Summary
Background
Minimal hepatic encephalopathy (HE) and HE grade 1 (HE1) according to the West Haven criteria have recently been grouped as one entity named—covert HE‐ (CHE). Data regarding the ...impact of CHE on health‐related quality of life (HRQoL) and sleep quality are controversial.
Aim
First, to determine whether CHE affects HRQoL and sleep quality of cirrhotic patients and second, whether minimal HE (MHE) and HE1 affect HRQoL and sleep quality to a comparable extent.
Methods
A total of 145 consecutive cirrhotic patients were enrolled. HE1 was diagnosed clinically according to the West Haven criteria. Critical flicker frequency and the Psychometric Hepatic Encephalopathy Score were used to detect MHE. Chronic Liver Disease Questionnaire (CLDQ) was used to assess HRQoL and Pittsburgh Sleep Quality Index (PSQI) was applied to assess sleep quality.
Results
Covert HE was detected in 59 (40.7%) patients (MHE: n = 40; HE1: n = 19). Multivariate analysis identified CHE (P < 0.001) and female gender (P = 0.006) as independent predictors of reduced HRQoL (CLDQ total score). CHE (P = 0.021), low haemoglobin (P = 0.024) and female gender (P = 0.003) were identified as independent predictors of poor sleep quality (PSQI total score). Results of CLDQ and PSQI were comparable in patients with HE1 and MHE (CLDQ: 4.6 ± 0.9 vs 4.5 ± 1.2, P = 0.907; PSQI: 11.3 ± 3.8 vs 9.9 ± 5.0, P = 0.3).
Conclusion
Covert HE was associated with impaired HRQoL and sleep quality. MHE and HE1 affected both outcomes to a comparable extent supporting the use of CHE as a clinically useful term for patients with both entities of HE in clinical practice.
Linked ContentThis article is linked to Neuberger and Labenz and Wörns papers. To view these articles visit https://doi.org/10.1111/apt.14857 and https://doi.org/10.1111/apt.14867.
Introduction
Recurrent hemarthroses disturbing force/movement control are likely to impair postural balance.
Aim
To investigate the possible changes in static postural balance parameters in children ...with haemophilia (CwH) and to reveal its relationship with Haemophilia Joint Health Score (HJHS).
Methods
Twenty‐one CwH aged 6–18 who had haemophilic arthropathy in at least one lower limb joint and 21 healthy peers were evaluated by using a force platform. Centre of pressure (CoP) signals were displayed as a map in both anteroposterior direction (APD) and mediolateral direction (MLD) by statokinesigram. Accordingly, the amplitude, velocity and standard deviation of CoP displacements along with the perimeter and ellipse area were measured. Assessments were made under eyes opened and eyes closed in bipedal stance for 60 s. Joint health and muscle strength were evaluated with HJHS and digital dynamometer, respectively.
Results
Velocity and amplitude of CoP displacements in MLD were increased in CwH (p˂0.05). It was also found that these parameters were moderate correlated with the clinical score of the lower limb joints (p˂0.05). In CwH, standard deviation of CoP displacements in the APD was significantly higher in eyes closed, while standard deviation in MLD was significantly higher in eyes opened (p˂0.05).
Conclusion
Disturbances during bipedal stance reveal the need for balance evaluation in CwH. Increased mediolateral oscillations may be an early sign of disorders of the musculoskeletal system in CwH. In addition to improving joint health, postural balance exercises that increase MLD stability have to be included in the rehabilitation programme of CwH.
We study the downlink interference problem in a two-tier orthogonal frequency-division multiple-access (OFDMA) system. Assume that macro- and femtotiers share the same spectrum and that the femtotier ...uses a closed-access scheme. Cross-tier and intercell interference in the two tiers is investigated. Resorting to game theory and variational inequality (VI) theory, we formulate the problem mathematically and design algorithms for the solution. With the algorithms, the femto base stations (FBSs) can dynamically allocate their power according to the feedback from the macrotier to avoid cross-tier interference and to adapt to intercell interference. The overall power allocation of the femtotier reaches an equilibrium, provided that every FBS aims to maximize its own Shannon capacity. The algorithms can be distributively implemented and can mitigate the interference quickly without unnecessary performance loss. Simulation results are provided to demonstrate the performance of our algorithms and to compare with other related algorithms.
