Morphologic Alterations Precede Functional Hepatic Impairment as Determined by 13C-Methacetin Liver Function Breath Test in Adult Fontan Patients

Objectives: Fontan-associated liver disease (FALD) is the most common end-organ dysfunction affecting up to 70–80% of the Fontan population. The clinical significance of FALD is incompletely understood and no unambiguous correlation between hepatic function and FALD severity has been established. In this study, we sought to evaluate maximal liver function capacity with liver maximum function capacity test (LiMAx®) in adult Fontan patients.Methods: Thirty-nine adult Fontan patients (median age: 29.4 years [IQR 23.4; 37.4], median follow-up after Fontan operation: 23.9 years [IQR 17.8;26.4]) were analyzed in a cross-sectional observational study using LiMAx® test (Humedics GmbH, Berlin, Germany), laboratory testing, transient elastography (TE) and hepatic ultrasound. The LiMAx® test is based on the metabolism of 13C-methacetin, which is administered intravenously and cleaved by the hepatic cytochrome P4501A2 to paracetamol and 13CO2, which is measured in exhaled air and correlates with maximal liver function capacity.Results: Maximal liver function capacity assessed by LiMAx® test was normal in 28 patients (>315 μg/h*kg) and mildly to moderately impaired in 11 patients (140–314 μg/h*kg), while no patient displayed severe hepatic impairment (<139 μg/kg*h). No correlation was found between maximal liver function capacity and hepatic stiffness by TE (r2 = −0.151; p = 0.388) or the presence of sonographic abnormalities associated with FALD (r2 = −0.204, p = 0.24). There was, however, an association between maximal liver function capacity and the laboratory parameters bilirubin (r2 = −0.333, p = 0.009) and γ-glutamyl transferase (r2 = −0.367; p = 0.021). No correlation was detected between maximal liver function capacity and the severity of FALD (r2 = −0.235; p = 0.152).Conclusion: To the best of our knowledge, this is the first study to evaluate maximal liver function capacity using LiMAx® test in Fontan patients, which is a useful complementary diagnostic instrument to assess chronic hepatic injury. Maximal liver function capacity was preserved in most of our adult Fontan patients despite morphologic evidence of FALD. Moreover, maximal liver function capacity does not correlate with the extent of FALD severity evaluated by sonography or laboratory analysis. Thus, the development and progression of FALD in Fontan patients is not a uniform process and diagnostics of chronic hepatic injury during follow-up should encompass various modalities.

A Modified Nonsmooth Levenberg–Marquardt Algorithm for the General Mixed Complementarity Problem

As is well known, the mixed complementarity problem is equivalent to a nonsmooth equation by using a median function. By investigating the generalized Jacobi of a composite vector-valued maximum function, a nonsmooth Levenberg–Marquardt algorithm is proposed in this paper. In the present algorithm, we adopt a new LM parameter form and discuss the local convergence rate under the local error bound condition, which is weaker than nonsingularity. Finally, the numerical experiments and the application for the real-time pricing in smart grid illustrate the effectiveness of the algorithm.

Evaluation of Fingertip Injuries and Modalities of Flap Coverage in the Emergency Settings: A Retrospective Study

Background Fingertip comprises the nail complex and glabrous pulp, which is richly vascularized and innervated, built around the distal phalanx. The fingertip is commonly affected because it is the most distal part of the hand so it's easily to be injured during athletic participation, occupational activities or in accidents. Various fingertip reconstruction methods are reported as healing by secondary intention, shortening and primary closure, skin grafts and flaps. Flaps are considered when there's a big soft tissue loss or an exposed bone. Complications of fingertip reconstructions are common such as flexion deformity and neuroma. Objective In this study, we assessed and compared the outcomes of different modalities of soft tissue covemge using different flap techniques in cases of fingertip injuries as regalding the incidence of neuroma, necrosis, donor site morbidity, joint stiffness and sensory impairment, together with the patient satisfaction. Patients and Methods We analyzed a retrospective cohort study of 90 patients with 96 fingertip injuries who underwent coverage by various flap techniques at Ain Shams University Hospitals in the period between July 2017 and July 2019. Results The V-Y Advancement flap and the Cross-finger flap were the commonest flaps done in 26 cases (27.1%) and 25 cases (26.0%) respectively. There's a highly statistically significance in the incidence of necrosis in abdominal flap (100%) followed by Moberg flap (46.2%). In addition, there is a statistically significance in the incidence of neuroma in Moberg flap (53.8%). Most of patients who underwent coverage by flap technique were very satisfied by the results (60.4%). Conclusion Many techniques have been described for reconstruction of fingertip trauma including revision amputation, skin grafting, local flaps, distant flaps and free flaps. The treatment choice depends on many factors such as patient preference, culture, resources available and surgeon skills. The goals of reconstruction in fingertip amputations are to cover the defect with a satisfactory cosmetic appearance, establish maximum function and preservation of sensation.

