Refractory gastro-oesophageal reflux disease : a major management issue in clinical practice

CITATION: Van Rensburg, C. 2009. Refractory gastro-oesophageal reflux disease : a major management issue in clinical practice. Continuing Medical Education, 27(5):210-214.The original publication is available at http://www.cmej.org.zahttp://www.cmej.org.za/index.php/cmej/issue/view/98/showTocPublisher's versio

Management of Acute Gastric Ulcer Bleeding

No Abstract

A SiGe BiCMOS LNA for mm-wave applications

A 5 GHz continuous unlicensed bandwidth is available at millimeter-wave (mm-wave) frequencies around 60 GHz and offers the prospect for multi gigabit wireless applications. The inherent atmospheric attenuation at 60 GHz due to oxygen absorption makes the frequency range ideal for short distance communication networks. For these mm-wave wireless networks, the low noise amplifier (LNA) is a critical subsystem determining the receiver performance i.e., the noise figure (NF) and receiver sensitivity. It however proves challenging to realise high performance mm-wave LNAs in a silicon (Si) complementary metal-oxide semiconductor (CMOS) technology. The mm-wave passive devices, specifically on-chip inductors, experience high propagation loss due to the conductivity of the Si substrate at mm-wave frequencies, degrading the performance of the LNA and subsequently the performance of the receiver architecture. The research is aimed at realising a high performance mm-wave LNA in a Si BiCMOS technology. The focal points are firstly, the fundamental understanding of the various forms of losses passive inductors experience and the techniques to address these issues, and secondly, whether the performance of mm-wave passive inductors can be improved by means of geometry optimising. An associated hypothesis is formulated, where the research outcome results in a preferred passive inductor and formulates an optimised passive inductor for mm-wave applications. The performance of the mm-wave inductor is evaluated using the quality factor (Q-factor) as a figure of merit. An increased inductor Q-factor translates to improved LNA input and output matching performance and contributes to the lowering of the LNA NF. The passive inductors are designed and simulated in a 2.5D electromagnetic (EM) simulator. The electrical characteristics of the passive structures are exported to a SPICE netlist which is included in a circuit simulator to evaluate and investigate the LNA performance. Two LNAs are designed and prototyped using the 13μ-m SiGe BiCMOS process from IBM as part of the experimental process to validate the hypothesis. One LNA implements the preferred inductor structures as a benchmark, while the second LNA, identical to the first, replaces one inductor with the optimised inductor. Experimental verification allows complete characterization of the passive inductors and the performance of the LNAs to prove the hypothesis. According to the author's knowledge, the slow-wave coplanar waveguide (S-CPW) achieves a higher Q-factor than microstrip and coplanar waveguide (CPW) transmission lines at mm-wave frequencies implemented for the 130 nm SiGe BiCMOS technology node. In literature, specific S-CPW transmission line geometry parameters have previously been investigated, but this work optimises the signal-to-ground spacing of the S-CPW transmission lines without changing the characteristic impedance of the lines. Optimising the S-CPW transmission line for 60 GHz increases the Q-factor from 38 to 50 in simulation, a 32 % improvement, and from 8 to 10 in measurements. Furthermore, replacing only one inductor in the output matching network of the LNA with the higher Q-factor inductor, improves the input and output matching performance of the LNA, resulting in a 5 dB input and output reflection coefficient improvement. Although a 5 dB improvement in matching performance is obtained, the resultant noise and gain performance show no significant improvement. The single stage LNAs achieve a simulated gain and NF of 13 dB and 5.3 dB respectively, and dissipate 6 mW from the 1.5 V supply. The LNA focused to attain high gain and a low NF, trading off linearity and as a result obtained poor 1 dB compression of -21.7 dBm. The LNA results are not state of the art but are comparable to SiGe BiCMOS LNAs presented in literature, achieving similar gain, NF and power dissipation figures.Dissertation (MEng)--University of Pretoria, 2012.Electrical, Electronic and Computer Engineeringunrestricte

APRI: A simple bedside marker for advanced fibrosis that can avoid liver biopsy in patients with NAFLD/NASH

Background. Non-alcoholic steatohepatitis (NASH) can lead to cirrhosis and hepatocellular carcinoma. The NASH fibrosis score (NFS) has proven to be a reliable, non-invasive marker for prediction of advanced fibrosis. Aspartate aminotransferase-to-platelet ratio index (APRI) is a simpler calculation than NFS, but has never been studied in patients with non-alcoholic fatty liver disease (NAFLD). Aim. To validate APRI as a non-invasive marker of liver fibrosis in subjects with NAFLD to be used in clinical practice. Design/Methods. The cohort consisted of 111 patients with histological diagnoses of NAFLD. The biopsy samples were staged and graded according to the NASH clinical research network (CRN) criteria. These were grouped into fatty liver disease (FLD), NASH, no/mild fibrosis, and advanced fibrosis. The sensitivity and specificity of APRI were compared with NFS and aspartate aminotransferase-to-alanine aminotransferase (AST/ALT) ratio. Results. The APRI was significantly higher in the advanced fibrosis group. The area under receiver operating characteristic (ROC) curve for APRI was 0.85 with an optimal cut-off of 0.98, giving a sensitivity of 75% and a specificity of 86%. The NFS was significantly lower in the advanced fibrosis group. The ROC for NFS gave an area under curve (AUC) of 0.77 and a cut-off value of -1.3 with a sensitivity of 76% and specificity of 69%. The positive predictive value for APRI was 54% as opposed to 34% for NFS. The negative predictive value was 93% for APRI and 94% for NFS. Conclusion. APRI compared favourably to NFS and was superior to AST/ALT for the prediction of advanced fibrosis. We therefore propose the use of APRI in a new algorithm for the detection of advanced fibrosis

Reliability and validity of the Gastrointestinal Symptom Rating Scale (GSRS) and Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire in dyspepsia: A six-country study

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