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Introduction Spinal cord infarctions (SCI) are scarce entities, constituting only 0.3‐1% of all strokes, with complete or posterior spinal cord involvement detailed in the case below being even rarer. Often caused by sudden interruption of blood flow to the spinal cord due to embolic phenomena, intrinsic factors such as connective tissue disease, and due to intra/post‐operative hypotension leading to ischemia or infarction. The resultant acute spinal cord dysfunction manifests as; motor weakness, loss of senses of pain and temperature, altered proprioception, bowel and bladder dysfunction Spinal blood supply comprises of the anterior spinal artery (ASA) and the two posterior spinal arteries, with supply to the spinal arteries being derived from various regional arteries: C1‐T3 is supplied by the vertebral arteries, T3‐T7 is served by a branch from the intercostal arteries, and the Adamkiewicz artery supplies T8 to the medullary conus. The thoracolumbar level is primarily supplied by only a small number of radicular arteries, originating from segmental branches of the aorta, specifically the posterior intercostal and lumbar branches, which extend towards the intervertebral foramina where they split into the anterior and posterior radicular arteries. The largest radicular artery, commonly referred to as the arteria radicularis magna of Adamkiewicz (or main anterior radicular artery), typically arises on the left between T9 and T12, but may be located on the right or emerge anywhere from T5 to L4 in approximately 17% of cases. This extensive segment of the spinal cord only is typically supplied by only two or three small radicular branches, occuring between the lower cervical and mid‐to‐lower thoracic levels, making it a watershed zone. Methods Case report and literature review Results 73‐year‐old woman with history of hypertension, long‐term smoking, extensive peripheral vascular disease, R lung cancer (in remission after 3 rounds of radiation, and newly diagnosed calcified heterogeneous left renal mass concerning for malignancy status‐post right femoral access with embolization of left lumbar arteries at the level of L1‐L3 with 800 micrometer particles and tungsten‐platinum coils on 12/19/22), transferred from a surgical center on 12/21/22 for post‐operative paraparesis (R›L), paresthesia , urinary retention, and constipation initially thought to be post‐anesthetic effects. MRI T and L spine with and without contrast demonstrated diffusion restriction from the level of T10 to the conus suggestive of anterior and posterior spinal cord infarct, thought to be in the setting of recent embolization with extensive atherosclerotic burden. Neurological exam significant for lower extremity paraparesis ( R 2/5 , L 3/5) with T10 sensory level to pin‐prick and temperature, hyporeflexia, and absent proprioception in bilateral lower extremities. Full dose aspirin and high intensity statin was started with patient managed conservatively due to presentation outside window for thrombolysis. Conclusion Spinal cord infarcts typically present with motor weakness due to ASA occlusion however, sensory level and proprioceptive loss as accompanying factors are important considerations to rule in total cord (anterior + posterior) infarcts, especially in post‐op patients undergoing thoraco‐lumbar access/embolization as earlier recognition may make them eligible for treatments such as thrombolysis.

Objectives The COVID-19 pandemic has spread to all states in India. Due to limitations in testing coverage, the true extent of the spread may not be fully reflected in the reported cases. In this study, we obtain time-varying estimates of the fraction of COVID-19 infections reported in the different states.Methods Following a methodology developed in prior work, we use a delay-adjusted case fatality ratio to estimate the true fraction of cases reported in different states. We also develop a delay adjusted test positivity estimation method and study the relationship between the estimated test positivity rate for each state and the estimated fraction of cases reported.Setting We apply this method of analysis to all Indian states reporting at least 100 deaths as of 10 October 2020.Results Our analysis suggests that delay-adjusted case fatality ratios observed in different states range from 0.47% to 3.55%. The estimated fraction of cases reported in different states ranges from 39% to 100% for an assumed baseline case fatality ratio of 1.38%, from 18.6% to 100% for an assumed baseline case fatality ratio of 0.66%, and from 2.8% to 19.7% for an assumed baseline case fatality ratio of 0.1%. We also demonstrate a statistically significant negative relationship between the fraction of cases reported in each state and the testing positivity rate.Conclusions The estimates provide a means to quantify and compare the trends of reporting and the true level of current infections in different states. This information may be used to guide policies for prioritising testing in different states, and also to analyse the time-varying effects of different quarantine measures adopted in different states.

