data packets from each sensor are transmitted to a remote estimator through wireless channels which could be attacked by a attacker and injected false data. Based on the data of reliable sensors and the relativity between reliable and unreliable sensors, a revised multi-sensor Kalman filter fusion algorithm is proposed. Under the proposed algorithm, an optimal linear false data injection attack strategy which is more general with an arbitrary mean of Gaussian distribution is designed. To further improve the detection performance, an Expected SARSA-based attack detection algorithm is proposed. Finally, simulation results based on an unmanned aerial vehicle are provided to illustrate the feasibility and efficiency of the obtained results.

Parallel Radars: From Digital Twins to Digital Intelligence for Smart Radar Systems.

Radar is widely employed in many applications, especially in autonomous driving. At present, radars are only designed as simple data collectors, and they are unable to meet new requirements for real-time and intelligent information processing as environmental complexity increases. It is inevitable that smart radar systems will need to be developed to deal with these challenges and digital twins in cyber-physical systems (CPS) have proven to be effective tools in many aspects. However, human involvement is closely related to radar technology and plays an important role in the operation and management of radars; thus, digital twins' radars in CPS are insufficient to realize smart radar systems due to the inadequate consideration of human factors. ACP-based parallel intelligence in cyber-physical-social systems (CPSS) is used to construct a novel framework for smart radars, called Parallel Radars. A Parallel Radar consists of three main parts: a Descriptive Radar for constructing artificial radar systems in cyberspace, a Predictive Radar for conducting computational experiments with artificial systems, and a Prescriptive Radar for providing prescriptive control to both physical and artificial radars to complete parallel execution. To connect silos of data and protect data privacy, federated radars are proposed. Additionally, taking mines as an example, the application of Parallel Radars in autonomous driving is discussed in detail, and various experiments have been conducted to demonstrate the effectiveness of Parallel Radars.

The Role of Children's PTSD Symptomatology in Non-Offending Caregivers' Secondary Traumatic Stress Symptomatology Following Disclosures of Sexual or Physical Abuse.

This research examined factors influencing levels of secondary traumatic stress (STS) in non-offending caregivers (NOCs) of children with histories of sexual or physical abuse. These factors included the nature of the abuse, NOCs' relationships with the initiators of the abuse, children's ages and genders, NOCs' trauma histories, and the elapsed time between children's disclosures of abuse and their trauma assessments. As a secondary objective, this research examined the interactions between children's self-reports of their own posttraumatic stress disorder (PTSD) symptomatology, NOCs' estimates of their children's PTSD symptomatology, and NOCs' self-reports of their own STS symptomatology. Participants from a clinical sample (N = 300, children = 150, NOCs = 150; child age M = 9.89, SD = 4.08; NOC age M = 37.87, SD = 9.23) completed structured intake interviews, the PTSD Checklist for the DSM-5 (PCL-5) and the Child PTSD Symptom Scale (CPSS; Child-Report and NOC-Report). Analytic strategies included point-biserial correlation coefficient calculations, linear regression analyses, and Analyses of Covariance (ANCOVAs). NOCs' levels of STS were impacted by their relationships with the initiators of the abuse and their own trauma histories. NOCs' self-reported STS symptomatology mirrored their estimates of their children's PTSD symptomatology. The discrepancy scores between children's self-reports of their PTSD symptomatology and NOCs' estimates of children's PTSD symptomatology were impacted by children's ages and genders. Clinical practitioners should note the importance of examining children's PTSD symptomatology and NOCs' STS symptomatology concurrently when making recommendations for trauma-informed evidence-based treatments.

Characterization of the Fecal Microbiome in Dogs Receiving Medical Management for Congenital Portosystemic Shunts.

Background: The GI microbiome has not been characterized in dogs being medically managed for congenital portosystemic shunts (CPSS). Objectives: To characterize the fecal microbiome in a population of dogs being medically managed for CPSS. Animals: 27 client-owned dogs. Methods: Prospective cohort study enrollment of fecal samples was performed with follow-up data collected retrospectively. The overall fecal dysbiosis index (DI) and individual bacterial abundances were determined using real-time qPCR. Medical management, clinical findings, clinicopathologic, and outcome variables were collected, and logistic regression analyses were performed to evaluate associations between these variables and overall DI and bacterial abundances. Numerical variables were evaluated with general linear models for normality and equal variance using Shapiro-Wilk test and Levene's test, respectively. Results: All dogs were administered a hepatic diet and lactulose, while antibiotics were used in 22 (81.5%) and acid suppressants in 7 (25.9%). Seventeen dogs (63.0%) had a DI >2. The median DI in this population was 3.02 (range 4.23-8.42), and the median DI in dogs receiving and not receiving antibiotics was 4.3 (range -4.23-8.42) and 1.52 (range -1.62-5.43), respectively. No significant association between any of the analyzed variables and the DI was identified. There was a significant association between the use of metronidazole and a larger abundance of E. coli (p = 0.024). Conclusions and Clinical Importance: Dysbiosis appears to be common in dogs that are being medically managed for CPSS, though the clinical significance remains unclear.