TORCH pattern recognition and particle identification performance Garcia Martin, L.M.; Blake, T.; Brook, N.H. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
10/2023, Volume:
1055
Journal Article
Peer reviewed
Open access
The TORCH detector aims to provide K/π (K/p) separation up to a momentum of about 10 (15) ▪ by measuring their time-of-flight at the LHCb detector. Prompt Cherenkov photons are produced in a quartz ...radiator bar of 10 mm thickness, and propagated via total internal reflection to the periphery of the detector, where they are focused onto an array of microchannel plate photomultipliers that measure the photon arrival time and position. Pattern recognition techniques are used to compare the likelihood that the detector image is due to a given particle hypothesis. Good performance is obtained even for very high detector occupancies.
Cluster analysis, which is to partition a dataset into groups so that similar elements are assigned to the same group and dissimilar elements are assigned to different ones, has been widely studied ...and applied in various fields. The two challenging tasks in clustering are determining the suitable number of clusters and generating clusters of arbitrary shapes. This paper proposes a new concept of “epsilon radius neighbors” which plays an essential role in the cluster-forming process, thereby determining both the number of clusters and the shape of clusters, automatically. Based on “epsilon radius neighbors,” a new clustering algorithm in which the epsilon radius value is adapted to the characteristics of each cluster in the current partition is proposed. Recently, clustering has been widely applied in environmental applications, including underground water quality monitoring. However, the existing studies have simply applied conventional clustering techniques, in which the abovementioned two challenging tasks have not been solved already. Therefore, in this paper, the proposed clustering algorithm is applied in assessing the underground water quality in Phu My Town, Ba Ria-Vung Tau Province, Vietnam. The experimental results on benchmark datasets demonstrate the effectiveness of the proposed algorithm. For the quality of underground water, the new algorithm results in four clusters with different characteristics. Through this application, we found that the new algorithm might provide valuable reference information for underground water management.
In this paper, we study a system consisting of a single source, a single destination, and multiple layers of parallel relays. The system is considered as a combination of broadcast channels, multiple ...input multiple output (MIMO) X channels, and multiple-access channels. Interference alignment (IA) is used throughout the whole system, and perfect channel state information (CSI) is assumed available at all the transmitters and receivers. Iterative algorithms are applied to find the proper transmit and receive matrices in the broadcast channels and multiple-access channels. For the MIMO X channels, based on IA technique, we design the transmit and receive beamforming matrices. Finally, in order to maximize the total transmission rate of the whole system, we optimize the power allocation of each transmitter.
In this paper, we extend the distributed power control problem for one-to-one transmissions in Gaussian interference channels to one-to-many transmission scenarios. We assume a user-centric wireless ...network where the end users play the roles of decision makers. We formulate the power control problem as a noncooperative game. New challenges arise due to the coupling issues among power strategy spaces of distributed end users, which make standard Nash equilibrium based noncooperative game approach inapplicable. Indeed, our problem turns out to be a generalized Nash equilibrium problem (GNEP). Resorting to variational inequality theory, we show several fundamental properties of the GNEP. Then we propose a penalty-based distributed algorithm IP^2JA, which possesses favorable properties for practical implementation. Numerical results are provided to verify our arguments and proposed algorithm.
Computed virtual chromoendoscopy (CVC) is a new imaging technique that enhances mucosal surface contrast and highlights the vascular pattern without the need for dye-spraying as in conventional ...chromoendoscopy. The aim of this prospective randomized pilot study with a crossover design was to compare CVC with conventional chromoendoscopy with acetic acid (CAA) for the detection of high grade intraepithelial neoplasia (HGIN) or early cancer in patients with Barrett's esophagus.