There is growing interest in using embryonic stem cell (ESC) and induced pluripotent stem cell (iPSC) derivatives for tissue regeneration. However, an increased understanding of human immune responses to stem cell-derived allografts is necessary for maintaining long-term graft persistence. To model this alloimmunity, humanized mice engrafted with human hematopoietic and immune cells could prove to be useful. In this study, an in-depth analysis of graft-infiltrating human lymphocytes and splenocytes revealed that humanized mice incompletely model human immune responses toward allogeneic stem cells and their derivatives. Furthermore, using an “allogenized” mouse model, we show the feasibility of reconstituting immunodeficient mice with a functional mouse immune system and describe a key role of innate immune cells in the rejection of mouse stem cell allografts.

Objective To estimate the prevalence of non-communicable disease (NCD) risk factors in Kerala.Design A community-based, cross-sectional survey.Participants In 2016–2017 a multistage, cluster sample of 12 012 (aged 18–69 years) participants from all 14 districts of Kerala were studied.Main outcome measures NCD risk factors as stipulated in the WHO’s approach to NCD risk factors surveillance were studied. Parameters that were studied included physical activity score, anthropometry, blood pressure (BP), and fasting blood glucose (FBG) and morning urine sample to estimate dietary intake of salt.Results The mean age was 42.5 years (SD=14.8). Abdominal obesity was higher in women (72.6%; 95% CI 70.7 to 74.5) compared with men (39.1%; 95% CI 36.6 to 41.7), and also higher among urban (67.4%; 95% CI 65.0 to 69.7) compared with rural (58.6%; 95% CI 56.6 to 60.5) residents. Current use of tobacco and alcohol in men was 20.3% (95% CI 18.6 to 22.1) and 28.9% (95% CI 26.5 to 31.4), respectively. The estimated daily salt intake was 6.7 g/day. The overall prevalence of raised BP was 30.4% (95% CI 29.1 to 31.7) and raised FBG was 19.2% (95% CI 18.1 to 20.3). Raised BP was higher in men (34.6%; 95% CI 32.6 to 36.7) compared with women (28%; 95% CI 26.4 to 29.4), but was not different between urban (33.1%; 95% CI 31.3 to 34.9) and rural (29.8%; 95% CI 28.3 to 31.3) residents. Only 12.4% of individuals with hypertension and 15.3% of individuals with diabetes were found to have these conditions under control. Only 13.8% of urban and 18.4% of rural residents did not have any of the seven NCD risk factors studied.Conclusion Majority of the participants had more than one NCD risk factor. There was no rural–urban difference in terms of raised BP or raised FBG prevalence in Kerala. The higher rates of NCD risk factors and lower rates of hypertension and diabetes control call for concerted primary and secondary prevention strategies to address the future burden of NCDs.

