Study on the Application Value of Liver Function and Serological Index Levels in the Diagnosis of Fatty Liver

Objective:To explore the application value of liver function and serological index detection in diagnosing fatty liver.Methods:Ninety patients with fatty liver disease(disease group)and ninety healthy subjects(healthy group)were selected as the subjects of this study.They all underwent liver function index testing and serological index testing.Test results were compared,and the diagnostic accuracy of single and combined tests was evaluated.Results:Liver function indicators of patients in the disease group were higher than those in the healthy group,with severe patients exhibiting higher levels than moderate patients and mild patients(P<0.05).Serological indicators in patients in the disease group were higher than those in the healthy group,with severe patients showing higher levels than moderate patients and mild patients(P<0.05).The diagnostic accuracy of liver function index testing was higher than that of serological index testing,and the accuracy of combined testing was higher than that of single testing(P<0.05).Conclusion:In diagnosing fatty liver,combining liver function testing and serological testing enables the initial diagnosis of the disease and facilitates the accurate assessment of its severity.

Semen analysis in 21st century medicine： the need for sperm function testing

Sperm function testing, once commonly performed for the infertile couple before employing assisted reproductive technology （ART）, has fallen out of favour in many reproductive medicine centers throughout the world. Indeed, the most recent addition of the ＇World Health Organisation （WHO） Laboratory Manual for the Examination and Processing of Hu- man Semen＇ now groups many of these procedures into a section termed Research Procedures. In large part, this reflects the current clinical practice of bypassing the in-depth evaluation of the male partner, while assuming that if a spermatozoon can be found for intracytoplasmic sperm injection （ICSI）, it must be a healthy cell capable of achieving fertilization. Never- theless, sperm function testing can provide valuable clinical insights into defects causing male infertility. Admittedly, in some cases, functional sperm deficiencies can be overcome using an ART. In other cases, couples will be empowered by the knowledge of the cause of their infertility, and for some couples, perhaps even the likelihood of ICSI success （relative to the spermatozoa）. The knowledge allows them to make truly informed reproductive decisions, including （perhaps） the de- cision to seek donor insemination, to adopt or to remain childless. Knowledge of the cause of their infertility may provide closure for couples and a sense of confidence regarding their choice of reproductive treatment.

THE SIGNIFICANCE OF TESTING PREOPERATIVE VISUAL FUNCTION IN CATARACT USING LASER INTERFEROMETRIC VISUAL ACUITY AND ERG

Tests of preoperative visual function and prediction of postoperative E chart visual acuity(ECVA) using laser interferometric visual acuity(LIVA) and electroretinogram(ERG) were performed in 16 cases(19 eyes) of cataract. The results showed that the coincident rate between preoperative LIVA and postoperative ECVA was 63.2%, and there was a parallel correlation between preoperative amplitude of photopic ERG b-wave and postoperative ECVA in 79.0% of the eyes. Comparing these two methods, the test of LIVA ...

High Heat Flux Testing of B_4C/Cu and SiC/Cu Functionally Graded Materials Simulated by Laser and Electron Beam

B4C, SiC and C, Cu functionally graded-materials (FGMs) have been developed by plasma spraying and hot pressing. Their high-heat flux properties have been investigated by high energy laser and electron beam for the simulation of plasma disruption process of the future fusion reactors, And a study on eroded products of B4C/Cu FGM under transient thermal load of electron beam was performed. In the experiment, SEM and EDS analysis indicated that B4C and SiC were decomposed, carbon was preferentially evaporated under high thermal load, and a part of Si and Cu were melted, in addition, the splash of melted metal and the particle emission of brittle destruction were also found. Different erosive behaviors of carbon-based materials (CBMs) caused by laser and electron beam were also discussed.