Generating Set Search Method with Optimal Bind Tolerance for Solving the Economic Load Dispatch Problem of Thermal Stations

A non-derivative direct search approach called Generating Set Search (GSS) algorithm with varying bind tolerance to solve non-convex Economic Load Dispatch problem of the thermal stations in Nigeria is presented. A complete poll was carried out with initial mesh size of 1.0, expansion factor of 2.0 and contraction factor of 0.5. The binding tolerance was varied from 100 – 2200 with an increment of 100. The stopping criteria were based on the following: mesh tolerance of 0.000001, maximum iteration of 1500 and maximum function evaluation of 30000. The Economic Load Dispatch of 2500 MW, 3000 MW, 3500 MW and 4000 MW produced optimal solutions at binding tolerances of 500, 600, 1100, and 1600 respectively. The economic cost (measured in quantity of fuel) obtained for the dispatch of 2500 MW, 3000 MW, 3500 MW and 4000 MW were 83577.6936190168 MMBTU/hr, 83577.6936667599 MMBTU/hr, 83577.6937160183 MMBTU/hr and 83577.694264612 MMBTU/hr respectively. The evaluations carried out on the function in order to obtain the best solution were 1484, 5709, 6895 and 7556 for 2500 MW, 3000 MW, 3500 MW and 4000 MW of load respectively. Although the optimal bind tolerances had more iterations and evaluations, these can be traded off for the best solutions offered.<br>

Generating Set Search Method with Optimal Bind Tolerance for Solving the Economic Load Dispatch Problem of Thermal Stations

A non-derivative direct search approach called Generating Set Search (GSS) algorithm with varying bind tolerance to solve non-convex Economic Load Dispatch problem of the thermal stations in Nigeria is presented. A complete poll was carried out with initial mesh size of 1.0, expansion factor of 2.0 and contraction factor of 0.5. The binding tolerance was varied from 100 – 2200 with an increment of 100. The stopping criteria were based on the following: mesh tolerance of 0.000001, maximum iteration of 1500 and maximum function evaluation of 30000. The Economic Load Dispatch of 2500 MW, 3000 MW, 3500 MW and 4000 MW produced optimal solutions at binding tolerances of 500, 600, 1100, and 1600 respectively. The economic cost (measured in quantity of fuel) obtained for the dispatch of 2500 MW, 3000 MW, 3500 MW and 4000 MW were 83577.6936190168 MMBTU/hr, 83577.6936667599 MMBTU/hr, 83577.6937160183 MMBTU/hr and 83577.694264612 MMBTU/hr respectively. The evaluations carried out on the function in order to obtain the best solution were 1484, 5709, 6895 and 7556 for 2500 MW, 3000 MW, 3500 MW and 4000 MW of load respectively. Although the optimal bind tolerances had more iterations and evaluations, these can be traded off for the best solutions offered.<br>