Objectives: DiabCare India 2011 was a cross-sectional study in patients with diabetes mellitus, undertaken to investigate the relationship between diabetes control, management and complications in a subset of urban Indian diabetes patients treated at referral diabetes care centres in India. Materials and Methods: This was a cross-sectional, multicentre (330 centres) survey in 6168 diabetes patients treated at general hospitals, diabetes clinics and referral clinics across India. Patient data, including medical and clinical examination reports during the past year were collected during their routine visit. The patients′ and physicians′ perceptions about diabetes management were recorded using a questionnaire. Results: A total of 6168 subjects with diabetes (95.8% type 2), mean age 51.9 ± 12.4 years and mean duration of diabetes, 6.9 ± 6.4 years were included. Mean HbA1c was 8.9 ± 2.1% and the mean fasting (FPG), post prandial (PPG) and random (RBG) plasma glucose levels were 148 ± 50 mg/dl 205 ± 66 mg/dl and 193 ± 68mg/dl respectively. Neuropathy was the most common complication (41.4%); other complications were: Foot (32.7%), eye (19.7%), cardiovascular (6.8%) and nephropathy (6.2%). The number of diabetic complications increased with mean duration of diabetes. Most (93.2%) of the patients were on oral anti-diabetic drugs (OADs) and 35.2% were on insulin (±OADs). More than 15% physicians felt that the greatest barrier to insulin therapy from patient′s perspective were pain and fear of using injectable modality; 5.2% felt that the greatest barrier to insulin therapy from physician′s perspective was the treatment cost; 4.8% felt that the major barriers to achieve optimum diabetic care in practice was loss to follow-up followed by lack of counselling (3.9%) and treatment compliance (3.6%). Conclusion: DiabCare India 2011 has shown that type 2 diabetes sets in early in Indians and glycaemic control is often sub-optimal in these patients. These results indicate a need for more structured intervention at an early stage of the disease and need for increased awareness on benefits of good glycaemic control. It cannot be overemphasized that the status of diabetes care in India needs to be further improved. (ClinTrials.gov identifier: NCT01351922)

Motivated by the synthesis of controllers from high-level temporal specifications, we present two algorithms to compute dominant strategies for continuous two-player zero-sum games based on the Counter-Example Guided Inductive Synthesis (CEGIS) paradigm. In CEGIS, we iteratively propose candidate dominant strategies and find counterexamples. For scalability, past work has constrained the number of counterexamples used to generate new candidates, which leads to oscillations and incompleteness, even in very simple examples. The first algorithm combines Satisfiability Modulo Theory (SMT) solving with optimization to efficiently implement CEGIS. The second abstracts previously refuted strategies, while maintaining a finite counterexample set. We characterize sufficient conditions for soundness and termination, and show that both algorithms are sound and terminate. Additionally, the second approach can be made complete to within an arbitrary factor. We conclude by comparing across different variants of CEGIS.

Autonomous vehicles have found wide-ranging adoption in aerospace, terrestrial as well as marine use. These systems often operate in uncertain environments and in the presence of noisy sensors, and use machine learning and statistical sensor fusion algorithms to form an internal model of the world that is inherently probabilistic. Autonomous vehicles need to operate using this uncertain world-model, and hence, their correctness cannot be deterministically specified. Even once probabilistic correctness is specified, proving that an autonomous vehicle will operate correctly is a challenging problem. In this paper, we address these challenges by proposing a correct-by-synthesis approach to autonomous vehicle control. We propose a probabilistic extension of temporal logic, named Chance Constrained Temporal Logic (C2TL), that can be used to specify correctness requirements in presence of uncertainty. C2TL extends temporal logic by including chance constraints as predicates in the formula which allows modeling of perception uncertainty while retaining its ease of reasoning. We present a novel automated synthesis technique that compiles C2TL specification into mixed integer constraints, and uses second-order (quadratic) cone programming to synthesize optimal control of autonomous vehicles subject to the C2TL specification. We also present a risk distribution approach that enables synthesis of plans with lower cost without increasing the overall risk. We demonstrate the effectiveness of the proposed approach on a diverse set of illustrative examples.

We consider the problem of privacy enforcement for dynamic systems using the technique of obfuscation. Our approach captures the trade-off between privacy and utility, in a formal reactive framework. Specifically, we model a dynamic system as an automaton or labeled transition system with predefined secret behaviors. The system generates event strings for some useful computation (utility). At the same time, it must hide its secret behaviors from any outside observer of its behavior (privacy). We formally capture both privacy and utility specifications within the model of the system. We propose as obfuscation mechanism for privacy enforcement the use of edit functions that suitably alter the output behavior of the system by inserting, deleting, or replacing events in its output strings. The edit function must hide secret behaviors by making them observationally equivalent to non-secret behaviors, while at the same time satisfying the utility requirement on the output strings. We develop algorithmic procedures that synthesize a correct-by-construction edit function satisfying both privacy and utility specifications. The synthesis procedure is based on the solution of a game where the edit function must react to the system moves by suitable output editing. After presenting an explicit algorithm for solving for the winning strategies of the game, we present two complementary symbolic implementations to address scalability of our methodology. The first symbolic implementation uses a direct encoding of the explicit algorithm using binary decision diagrams (BDDs). The second symbolic implementation reframes the synthesis of edit functions as a supervisory control problem and then applies a recently-developed tool for solving supervisory control problems using BDDs. Experimental results comparing the two symbolic implementations are provided.