Rapid retinal functional testing

The most prominent causes of loss of vision in individuals over 50 years include age-related macular degeneration(AMD),glaucoma,and diabetic retinopathy(DR).While it is important to screen for these diseases effectively,current eye care is not properly doing so for much of the population,resulting in unfortunate visual disability and high costs for patients.Innovative functional testing can be unified with other screening methods for a more robust and safer screening and prediction of disease.The goal in the creation of functional testing modalities is to develop highly sensitive screening tests that are easy to use,accessible to all users,and inexpensive.The tests herein are deployed on an iPad with easily understood and intuitive instructions for rapid,streamlined,and automatic administration.These testing modalities could become highly sensitive screenings for early detection of potentially blinding diseases.The applications from our collaborators at AMA Optics include a cone photostress recovery test for detection of AMD and diabetic macular edema(DME),brightness balance perception for optic nerve dysfunction and especially glaucoma,color vision testing which is a broad screening tool,and visual acuity test.Machine learning with the combined structural and functional data will optimize identification of disease and prediction of outcomes.Here,we review and assess various tests of visual function that are easily administered on a tablet for screening in primary care.These user-friendly and simple screening tests allow patients to be identified in the early stages of disease for referral to specialists,proper assessment and treatment.

Liver dysfunction-related COVID-19:A narrative review

The coronavirus 2019 disease(COVID-19)is caused by a novel coronavirus,severe acute respiratory syndrome coronavirus 2.This disease was designated by the World Health Organization as a pandemic on March 11,2020,which is not seen before.There are no classical features among the cases of the disease owing to the involvement of nearly all body tissues by the virus.Hepatic involvement is one of the characteristics of the COVID-19 course.There are six possible mechanisms of such involvement:Direct virus injury,drug-induced effect,inflammatory cytokine storm,hypoxia-ischemic destruction,abnormalities in liver function tests,and pre-existing chronic liver diseases.Liver abnormalities are seen commonly in the severe or critical stage of COVID-19.Therefore,these abnormalities determine the COVID-19 severity and carry a high rate of morbidity and mortality.The elderly and patients with comorbidities like diabetes mellitus and hypertension are more vulnerable to liver involvement.Another issue that needs to be disclosed is the liver manifestations following the COVID-19 vaccination,such as autoimmune hepatitis.Of note,complete vaccination with third and fourth booster doses is necessary for patients with previous chronic liver diseases or those who have been subjected to liver transplantation.This review aims to explore the various aspects of liver dysfunction during the COVID-19 course regarding the epidemiological features,predisposing factors,pathophysiological mechanisms,hepatic manifestations due to COVID-19 or following vaccination,role of liver function tests in the assessment of COVID-19 severity,adverse effects of the therapeutic agents for the disease,and prognosis.

Lung Function Impairment among Gasoline Attendants: A Cross-Sectional Study

Background: Occupational health is an important consideration, especially for people that work in an environment with pollutants. Gasoline attendants are individuals that work in filling stations. They are constantly exposed to gasoline fumes and automobile engine products from vehicle exhaust. This increases the risk of acute and chronic respiratory diseases and carcinogenesis among them. The risk of health complications tends to increase with the duration of exposure. The study aimed to determine the proportion of gasoline attendants with lung function impairment. Methods and Materials: Two hundred and eight eligible participants were recruited for this study. A cross-sectional analytical study was carried out in Esan West local government area of Edo state, Nigeria. The study was carried out for a period of six months from December 2015 to May 2016. A questionnaire was used to obtain information on demographic characteristics, work history, mode of exposure and duration of exposure to petrol fumes. Lung function was assessed using a DTspiro spirometer (Model POP 10. Serial no 110843-005);also the anthropometric parameters of the respondent were measured. Statistical analysis was done using IBM SPSS version 20.0. Frequency and percentages were used to present categorical data. The mean and standard deviation of continuous variables were calculated and compared using the student’s t-test. The criteria of significant association were assumed for a p-value less than 0.05. Results: A total of one hundred and forty petrol pump attendants and one hundred and forty controls participated in this study. The mean age for petrol pump attendants was 24 ± 3.1 years and 23 ± 2.8 years for the control group. There were no significant differences in the gender distribution and anthropometric parameters as observed in this study. The lung impairment pattern observed in this study was obstructive in twelve (8.6%) gasoline pump attendants and restrictive pattern in thirty-nine (27.9%) gasoline pump attendants, while only four (2.9%) had an obstructive pattern and twelve (8.6%) had a restrictive pattern of lung impairment among the control group. This implies that a restrictive pattern was predominant. This study also observed that there was an increase in the number of gasoline pump attendants with declined lung function compared to the control group. Conclusion: Restrictive pattern of lung impairment was more predominant than the obstructive pattern among gasoline pump attendants. As a result, public health interventions should be instituted among these individuals, especially in developing countries.