Cincinnati Prehospital Stroke Scale Implementation of an Urban County Severity-Based Stroke Triage Protocol: Impact and Outcomes on a Comprehensive Stroke Center.

BACKGROUND AND PURPOSE: Screening scales are recommended to assist field-based triage of acute stroke patients to designated stroke centers. Cincinnati prehospital stroke scale (CPSS) is a commonly used prehospital stroke screening tool and has been validated to identify large vessel occlusion (LVO). This study addresses the impact of county-based CPSS implementation to triage suspected LVO patients to a comprehensive stroke center (CSC). MATERIALS AND METHODS: Dekalb County in Atlanta, Georgia, implemented CPSS-based protocol with score of 3 and last seen normal time < 24 h mandating transfer to the nearest CSC if the added bypass time was <15 min. Frequency of stroke codes, LVO, IV-tPA use, and thrombectomy treatment were compared six months before and after protocol change (November 1, 2020). RESULTS: During the study period, 907 stroke patients presented to the CSC by EMS, including 289 (32%) with CPSS score 3. There was an increase in monthly ischemic stroke volume (pre-16 ± 2 vs.19 ± 3 p = 0.03), LVO (pre-4.3 ± 1.7 vs. post-7.0 ± 2.4; p = 0.03), EVT (pre-15% vs. post-30%; p = 0.001), without significant increase in stroke mimic volume or delay in mean time from last seen normal to IV-tPA (pre-165 ± 66, post-158 ± 49 min; p = 0.35). CPSS score 3 was associated with increased likelihood of LVO diagnosis (OR 8.5, 95% CI 5.0-14.4; p = 0.001) and decreased the likelihood of stroke mimics (OR 0.66, 95% CI 0.50-0.88; p = 0.004). CONCLUSION: CPSS is a quick, easy to implement, and reliable prehospital severity scale for EMS to triage LVO to CSC without delaying IV-tPA treatment or significantly increasing stroke mimics.

Evaluation of MALDI-TOF MS for Identification of Species in the Candida parapsilosis Complex from Candidiasis Cases.

BACKGROUND: Phenotypically identified Candida parapsilosis is actually a complex of 3 member species named Candida parapsilosis sensu stricto (CPSS), Candida orthopsilosis (CO), and Candida metapsilosis (CM), which can be identified only by molecular methods and automated methods such as MALDI-TOF mass spectrometry (MS). This study was undertaken to evaluate the VITEK MS, which uses the principle of MALDI-TOF MS for the identification of member species of C. parapsilosis complex (CPC). METHODS: In this cross-sectional study, 126 presumptively identified and stocked isolates of CPC were included. Definite identification to species level was done by VITEK MS and PCR as the gold standard method. Clinico-demographic characters and risk factors were analyzed. Antifungal susceptibility testing was performed for fluconazole and voriconazole. RESULTS: Twelve isolates were not identified as CPC either by VITEK MS or PCR and hence were excluded from the analysis. Out of 114 CPC isolates, 89 (78.1%), 18 (15.8%), and 7 (6.1%) isolates were identified as CPSS, CO, and CM, respectively, by VITEK MS. PCR identified 84 (79.2%), 15 (14.2%), and 7 (6.6%) isolates as CPSS, CO, and CM, respectively. However, PCR did not detect 8 isolates of CPSS detected by VITEK MS. VITEK MS showed 95.3% agreement in species identification and showed a kappa coefficient of 0.87, which is almost perfect agreement. Predominant isolations of all 3 species were from blood. Resistance was observed more in CPSS for both the azoles. CONCLUSION: MALDI-TOF MS can be used as a rapid, reliable, cost-effective method to identify the species of CPC.

Stealthy false data injection attacks with resource constraints against multi-sensor estimation systems.