Rehabilitation approach in oropharyngeal cancer: Case report

Introduction: Cancer rehabilitation can be preventive, restorative, supportive, and palliative. The rehabilitation goals change as the cancer pathway alters. Following any treatment for head and neck cancer, a physiatrist plays an essential role in preventing various complications and helping patients to mitigate impairments and restore function, optimizing their quality of life. Case description: This is a case study of a 56-year-old man with squamous cell cancer of the tongue managed with glossectomy, chemotherapy, and radiotherapy. He also has a remote history of acute myeloid leukemia involving the central nervous system, presenting with seizure and infective endocarditis. He underwent a sternotomy and an aortic valve replacement. His postoperative course was complicated by sternal infection, bradycardia with agonal breathing, and a weak pulse, for which the patient underwent cardiopulmonary resuscitation and achieved return of spontaneous circulation and was intubated and managed with antibiotics. He had a tracheostomy and underwent aggressive pulmonary toileting and suctioning in acute care. As the patient stabilized, he was transferred to in-patient rehabilitation. Interventions: While the patient was in the in-patient rehabilitation unit, cancer rehabilitation issues were addressed, including swallowing, pulmonary rehabilitation, management of upper-extremity deep venous thrombosis and infection, bowel and bladder issues, skin care, and evaluation of mental status. The patient’s cancer prognosis and future were discussed in collaboration with his oncologist. He was discharged with a palliative care plan. Conclusion: This report illustrates the significance of physical medicine and rehabilitation in management of cancer patients, as most cancer patients experience some deconditioning that results in physical challenges. As the prognosis for most types of cancers improves, it becomes more important to ensure that all cancer patients regain maximum function in the broadest sense to maximize their independence.

On distribution of a maximum of random variables

В работе исследуется способ идентификации методом Монте-Карло распределений нечетких случайных величин, в параметрическом задании которых присутствует функция максимума от взвешенных случайных величин. In this paper, we study a method for identifying by the Monte Carlo method distributions of fuzzy random variables, in the parametric setting of which there is a maximum function of weighted random variables.

THE MOSQUE BASED ZAKAT MANAGEMENT: A STUDY OF AMIL ZAKAT EXISTENCE IN BANJARMASIN

The main problem in this study is the legality of zakat managers' existence and the effectiveness of zakat management at mosques and langar in Banjarmasin as the most significant potential among Banjarmasin people who are known to be religious. The research seeks to reveal the existence and role, and efforts to revitalize the presence and function of amil zakat formed by the ta'mir/ mosque administrators who are the research objects. The research method applied is classified as field research. The research type is qualitative research. Data mining is carried out by interviewing the mosque ta'mir administrators and the committee / amil zakat and BAZNAS Banjarmasin administrators. Also, data collection is carried out by documentation. Based on the study results, it was found that the existence of amil zakat in most mosques in Banjarmasin. According to the zakat law, the form of committees was formed seasonally before Eid al-Fitr and did not formally and permanently establish management as Zakat Collection Units (UPZ). Only a small number of them have officially started the administration of amil zakat to become UPZ. The existence of amil, which is only ad hoc, has not shown the maximum function and role in the direction of zakat, especially in the management of zakat fitrah. Most of the amil/zakat committees formed by mosque administrators are only limited to serving the acceptance and distribution of zakat fitrah. The type of zakat mal is still relatively small. Regarding the optimization of the collection, especially the kind of zakat mal, the amil / mosque zakat committee, which is the subject of this research, has never made any efforts to pick up the ball (zakat mal) to the surrounding muzaki. Socialization or invitations for zakat distribution through amil's mosque are also only carried out in limited media (through mosque loudspeakers or banners).

Method for the Synthesis of Adaptive Algorithms for Estimating the Parameters of Dynamic Systems Based on the Decomposition Principle and the Joint Maximum Methodology

A method of synthesis of a filter for estimating the state of dynamic systems of Kalman type with an adaptive model built on the basis of the principle of decomposition of the system using kinematic relations from the condition of constancy of motion invariants has been developed. The structure of the model is determined from the condition of the maximum function of the generalized power up to a nonlinear synthesizing function that determines the rate of dissipation and, accordingly, the degree of structural adaptation. The resulting model has an explicit relation with the gradient of the estimation error functional, which makes it possible to adapt to the intensity of regular and random influences and can be used to construct a filter for estimating the state of the Kalman structure. On the basis of the developed method, a discrete algorithm is obtained and its comparative analysis with the classical Kalman filter is carried out.