Lung Function Impairment among Gasoline Attendants: A Cross-Sectional Study

Background: Occupational health is an important consideration, especially for people that work in an environment with pollutants. Gasoline attendants are individuals that work in filling stations. They are constantly exposed to gasoline fumes and automobile engine products from vehicle exhaust. This increases the risk of acute and chronic respiratory diseases and carcinogenesis among them. The risk of health complications tends to increase with the duration of exposure. The study aimed to determine the proportion of gasoline attendants with lung function impairment. Methods and Materials: Two hundred and eight eligible participants were recruited for this study. A cross-sectional analytical study was carried out in Esan West local government area of Edo state, Nigeria. The study was carried out for a period of six months from December 2015 to May 2016. A questionnaire was used to obtain information on demographic characteristics, work history, mode of exposure and duration of exposure to petrol fumes. Lung function was assessed using a DTspiro spirometer (Model POP 10. Serial no 110843-005);also the anthropometric parameters of the respondent were measured. Statistical analysis was done using IBM SPSS version 20.0. Frequency and percentages were used to present categorical data. The mean and standard deviation of continuous variables were calculated and compared using the student’s t-test. The criteria of significant association were assumed for a p-value less than 0.05. Results: A total of one hundred and forty petrol pump attendants and one hundred and forty controls participated in this study. The mean age for petrol pump attendants was 24 ± 3.1 years and 23 ± 2.8 years for the control group. There were no significant differences in the gender distribution and anthropometric parameters as observed in this study. The lung impairment pattern observed in this study was obstructive in twelve (8.6%) gasoline pump attendants and restrictive pattern in thirty-nine (27.9%) gasoline pump attendants, while only four (2.9%) had an obstructive pattern and twelve (8.6%) had a restrictive pattern of lung impairment among the control group. This implies that a restrictive pattern was predominant. This study also observed that there was an increase in the number of gasoline pump attendants with declined lung function compared to the control group. Conclusion: Restrictive pattern of lung impairment was more predominant than the obstructive pattern among gasoline pump attendants. As a result, public health interventions should be instituted among these individuals, especially in developing countries.

Research on Evacuation Path Planning Based on Improved Sparrow Search Algorithm

Reducing casualties and property losses through effective evacuation route planning has been a key focus for researchers in recent years.As part of this effort,an enhanced sparrow search algorithm(MSSA)was proposed.Firstly,the Golden Sine algorithm and a nonlinear weight factor optimization strategy were added in the discoverer position update stage of the SSA algorithm.Secondly,the Cauchy-Gaussian perturbation was applied to the optimal position of the SSA algorithm to improve its ability to jump out of local optima.Finally,the local search mechanism based on the mountain climbing method was incorporated into the local search stage of the SSA algorithm,improving its local search ability.To evaluate the effectiveness of the proposed algorithm,the Whale Algorithm,Gray Wolf Algorithm,Improved Gray Wolf Algorithm,Sparrow Search Algorithm,and MSSA Algorithm were employed to solve various test functions.The accuracy and convergence speed of each algorithm were then compared and analyzed.The results indicate that the MSSA algorithm has superior solving ability and stability compared to other algorithms.To further validate the enhanced algorithm’s capabilities for path planning,evacuation experiments were conducted using different maps featuring various obstacle types.Additionally,a multi-exit evacuation scenario was constructed according to the actual building environment of a teaching building.Both the sparrow search algorithm and MSSA algorithm were employed in the simulation experiment for multiexit evacuation path planning.The findings demonstrate that the MSSA algorithm outperforms the comparison algorithm,showcasing its greater advantages and higher application potential.