57 patients with Barrett's esophagus (mean length 3.8 cm) and a history of HGIN/early cancer or suspected HGIN/early cancer were randomly allocated to undergo either CAA or CVC. All patients were re-examined with the alternative procedure at 4 - 6 weeks after the initial endoscopy. The two procedures were performed by five endoscopists, who were blinded to the findings of the other examination. At each examination, targeted biopsies were taken from all detected lesions, followed by random four-quadrant biopsies.
In 24/57 patients, 30 lesions with HGIN/early cancer were detected. The sensitivity of targeted biopsies for HGIN/early cancer on a 'per lesion' basis was 87 % (26/30) for both CAA and CVC. The positive predictive value was 39 % (26/66) for CAA and 37 % (26/70) for CVC. In the 'per patient' analysis, sensitivity was 83 % (20/24) and 92 % (22/24) for CAA and CVC, respectively ( P = 0.617). Stepwise random four-quadrant biopsies identified only one patient with HGIN/early cancer that was missed by both, CAA and CVC.
Computed virtual chromoendoscopy is a helpful adjunct for surveillance of Barrett's esophagus and appears to be as accurate as conventional chromoendoscopy in the detection of HGIN/early cancer.
Summary
Nonerosive reflux disease (NERD) is commonly diagnosed in patients with symptoms of reflux. The aim of the present study was to determine whether high‐definition endoscopy (HD) plus equipped ...with the iScan function or chromoendoscopy with Lugol's solution might permit the differentiation of NERD patients from those without reflux symptoms, proven by targeted biopsies of endoscopic lesions. A total of 100 patients without regular intake of proton pump inhibitors and with a normal conventional upper endoscopy were prospectively divided into NERD patients and controls. A second upper endoscopy was performed using HD+ with additional iScan function and then Lugol's solution was applied. Biopsy specimens were taken from the gastroesophageal junction in all patients. A total of 65 patients with reflux symptoms and 27 controls were included. HD+ endoscopy with iScan revealed subtle mucosal breaks in 52 patients; the subsequent biopsies confirmed esophagitis in all cases. After Lugol's solution, 58 patients showed mucosal breaks. Sensitivity for the iScan procedure was 82.5%, whereas that for Lugol's solution was 92.06%. Excellent positive predictive values of 100% and 98.3%, respectively, were noted. The present study suggests that the majority of patients with NERD and typical symptoms of reflux disease can be identified by iScan or Lugol's chromoendoscopy as minimal erosive reflux disease (ERD) patients.
. The systemic response to ischemia-reperfusion that occurs after a cardiac arrest (CA) followed by the return of spontaneous circulation leads to endothelial toxicity and cytokine production, both ...responsible for the subsequent occurrence of severe cardiocirculatory dysfunction and early death. Resistin is emerging as a biomarker of proinflammatory status and myocardial ischemic injury and as a mediator of endothelial dysfunction. The study aimed to analyze the possible associations between several clinical and biological variables and the serum levels of resistin in CA survivors. Forty patients with out-of-hospital resuscitated CA, were enrolled in the study. Demographic, clinical and laboratory data (including serum resistin measurements at admission and at 6, 12, 24, 48 and 72 h) were recorded. For resistin, we calculated the area under the curve (AUC) using the trapezoidal method with measurements from 0 to 12 h, 0 to 24 h, 0 to 48 h and 0 to 72 h. Fifteen (37.5%) patients died in the first 72 h after CA. Cardiovascular comorbidities were present in 65% of patients. The majority of patients had post-CA shock (29 (72.5%)). Resistin serum levels rose in the first 12-24 h and decreased in the next 48-72 h. In univariate analysis, advanced age, longer duration of resuscitation, high sequential organ failure assessment score, high lactate levels, presence of cardiovascular comorbidities and the post-CA shock were associated with higher resistin levels. In multivariate analysis, post-CA shock or cardiovascular comorbidities were independently associated with higher AUCs for resistin for 0-12 h and 0-24 h. The only identified variable to independently predict higher AUCs for resistin for 0-48 h and 0-72 h was the presence of post-CA shock. Our data demonstrate strong independent correlation between high serum resistin levels, cardiac comorbidities and post-CA shock. The impact of the post-CA shock on serum concentration of resistin was greater than that of cardiac comorbidities.
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