This paper mainly investigates how to maximally degrade estimation performance of a cyber-physical system under limited resource. A stealthy false data injection (FDI) attack scheme is proposed to only attack partial sensor channels of a multi-sensor estimation system. The attack stealthiness condition and the compromised estimation error covariance are respectively derived, and then the stealthy attack problem is formed as a constrained optimization problem. An explicit solution of the optimal attack strategy is given and proven. Furthermore, the relationship between the compromised estimation error covariance and the attacked sensor is analyzed, and then the sensor selection principle is derived to decide which sensor channel should be attacked. Finally, two numerical simulation examples are provided to confirm the theoretical analysis results.

A new variant of Abernethy malformation treated by transhepatic interventional closure: a case report.

BACKGROUND: Congenital portosystemic shunts (CPSS) are rare vascular malformations and can be classified into extrahepatic and intrahepatic shunts. Extrahepatic CPSS, also termed Abernethy malformations are associated with severe long-term complications including portopulmonary hypertension, liver atrophy, hyperammoniemia and hepatic encephalopathy. We report a hitherto undescribed variant of Abernethy malformation requiring an innovative approach for interventional treatment. CASE PRESENTATION: We describe a 31-year-old patient following surgical repair of atrioventricular septal defect at the age of 6 years. In the long-term follow-up he showed persistent pulmonary hypertension which deteriorated despite dual pulmonary vasodilative treatment. When he developed arterial desaturation and symptomatic hyperammoniemia detailed reassessment revealed as underlying cause a hitherto undescribed variant of Abernethy malformation connecting the portal vein with the right lower pulmonary vein. Following interdisciplinary discussions we opted for an interventional approach. Since the malformation was un-accessible to interventional closure via antegrade venous or retrograde arterial access, a transhepatic percutaneous puncture of the portal vein was performed. Temporary balloon occlusion of the malformation revealed only a slight increase in portal venous pressure. Interventional occlusion of the large vascular connection was achieved via this transhepatic approach by successive implantation of two large vascular occluding devices. The postinterventional course was unremarkable and both ammonia levels and arterial saturation normalized at follow-up of 12 months. CONCLUSIONS: Portal vein anomalies should be included in the differential diagnoses of pulmonary hypertension or pulmonary arterio-venous malformations. Based on careful assessment of the anatomy and testing of portal vein hemodynamics interventional therapy of complex Abernethy malformations can be performed successfully in specialized centers.

"Decide and run!" The role of prehospital care providers in reducing time loss for patients with stroke diagnosis / "Dönts és siess!" A prehospitális ellátók szerepe az idoveszteség csökkentésében stroke-iránydiagnózisú betegek esetén.