Leap Motion-based virtual reality training for improving motor functional recovery of upper limbs and neural reorganization in subacute stroke patients

Virtual reality is nowadays used to facilitate motor recovery in stroke patients. Most virtual reality studies have involved chronic stroke patients; however, brain plasticity remains good in acute and subacute patients. Most virtual reality systems are only applicable to the proximal upper limbs （arms） because of the limitations of their capture systems. Nevertheless, the functional recovery of an affected hand is most difficult in the case of hemiparesis rehabilitation after a stroke. The recently developed Leap Motion controller can track the fine movements of both hands and fingers. Therefore, the present study explored the effects of a Leap Motion-based virtual reality system on subacute stroke. Twenty-six subacute stroke patients were assigned to an experimental group that received virtual reality training along with conventional occupational rehabilitation, and a control group that only received conventional rehabilitation. The Wolf motor func- tion test （WMFT） was used to assess the motor function of the affected upper limb; functional magnetic resonance imaging was used to measure the cortical activation. After four weeks of treatment, the motor functions of the affected upper limbs were significantly improved in all the patients, with the improvement in the experimental group being significantly better than in the control group. The action perfor- mance time in the WMFT significantly decreased in the experimental group. Furthermore, the activation intensity and the laterality index of the contralateral primary sensorimotor cortex increased in both the experimental and control groups. These results confirmed that Leap Motion-based virtual reality training was a promising and feasible supplementary rehabilitation intervention, could facilitate the recovery of motor functions in subacute stroke patients. The study has been registered in the Chinese Clinical Trial Registry （registration number： ChiCTR-OCH- 12002238）.

Prognostic value of cortisol and thyroid function tests in poisoned patients admitted to toxicology ICU

BACKGROUND: Prognostic value of cortisol and thyroid function tests(TFTs) has previously been evaluated in medical ICUs. We aimed to evaluate prognostic efficacy of cortisol and TFTs in critically ill poisoned patients admitted to toxicology intensive care unit(ICU).METHODS: In a prospective study of consecutively enrolled subjects admitted to the toxicology ICU, lab analyses included TFTs(total T3 and T4 as well as TSH) and cortisol levels drawn between 8 am–10 am during period of the first 24 hours post-ingestion/exposure. Simplified Acute Physiology Score Ⅱ(SAPS Ⅱ) and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) were recorded. All scores were compared to detect the best prognostic factor. Type of poisoning was also included.RESULTS: In 200 patients evaluated, 129 were male and mean age was 31 years. In general, SAPS Ⅱ, T4, and cortisol could prognosticate death. After regression analysis, only cortisol had such efficacy(P=0.04; OR=1.06; 95%CI=1.05–1.08; cut-off=42 μg/d L; sensitivity=70%; specificity=82%). Between aluminium phosphide(ALP)-and non ALP-poisoned patients, level of consciousness, mean arterial pressure, and cortisol level could prognosticate death in ALP poisoning(all Ps<0.001 in both uni and multivariate analyses). Median(interquartile range; IQR) GCS was 7(6, 10) and 15(8, 15) in non-ALP and ALP-poisoned patients(P<0.003). SAPS Ⅱ and APACHE Ⅱ could not prognosticate death at all.CONCLUSION: Cortisol best prognosticated outcomes for subjects admitted to the toxicology ICU. Its level is higher in ALP-poisoned patients probably due to the higher stress while they remain conscious till the final stages of toxicity and are aware of deterioration of their clinical condition or may be due to their significantly lower blood pressures.

Abnormal liver function tests associated with severe rhabdomyolysis

Rhabdomyolysis is a syndrome of skeletal muscle injury with release of cellular constituents such as potassium,phosphate,urate and intracellular proteins such as myoglobin into the circulation,which may cause complications including acute kidney injury,electrolyte disturbance and cardiac instability.Abnormal liver function tests are frequently observed in cases of severe rhabdomyolysis.Typically,there is an increase in serum aminotransferases,namely aspartate aminotransferase and alanine aminotransferase.This raises the question of liver injury and often triggers a pathway of investigation which may lead to a liver biopsy.However,muscle can also be a source of the increased aminotransferase activity.This review discusses the dilemma of finding abnormal liver function tests in the setting of muscle injury and the potential implications of such an association.It delves into some of the clinical and experimental evidence for correlating muscle injury to raised aminotransferases,and discusses pathophysiological mechanisms such as oxidative stress which may cause actual liver injury.Serum aminotransferases lack tissue specificity to allow clinicians to distinguish primary liver injury from muscle injury.This review also explores potential approaches to improve the accuracy of our diagnostic tools,so that excessive or unnecessary liver investigations can be avoided.

