239 research outputs found
Impact of Hepatic Encephalopathy in Cirrhosis on Quality-of-Life Issues
Hepatic encephalopathy (HE) has a major impact on health-related quality of life (HRQOL) in patients, which has clinical and psychosocial consequences. HRQOL in cirrhosis has been measured by generic and liver-specific instruments, with most studies indicating a negative impact of HE. HRQOL abnormalities span daily functioning, sleep-wake cycle changes, and the ability to work. Of these, sleep-wake cycle changes have a major effect on HRQOL, which remains challenging to treat. The personal effect of HRQOL is modulated by the presence of HE, the etiology of cirrhosis, and cognitive reserve. Patients with higher cognitive reserve are able to tolerate HE and its impact on HRQOL better than those with a poor cognitive reserve. The impact of HRQOL impairment is felt by patients (higher mortality and poor daily functioning), as well as by caregivers and families. Caregivers of patients with HE bear a major financial and psychological burden, which may affect their personal health and longevity
Hepatic encephalopathy in patients with acute decompensation of cirrhosis and acute-on-chronic liver failure
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Hepatic encephalopathy in patients with acute decompensation of cirrhosis and acute-on-chronic liver failure
Transcranial Direct Corrent stimulation (tDCS) of the anterior prefrontal cortex (aPFC) modulates reinforcement learning and decision-making under uncertainty: A doubleblind crossover study
Reinforcement learning refers to the ability to acquire
information from the outcomes of prior choices (i.e.
positive and negative) in order to make predictions on the
effect of future decision and adapt the behaviour basing on
past experiences. The anterior prefrontal cortex (aPFC) is considered
to play a key role in the representation of event value,
reinforcement learning and decision-making. However, a
causal evidence of the involvement of this area in these processes
has not been provided yet. The aim of the study was to
test the role of the orbitofrontal cortex in feedback processing,
reinforcement learning and decision-making under uncertainly.
Eighteen healthy individuals underwent three sessions of
tDCS over the prefrontal pole (anodal, cathodal, sham) during
a probabilistic learning (PL) task. In the PL task, participants
were invited to learn the covert probabilistic stimulusoutcome
association from positive and negative feedbacks in
order to choose the best option. Afterwards, a probabilistic
selection (PS) task was delivered to assess decisions based
on the stimulus-reward associations acquired in the PL task.
During cathodal tDCS, accuracy in the PL task was reduced
and participants were less prone to maintain their choice after
positive feedback or to change it after a negative one (i.e., winstay
and lose-shift behavior). In addition, anodal tDCS affected
the subsequent PS task by reducing the ability to choose the
best alternative during hard probabilistic decisions. In conclusion,
the present study suggests a causal role of aPFC in feedback
trial-by-trial behavioral adaptation and decision-making
under uncertainty
Neuropsychiatric performance and treatment of hepatitis C with direct-acting antivirals: a prospective study
Background: Since direct-acting antivirals (DAAs) have been approved for the treatment of hepatitis C virus (HCV) infection, a small series of patients with new-onset neuropsychiatric alterations have been referred to us. We therefore set out to study neuropsychiatric function in relation to DAAs prospectively.
Methods: Ten patients with cirrhosis and 12 post-liver transplant (post-LT) patients were enrolled. All underwent wake electroencephalography (EEG) and a neuropsychological evaluation (paper and pencil battery, simple/choice reaction times, working memory task) at baseline, at the end of treatment with DAAs and after 6 months. At the same time points, full blood count, liver/kidney function tests, quantitative HCV RNA, ammonia and immunosuppressant drug levels were obtained, as appropriate.
Results: Patients with cirrhosis were significantly older than post-LT patients (65\ub112 vs 55\ub17 years; P<0.05). Neuropsychological performance and wake EEG were comparable in the two groups at baseline. At the end of a course of treatment with DAAs, a significant slowing in choice reaction times and in the EEG (increased relative delta power) was observed in patients with cirrhosis, which resolved after 6 months. In contrast, no significant changes over time were observed in the neuropsychiatric performance of post-LT patients. No significant associations were observed between neuropsychiatric performance and stand-alone/combined laboratory variables.
Conclusion: Some degree of neuropsychiatric impairment was observed in relation to treatment with DAAs in patients with cirrhosis, but not in post-LT patients, suggesting that the former may be sensitive to mild DAA neurotoxicity
A timely call to arms: COVID-19, the circadian clock, and critical care
We currently find ourselves in the midst of a global coronavirus disease 2019 (COVID-19) pandemic, caused by the highly infectious novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we discuss aspects of SARS-CoV-2 biology and pathology and how these might interact with the circadian clock of the host. We further focus on the severe manifestation of the illness, leading to hospitalization in an intensive care unit. The most common severe complications of COVID-19 relate to clock-regulated human physiology. We speculate on how the pandemic might be used to gain insights on the circadian clock but, more importantly, on how knowledge of the circadian clock might be used to mitigate the disease expression and the clinical course of COVID-19
Hepatic encephalopathy : novel insights into classification, pathophysiology and therapy
Hepatic encephalopathy (HE) is a frequent and serious complication of both chronic liver disease and acute liver failure. HE manifests as a wide spectrum of neuropsychiatric abnormalities, from subclinical changes (mild cognitive impairment) to marked disorientation, confusion and coma. The clinical and economic burden of HE is considerable, and it contributes greatly to impaired quality of life, morbidity and mortality. This review will critically discuss the latest classification of HE, as well as the pathogenesis and pathophysiological pathways underlying the neurological decline in patients with end-stage liver disease. In addition, management strategies, diagnostic approaches, currently available therapeutic options and novel treatment strategies are discussed
Expected accuracy of proximal and distal temperature estimated by wireless sensors, in relation to their number and position on the skin
A popular method to estimate proximal/distal temperature (TPROX and TDIST) consists in calculating a weighted average of nine wireless sensors placed on pre-defined skin locations. Specifically, TPROX is derived from five sensors placed on the infra-clavicular and mid-thigh area (left and right) and abdomen, and TDIST from four sensors located on the hands and feet. In clinical practice, the loss/removal of one or more sensors is a common occurrence, but limited information is available on how this affects the accuracy of temperature estimates. The aim of this study was to determine the accuracy of temperature estimates in relation to number/position of sensors removed. Thirteen healthy subjects wore all nine sensors for 24 hours and reference TPROX and TDIST time-courses were calculated using all sensors. Then, all possible combinations of reduced subsets of sensors were simulated and suitable weights for each sensor calculated. The accuracy of TPROX and TDIST estimates resulting from the reduced subsets of sensors, compared to reference values, was assessed by the mean squared error, the mean absolute error (MAE), the cross-validation error and the 25th and 75th percentiles of the reconstruction error. Tables of the accuracy and sensor weights for all possible combinations of sensors are provided. For instance, in relation to TPROX, a subset of three sensors placed in any combination of three non-homologous areas (abdominal, right or left infra-clavicular, right or left mid-thigh) produced an error of 0.13°C MAE, while the loss/removal of the abdominal sensor resulted in an error of 0.25°C MAE, with the greater impact on the quality of the reconstruction. This information may help researchers/clinicians: i) evaluate the expected goodness of their TPROX and TDIST estimates based on the number of available sensors; ii) select the most appropriate subset of sensors, depending on goals and operational constraints
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