Összefoglaló. Bevezetés: A stroke-betegek ellátásában arra kell törekedni, hogy a tünetek jelentkezését követoen minél elobb a szakmai centrumba kerüljön a beteg. Célkituzés: Kutatásunkban a terápiás idoablak tarthatósága céljából vizsgáltuk, hogy mely tényezok bírnak hatással a prehospitális ellátás idotartamaira. Módszer: Keresztmetszeti, kvantitatív kutatásunkhoz az adatgyujtést két magyarországi város mentoállomásán, orvosi kompetenciával rendelkezo (eset-, rohamkocsi) és orvosi kompetenciával nem rendelkezo (mentogépkocsi) mentoegység szintjén végeztük 2017-es adatok feldolgozásával olyan betegek körében, akiknek a mentoegység általi iránydiagnózisa stroke volt (n = 220). Vizsgáltuk, hogy a mentoegységek által elvégzett vizsgálatok, a tapasztalt tünetek, a terápiás idoablakon belüliség miként befolyásolta a prehospitális idoket. Az adatfeldolgozást SPSS 26.0 statisztikai programmal végeztük. Az elemzéshez leíró statisztikát, χ2-próbát, F-próbát és T-próbát alkalmaztunk. Eredmények: Megállapítottuk, hogy az alkalmazott score-rendszer vizsgálati elemei közül, ha aphasia volt észlelheto a betegnél, úgy szignifikánsan meghosszabbodott a helyszínen töltött ido (p = 0,003). A gyors ABCDE-betegvizsgálat D-lépésében kötelezo a betegnél a vércukorszintmérés, ugyanakkor ez mintánk 25,45%-ában elmaradt. A helyszíni muszeres vércukorszintmérés hatással van a prehospitális késés alakulására az orvosi kompetencia nélküli egységek vonatkozásában (p<0,001). Következtetés: A helyszínen töltött ido az emelt szintu mentoegységek esetében hosszabb, mint az alacsonyabb szintu egységeknél. Következtetésként levonhatjuk, hogy a motoros vagy szenzoros aphasia nem befolyásolja a terápiát, pusztán a stroke-diagnózis valószínuségét növelo egyik tünet, így a helyszíni ido emiatti megnyúlása mindenképpen kerülendo, amire javasolt a továbbképzések alkalmával is felhívni az ellátók figyelmét. Az orvosi kompetencia nélküli egységek esetében beavatkozást igényel a muszeres vércukormérés idorabló hatásának csökkentése, hiszen látható, hogy az orvosi kompetenciával rendelkezo egységeknél ez a vizsgálat nem jelenik meg mint késést okozó tényezo. Orv Hetil. 2022; 163(7): 279-287. INTRODUCTION: When treating stroke patients, the aim should be to get the patient to a specialist stroke centre as soon as possible. OBJECTIVE: In our study, in order to be able to stay within the therapeutic window, we investigated which variables affect the time period of prehospital treatment. METHOD: For our cross-sectional quantitative study, we gathered data from two ambulance stations in Hungary, comparing the competence of physician and non-physician units. We processed information from 2017 regarding patients whose initial diagnosis was stroke (n = 220). We examined how investigations by the ambulance unit, symptoms experienced and therapeutic time window have affected prehospital times. As for the statistic software, we used SPSS 26.0. The analysis was conducted by performing χ2 test, F-test and T-test. RESULTS: We identified that if the aphasia component of the used score system was positive, the on-scene time increased significantly (p = 0.003). In the D section of the rapid ABCDE assessment, it is mandatory to measure the blood glucose level of the patient, however, in our sample it was omitted in 25.45% of the cases. We identified that on-site blood glucose measurement has an effect on prehospital delay for non-physician units (p<0.001). CONCLUSION: We found that the on-scene time is longer for physician units than for non-physician units. We concluded that motor or sensory aphasia does not affect the therapy, it is just one of the symptoms that can increase the likelihood of stroke diagnosis, therefore prolonging time for assessing aphasia in the field should be avoided. Moreover, it is recommended to make care providers aware of this during training sessions. Improvements are required in non-physician units to reduce the time consumed by blood glucose measurement, as it has been shown that within physician units this test does not appear to be a delay-causing factor. Orv Hetil. 2022; 163(7): 279-287.

Identification and expression analysis of ten novel small non-coding RNAs (sncRNAs) in cancer cells using a high-throughput sequencing approach.

Non-coding RNAs are characterized as RNA molecules, which lack the capacity to encode protein structures and appear to include a level of internal signals. Moreover, they control various stages of gene expression, thus controlling the cell physiology and development. In this study, we implemented a high-throughput sequencing approach based on the primary semi-conductor technology and computational tools, in order to identity novel small non-coding RNAs. Fourteen human cancer cell lines were cultured, and RNA samples were enriched for small RNAs following semi-conductor next generation sequencing (NGS). Bioinformatics analysis of NGS data revealed the existence of several classes of ncRNAs using the miRDeep* and CPSS 2.0 software. To investigate the existence of the predicted non-coding RNA sequences in cDNA pools of cell lines, a developed qPCR-based assay was implemented. The structure of each novel small ncRNA was visualized, using the RNAfold algorithm. Our results support the existence of twenty (20) putative new small ncRNAs, ten (10) of which have had their expression experimentally validated and presented differential profiles in cancerous and normal cells. A deeper comprehension of the ncRNAs interactive network and its role in cancer can therefore be translated into a wide range of clinical applications. Despite this progress, further scientific research from different perspectives and in different fields is needed, so that the riddle of the human transcriptome can be solved.

Event-triggering control scheme for discrete time Cyberphysical Systems in the presence of simultaneous hybrid stochastic attacks.

Industry Revolution 4.0 pushes the industry to digitize all its operations. Cyberphysical Systems (CPSs), such as autonomous automobile systems and medical monitoring are examples of this revolution. However, as these systems are interconnected via the Internet, they become more vulnerable to cyber-attacks and in particular, stealthy attacks. Cyber attacks could affect the operations of CPS and cause physical damages before any indication. So, there is a need to design a secure control system to withstand in these circumstances. In this article, an event-triggering control scheme is designed for discrete time CPSs contain random delays in measurements and actuation signals and subject to simultaneous hybrid distributed denial of service (DDoS) and deception attacks. The cyber attacks are designed as Bernoulli distributed white sequences with conditional probabilities that are variable. Moreover, An event-triggering control scheme is proposed for decreasing the communication overhead in the system, such that the measurements' signals are sent when a selected triggering condition is met. An observer based control is designed to maintain the stability of the CPS under all possible scenarios of single or hybrid simultaneous attacks in the forward and or backward communication. Linear matrix inequalities are used to represent the overall control scheme. At the end, two illustrative examples are presented and discussed to show the effectiveness of the presented scheme.