Walking-friendly built environments and objectively measured physical function in older adults

Background:Few studies have examined the associations between urban design attributes and older adults’physical function.Especially,it is not well known how built-environment attributes may influence physical function in Asian cities.The aim of this study was to examine associations between objectively measured environmental attributes of walkability and objectively assessed physical function in a sample of Japanese older adults.Methods:Cross-sectional data collected in 2013 from 314 older residents(aged 65-84 years)living in Japan were used.Physical function was estimated from objectively measured upper-and lower-body function,mobility,and balance by a trained research team member.A comprehensive list of built-environment attributes,including population density,availability of destinations,intersection density,and distance to the nearest public transport station,were objectively calculated.Walk Score as a composite measure of neighborhood walkability was also obtained.Results:Among men,higher population density,availability of destinations,and intersection density were significantly associated with better physical function performance(1-legged stance with eyes open).Higher Walk Score was also marginally associated with better physical function performance(1-legged stance with eyes open).None of the environmental attributes were associated with physical function in elderly women.Conclusion:Our findings indicate that environmental attributes of walkability are associated with the physical function of elderly men in the context of Asia.Walking-friendly neighborhoods can not only promote older adults’active behaviors but can also support their physical function.

Sperm function tests after vasovasostomy

Aim: To evaluate the sperm function after vasovasostomy. Methods: Semen samples from 42 subjects aftervasovasostomy (Group A: 1-6 months, Group B: 6-12 months; Group C: 12-18 months after vasectomy rever-sal) were investigated. Semen from 34 normal fertile men was used as controls. Sperm function tests, including hypo-osmotic swelling test (HOST), acridine orange (AO) fluorescence, acrosome reaction (triple-stain), cervical mucuspenetration test (CMPT), etc were done. Results: After vasectomy reversal, the percentage of HOST was signifi-cantly lower than that of the normal fertile men. In regard to AO, there were no significant differences between thethree vasovasostomy groups and between these 3 groups and the controls. With triple-stain, the percentage of normalacrosome reaction was significantly lower in Group A as compared with the controls, but not in Groups B and C. Therewere no significant differences in the results of CMPT between the vasovasostomy groups and the controls. However,the number of 'poor' type was significantly higher in Groups A and C than in the controls; the percentage of 'nega-tive' type were higher in Groups A and B than in the controls. Conclusion: After vasovasostomy a lower level ofHOST remained for one year and gradually recovered after one year. Six months after vasectomy reversal, the percent-age of acrosome reaction could be changed from lower level to normal range. The data of AO indicated that the geneticmaterial (double-stranded DNA) in spermatozoa was not affected by vasovasostomy. To evaluate the result of CMPTafter vasectomy reversal, not only the normal results but also the abnormal results ('poor' and 'negative' types)should also be considered.Aim: To evaluate the sperm function after vasovasostomy. Methods: Semen samples from 42 subjects aftervasovasostomy (Group A: 1-6 months, Group B: 6-12 months; Group C: 12-18 months after vasectomy rever-sal) were investigated. Semen from 34 normal fertile men was used as controls. Sperm function tests, including hypo-osmotic swelling test (HOST), acridine orange (AO) fluorescence, acrosome reaction (triple-stain), cervical mucuspenetration test (CMPT), etc were done. Results: After vasectomy reversal, the percentage of HOST was signifi-cantly lower than that of the normal fertile men. In regard to AO, there were no significant differences between thethree vasovasostomy groups and between these 3 groups and the controls. With triple-stain, the percentage of normalacrosome reaction was significantly lower in Group A as compared with the controls, but not in Groups B and C. Therewere no significant differences in the results of CMPT between the vasovasostomy groups and the controls. However,the number of 'poor' type was significantly higher in Groups A and C than in the controls; the percentage of 'nega-tive' type were higher in Groups A and B than in the controls. Conclusion: After vasovasostomy a lower level ofHOST remained for one year and gradually recovered after one year. Six months after vasectomy reversal, the percent-age of acrosome reaction could be changed from lower level to normal range. The data of AO indicated that the geneticmaterial (double-stranded DNA) in spermatozoa was not affected by vasovasostomy. To evaluate the result of CMPTafter vasectomy reversal, not only the normal results but also the abnormal results ('poor' and 'negative' types)should also be considered.Aim: To evaluate the sperm function after vasovasostomy. Methods: Semen samples from 42 subjects aftervasovasostomy (Group A: 1-6 months, Group B: 6-12 months; Group C: 12-18 months after vasectomy rever-sal) were investigated. Semen from 34 normal fertile men was used as controls. Sperm function tests, including hypo-osmotic swelling test (HOST), acridine orange (AO) fluorescence, acrosome reaction (triple-stain), cervical mucuspenetration test (CMPT), etc were done. Results: After vasectomy reversal, the percentage of HOST was signifi-cantly lower than that of the normal fertile men. In regard to AO, there were no significant differences between thethree vasov

