Background
The accuracy of diagnosis and clinical implications of the hepatoadrenal syndrome, as currently diagnosed using total cortisol, remain to be validated.
Aim
The aim of this study was to ...assess adrenal function using free cortisol in stable cirrhosis and study the potential implications of any abnormalities for renal and/or cardiac function.
Methods
Sixty-one stable consecutively enrolled patients with cirrhosis underwent assessment of adrenal function using the low-dose short Synacthen test, renal function by
51
Cr-EDTA glomerular filtration rate (GFR), and cardiac function by two-dimensional echocardiography.
Results
Eleven patients (18%) had total peak cortisol (PC) < 500 nmol/L, but no patient had free PC < 33 nmol/L indicating that diagnosis of AI using total cortisol is not confirmed using free cortisol. Free cortisol did not correlate with GFR or parameters of cardiac function. Patients with higher Child–Pugh class had progressively lower free cortisol. Patients with low GFR < 60 mL/min (
N
= 22) had more frequently grade II–III diastolic dysfunction (66.7% vs. 17.6%;
p
= 0.005) and had higher Child–Pugh and MELD score compared to those with normal GFR.
Conclusions
Diagnosis of AI using total cortisol is not confirmed using free cortisol and is thus considered unreliable in cirrhosis. Free cortisol is not associated with renal or cardiac dysfunction. Lower free cortisol in more advanced stages of liver disease might be secondary to decreased synthesis due to lower cholesterol levels. Irrespective of free cortisol, parameters of cardiac dysfunction are associated with renal impairment supporting the cardio–renal hypothesis.
In this paper the design and implementation of a re-configurable embedded system for capacitive sensor array interfacing is presented. The system uses a capacitance to frequency converter to measure ...the sensor variations and a soft processor core (LEON3) for reading the frequency values at specified time intervals and interfacing the system to the outside world. An embedded operating system (LINUX) is incorporated to facilitate and give flexibility to the system use. The proposed sensor interface can be used in different application domains. Two measurements examples are presented: a gas sensor array comprised of 4 sensors and a multi-axial textile tensile testing apparatus with 8 sensors.