Prospective Evaluation of a Two-Scale Protocol for Prehospital Large Vessel Occlusion Detection.

Background and purposes: Stroke severity scales may expedite prehospital large vessel occlusion (LVO) stroke detection, but few are validated for paramedic use. We evaluated the feasibility of introducing the Cincinnati Stroke Triage Assessment Tool (C-STAT) in the field and its capacity to detect LVO stroke.Methods: We performed a prospective paramedic-based study assessing C-STAT in the field on patients currently redirected to two comprehensive stroke centers (CSC), based on a Cincinnati Prehospital Stroke Scale (CPSS) score of 3/3. C-STAT was administered by on-site paramedics with telephone guidance from trained centralized clinical support paramedics.Results: Between October 2018 and November 2019, C-STAT scores were obtained in 188/218 (86.2%) patients, among which 118/188 (62.8%) were positive. Paramedics reported performing the C-STAT in less than 5 minutes on 170/188 (90.4%) patients and noted no difficulties administering the scale in 151/188 (80.3%). A positive C-STAT identified 51/68 (75%) LVO strokes in the cohort, demonstrating a 43% (95% CI: 38%-48%) positive and 76% (95% CI: 66%-83%) negative predictive value for LVO stroke diagnosis. In a cohort of 100 patients with CPSS 3/3, requiring a positive C-STAT for redirection would decrease CSC patient volume by 37 but miss 9 of 36 LVO strokes.Conclusion: Prehospital administration of the C-STAT was feasible, using a model of minimal paramedic training and real-time telephone guidance. A protocol based on both a CPSS 3/3 and a positive C-STAT would decrease CSC redirected patient volume by one-third but would miss one-quarter of LVO strokes when compared to a CPSS-based protocol.

Carboxy-Terminal Processing Protease Controls Production of Outer Membrane Vesicles and Biofilm in Acinetobacter baumannii.

Carboxy-terminal processing protease (Ctp) is a serine protease that controls multiple cellular processes through posttranslational modification of proteins. Acinetobacter baumannii ATCC 17978 ctp mutant, namely MR14, is known to cause cell wall defects and autolysis. The objective of this study was to investigate the role of ctp mutation-driven autolysis in regulating biofilms in A. baumannii and to evaluate the vesiculation caused by cell wall defects. We found that in A. baumannii, Ctp is localized in the cytoplasmic membrane, and loss of Ctp function enhances the biofilm-forming ability of A. baumannii. Quantification of the matrix components revealed that extracellular DNA (eDNA) and proteins were the chief constituents of MR14 biofilm, and the transmission electron microscopy further indicated the presence of numerous dead cells compared with ATCC 17978. The large number of MR14 dead cells is potentially the result of compromised outer membrane integrity, as demonstrated by its high sensitivity to sodium dodecyl sulfate (SDS) and ethylenediaminetetraacetic acid (EDTA). MR14 also exhibited the hypervesiculation phenotype, producing outer-membrane vesicles (OMVs) of large mean size. The MR14 OMVs were more cytotoxic toward A549 cells than ATCC 17978 OMVs. Our overall results indicate that A. baumanniictp negatively controls pathogenic traits through autolysis and OMV biogenesis.

Psychometric Evaluation of the Caregiver Version of the Child PTSD Symptom Scale in a Recently Immigrated, Spanish Speaking Population.

In recent years, there has been a large increase in the number of youth and families emigrating from Central America to the United States to escape extreme violence and crime victimization. As a result, the rate of trauma-exposure and trauma-related distress among this population is alarmingly high and necessitates representation of this population in psychological research, particularly related to trauma symptom measurement. The broad aim of the current study was to examine the psychometric performance of caregiver-reported data on one such instrument intended to measure youth trauma symptoms. Specifically, we sought to document the psychometric performance of the Child PTSD Symptoms Scale (CPSS) with recently immigrated Spanish-Speaking youth and caregivers from Central America by examining the convergent, divergent, and concurrent validity of the caregiver-report form. Overall, the measure showed psychometric promise as it broadly demonstrated adequate concurrent and convergent. Results also suggested that further research is needed to better understand how to reduce the comorbidity that is often depicted in caregiver reports, which can lead to poor discriminant validity. Regardless, current findings suggest the appropriateness of incorporating caregiver reports of youth trauma in Spanish-speaking, recently immigrated youth.