Does a combined intervention program of repetitive transcranial magnetic stimulation and intensive occupational therapy affect cognitive function in patients with post-stroke upper limb hemiparesis?

Low-frequency repetitive transcranial magnetic stimulation（LF-r TMS） to the contralesional hemisphere and intensive occupational therapy（i OT） have been shown to contribute to a significant improvement in upper limb hemiparesis in patients with chronic stroke. However, the effect of the combined intervention program of LF-r TMS and i OT on cognitive function is unknown. We retrospectively investigated whether the combined treatment influence patient＇s Trail-Making Test part B（TMT-B） performance, which is a group of easy and inexpensive neuropsychological tests that evaluate several cognitive functions. Twenty-five patients received 11 sessions of LF-r TMS to the contralesional hemisphere and 2 sessions of i OT per day over 15 successive days. Patients with right- and left-sided hemiparesis demonstrated significant improvements in upper limb motor function following the combined intervention program. Only patients with right-sided hemiparesis exhibited improved TMT-B performance following the combined intervention program, and there was a significant negative correlation between Fugl-Meyer Assessment scale total score change and TMT-B performance. The results indicate the possibility that LF-r TMS to the contralesional hemisphere combined with i OT improves the upper limb motor function and cognitive function of patients with right-sided hemiparesis. However, further studies are necessary to elucidate the mechanism of improved cognitive function.

Advances in preoperative assessment of liver function

BACKGROUND： Postoperative liver failure remains a lifethreatening complication. Preoperative evaluation of liver function is essential in reducing the complications after hepatectomy. However, it is difficult to accurately evaluate liver function before surgery because of the limitations of the liver function tests available. Recent advances in liver function tests improved the ability to assess liver function. The present review was to analyze these methods and their advantages.DATA SOURCES： MEDLINE was searched using the terms of ＂liver function test＂, ＂liver function evaluation＂ and ＂galactosyl serum albumin＂. Relevant articles published in English and Chinese from 1961 to 2014 were reviewed.RESULTS： Although serological tests are used frequently in practice, they reflect the degree of total liver damage or function, not the remnant of liver function. Child-Pugh score and model for end-stage liver disease（MELD） score assess whole liver function, and are particularly useful in determining whether patients with hepatocellular carcinoma and cirrhosis are candidates for resection or transplantation, but cannot determine the safe extent or removal. The indocyanine green and other metabolic quantitative liver function tests can evaluate functional hepatocytes, making them more accurate in predicting liver function. Computed tomography（CT）volumetry can provide anatomic information on the remnant liver volume but not on functional volume. 99mTc-galactosyl serum albumin scintigraphy, combined with single photon emission computed tomography, CT and three-dimensional reconstruction, may be a better quantitative measure of liver function, especially of remnant liver function.CONCLUSIONS： Tests used to evaluate liver functional reserve and to predict surgical risk have limitations. 99mTc-galactosylserum albumin scintigraphy, which can more accurately evaluate the whole and regional liver function, may be promising in predicting resection margins and risks of liver failure.

Liver function in COVID-19 infection

Coronavirus disease 2019(COVID-19)disease affects multiple organs,including anomalies in liver function.In this review we summarize the knowledge about liver injury found during severe acute respiratory syndrome coronavirus 2(SARSCoV-2)infection with special attention paid to possible mechanisms of liver damage and abnormalities in liver function tests allowing for the evaluation of the severity of liver disease.Abnormalities in liver function observed in COVID-19 disease are associated with the age and sex of patients,severity of liver injury,presence of comorbidity and pre-treatment.The method of antiviral treatment can also impact on liver function,which manifests as increasing values in liver function tests.Therefore,analysis of variations in liver function tests is necessary in evaluating the progression of liver injury to severe disease.