Author(s): Zheng Li [sup.1] , Shuai Zhao [sup.2] , Raman V. Nelakanti [sup.1] , Kaixuan Lin [sup.1] , Tao P. Wu [sup.1] [sup.7] , Myles H. Alderman III [sup.1] , [...], The recent discovery of N.sup.6-methyladenine (N.sup.6-mA) in mammalian genomes suggests that it may serve as an epigenetic regulatory mechanism.sup.1. However, the biological role of N.sup.6-mA and the molecular pathways that exert its function remain unclear. Here we show that N.sup.6-mA has a key role in changing the epigenetic landscape during cell fate transitions in early development. We found that N.sup.6-mA is upregulated during the development of mouse trophoblast stem cells, specifically at regions of stress-induced DNA double helix destabilization (SIDD).sup.2-4. Regions of SIDD are conducive to topological stress-induced unpairing of the double helix and have critical roles in organizing large-scale chromatin structures.sup.3,5,6. We show that the presence of N.sup.6-mA reduces the in vitro interactions by more than 500-fold between SIDD and SATB1, a crucial chromatin organizer that interacts with SIDD regions. Deposition of N.sup.6-mA also antagonizes SATB1 function in vivo by preventing its binding to chromatin. Concordantly, N.sup.6-mA functions at the boundaries between euchromatin and heterochromatin to restrict the spread of euchromatin. Repression of SIDD-SATB1 interactions mediated by N.sup.6-mA is essential for gene regulation during trophoblast development in cell culture models and in vivo. Overall, our findings demonstrate an unexpected molecular mechanism for N.sup.6-mA function via SATB1, and reveal connections between DNA modification, DNA secondary structures and large chromatin domains in early embryonic development. The DNA modification N.sup.6-methyladenine regulates gene expression during mouse trophoblast development by depositing at the boundaries of active chromatin and preventing its spread by antagonizing the chromatin organizer SATB1.

We consider the problem of synthesizing an obfuscation policy that enforces privacy while preserving utility with formal guarantees. Specifically, we consider plants modeled as finite automata with predefined secret behaviors. A given plant generates event strings for some useful computation, but meanwhile wants to hide its secret behaviors from any outside observer. We formally capture the privacy and utility specifications using the automaton model of the plant. To enforce both specifications, we propose an obfuscation mechanism where an edit function “edits” the plant’s output in a reactive manner. We develop algorithmic procedures that synthesize a correct-by-construction edit function satisfying both privacy and utility specifications. To address the state explosion problem, we encode the synthesis algorithm symbolically using Binary Decision Diagrams. We present EdiSyn, an implementation of our algorithms, along with experimental results demonstrating its performance on illustrative examples. This is the first work, to our knowledge, to successfully synthesize controllers satisfying both privacy and utility requirements.

We present a counterexample-guided inductive synthesis approach to controller synthesis for cyber-physical systems sub- ject to signal temporal logic (STL) specifications, operating in potentially adversarial nondeterministic environments. We encode STL specifications as mixed integer-linear constraints on the variables of a discrete-time model of the system and environment dynamics, and solve a series of optimization problems to yield a satisfying control sequence. We demonstrate how the scheme can be used in a receding horizon fashion to fulfill properties over unbounded horizons, and present experimental results for reactive controller synthesis for case studies in building climate control and autonomous driving.