Factors associated with spontaneous stone passage in a contemporary cohort of patients presenting with acute ureteric colic. Results from the MIMIC Study (A Multi-centre cohort study evaluating the role of Inflammatory Markers in patients presenting with acute ureteric Colic)

Objectives There is conflicting data on the role of white blood cell count (WBC) and other inflammatory markers in spontaneous stone passage in patients with acute ureteric colic. The aim of the study was to assess the relationship of WBC and other routinely collected inflammatory and clinical markers including stone size, stone position and Medically Expulsive Therapy use (MET) with spontaneous stone passage (SSP) in a large contemporary cohort of patients with acute ureteric colic. Subjects and Methods Multi‐centre retrospective cohort study coordinated by the British Urology Researchers in Surgical Training (BURST) Research Collaborative at 71 secondary care hospitals across 4 countries (United Kingdom, Republic of Ireland, Australia and New Zealand). 4170 patients presented with acute ureteric colic and a computer tomography confirmed single ureteric stone. Our primary outcome measure was SSP as defined by the absence of need for intervention to assist stone passage. Multivariable mixed effects logistic regression was used to explore the relationship between key patient factors and SSP. Results 2518 patients were discharged with conservative management and had further follow up with a SSP rate of 74% (n = 1874/2518). Sepsis after discharge with conservative management was reported in 0.6% (n = 16/2518). On multivariable analysis neither WBC, Neutrophils or CRP were seen to predict SSP, with an adjusted OR of 0.97 [95% CI 0.91 to 1.04, p = 0.38], 1.06 [95% CI 0.99 to 1.13, p = 0.1] and 1.00 [95% CI 0.99 to 1.00, p = 0.17], respectively. Medical expulsive therapy (MET) also did not predict SSP [adjusted OR 1.11 [95% CI 0.76 to 1.61]). However, stone size and stone position were significant predictors. SSP for stones 7mm. For stones in the upper ureter the SSP rate was 52% [95% CI 48 to 56], middle ureter was 70% [95% CI 64 to 76], and lower ureter was 83% [95% CI 81 to 85]. Conclusion In contrast to the previously published literature, we found that in patients with acute ureteric colic who are discharged with initial conservative management, neither WBC, Neutrophil count or CRP help determine the likelihood of spontaneous stone passage. We also found no overall benefit from the use of MET. Stone size and position are important predictors and our findings represent the most comprehensive stone passage rates for each mm increase in stone size from a large contemporary cohort adjusting for key potential confounders. We anticipate that these data will aid clinicians managing patients with acute ureteric colic and help guide management decisions and the need for intervention

Finite-Alphabet Constant-Amplitude Training Sequences for Multiple-Antennas

We propose a method to identify training sequences for multiple-antenna transmissions over quasi-static frequency-selective channels. These sequences are constructed to belong to a standard constant-amplitude 2m-PSK constellation (such as BPSK, QPSK etc) to simplify the transmitter/receiver implementation. Many practical systems use training of predetermined length. Optimal sequences do not exist for all training sequence lengths and constellation alphabets. The proposed method allows us to identify training sequences that belong to a standard constellation for an arbitrary training sequence length and an arbitrary number of unknown channel taps. Performance bounds derived indicate that these sequences achieve near-optimum performance

Reduced-Complexity Training Schemes for Multiple-Antenna Broadband Transmissions

This paper addresses the problem of training sequence design for multiple-antenna transmissions over quasi-static frequency-selective channels. As performance metric for channel estimation, mean square error is adopted. To achieve the minimum mean square error, the training sequences transmitted from the multiple antennas must have impulse-like auto-correlation and zero cross-correlation. We reduce the problem of designing multiple training sequences to the much easier and well-understood problem of designing a single training sequence with impulse-like auto-correlation. To this end, we propose to encode the training sequences with a space-time code, that may be the same or different from the space-time code that encodes the information symbols. Designing one instead of multiple training sequences reduces the search space significantly and simplifies the construction of optimal or suboptimal training sequences

Training-Based Channel Estimation for Multiple Antenna Broadband Transmissions

This paper addresses the problem of training sequence design for multiple-antenna transmissions over quasi-static frequency-selective channels. To achieve the channel estimation minimum mean square error, the training sequences transmitted from the multiple antennas must have impulse-like auto correlation and zero cross correlation. We reduce the problem of designing multiple training sequences to the much easier and well-understood problem of designing a single training sequence with impulse-like auto correlation. To this end, we propose to encode the training symbols with a space-time code, that may be the same or different from the space-time code that encodes the information symbols

Prefiltered M-BCJR Equalizer for MIMO Frequency-Selective Channels

This paper addresses the problem of soft equalization for space-time-coded transmissions over frequency-selective fading channels. The structure of the space-time code is embedded in the channel impulse response for efficient joint equalization and decoding. The proposed equalization/decoding approach uses a prefilter to concentrate the effective channel power in a small number of taps followed by a reduced-complexity maximum a posteriori probability (MAP) equalizer/decoder to produce soft decisions. The prefilter introduces residual intersymbol interference which degrades the performance of MAP when applied to the trellis of the shortened channel. However, the shape of the overall shortened channel impulse response allows the M-algorithm to approximate the prefiltered MAP performance with a small number of states. Based on this general framework, we investigate several enhancements such as using different prefilters for the forward and backward recursions, concatenating two trellis steps during decoding, and temporal oversampling. The performance is evaluated through simulations over the EDGE typical urban channel

Prefiltered space-time M-BCJR equalizer for frequency-selective channels

This paper addresses the problem of soft equalization for space-time-coded transmissions over frequency-selective fading channels. The structure of the space-time code is embedded in the channel impulse response for efficient joint equalization and decoding. The proposed equalization/decoding approach uses a prefilter to concentrate the effective channel power in a small number of taps followed by a reduced-complexity maximum a posteriori probability (MAP) equalizer/decoder to produce soft decisions. The prefilter introduces residual intersymbol interference which degrades the performance of MAP when applied to the trellis of the shortened channel. However, the shape of the overall shortened channel impulse response allows the M-algorithm to approximate the prefiltered MAP performance with a small number of states. Based on this general framework, we investigate several enhancements such as using different prefilters for the forward and backward recursions, concatenating two trellis steps during decoding, and temporal oversampling. The performance is evaluated through simulations over the EDGE typical urban channel