Is forced oscillation technique the next respiratory function test of choice in childhood asthma

Respiratory diseases, especially asthma, are common in children. While spirometry contributes to asthma diagnosis and management in older children, it has a limited role in younger children whom are often unable to perform forced expiratory manoeuvre. The development of novel diagnostic methods which require minimal effort, such as forced oscillation technique(FOT) is, therefore, a welcome and promising addition. FOT involves applying external, small amplitude oscillations to the respiratory system during tidal breathing. Therefore, it requires minimal effort and cooperation. The FOT has the potential to facilitate asthma diagnosis and management in preschool children by faciliting the objective measurement of baseline lung function and airway reactivity in children unable to successfully perform spirometry. Traditionally the use of FOT was limited to specialised centres. However, the availability of commercial equipment resulted in its use both in research and in clinical practice. In this article, we review the available literature on the use of FOT in childhood asthma. The technical aspects of FOT are described followed by a discussion of its practical aspects in the clinical field including the measurement of baseline lung function and associated reference ranges, bronchodilator responsiveness and bronchial hyperresponsiveness. We also highlight the difficulties and limitations that might be encountered and future research directions.

Implementation of a Subjective Visual Vertical and Horizontal Testing System Using Virtual Reality

Subjective visual vertical(SVV)and subjective visual horizontal(SVH)tests can be used to evaluate the perception of verticality and horizontality,respectively,and can aid the diagnosis of otolith dysfunction in clinical practice.In this study,SVV and SVH screen version tests are implemented using virtual reality(VR)equipment;the proposed test method promotes a more immersive feeling for the subject while using a simple equipment configuration and possessing excellent mobility.To verify the performance of the proposed VR-based SVV and SVH tests,a reliable comparison was made between the traditional screen-based SVV and SVH tests and the proposed method,based on 30 healthy subjects.The average results of our experimental tests on the VR-based binocular SVV and SVH equipment were−0.15◦±1.74 and 0.60◦±1.18,respectively.The proposed VR-based method satisfies the normal tolerance for horizontal or vertical lines,i.e.,a±3◦error,as defined in previous studies,and it can be used to replace existing test methods.

Liver function tests and metabolic-associated fatty liver disease:Changes in upper normal limits,does it really matter?

BACKGROUND Metabolic-associated fatty liver disease(MAFLD)is the commonest cause of abnormal liver function tests(LFTs).Current upper normal of limit(UNL)of LFTs was derived from a“healthy”population,where undiagnosed MAFLD and viral hepatitis might be suspected.AIM To evaluated potential implications of changes in UNL of alanine aminotransferase(ALT)in MAFLD.METHODS We retrospectively assessed consecutive first referrals with a diagnosis of MAFLD from 2010 to 2017.The conventional UNL of ALT was 45 IU/L for men and 34 IU/L for women,while a low UNL of ALT was 30 IU/L for men and 19 IU/L for women.The UNL of aspartate aminotransferase(AST)was 40 IU/L.RESULTS Total 436 patients were enrolled;of these,288 underwent liver biopsy.Setting a lower UNL reduced the percentage of those with significant disease despite normal ALT;specifically,patients with advanced fibrosis(F≥F3)or definite“metabolic-associated steato-hepatitis(MASH)”(NAS≥5)within normal ALT decreased from 10%to 1%and from 28%to 4%respectively.However,the proportion of those with elevated ALT and no evidence of advanced fibrosis or“definite MASH”increased from 39%to 47%and from 3%to 19%.Overall,LFTs performed poorly in distinguishing“definite MASH”from simple steatosis(receiver operating characteristic areas under the curves 0.59 for ALT and 0.55 for AST).CONCLUSION Liver function tests might both under-and overestimate MASH-related liver disease.Reducing the UNL might not be beneficial and imply an increase in healthcare burden.Risk stratification in MAFLD should rely on a combination of risk factors,not on LFTs alone.