Performance Analysis of Systems with Coupled and Decoupled RISs

We analyze and compare different methods for handling the mutual coupling in RIS-aided communication systems. A new mutual coupling aware algorithm is derived where the reactance of each element is updated successively with a closed-form solution. In comparison to existing element-wise methods, this approach leads to a considerably reduced computational complexity. Furthermore, we introduce decoupling networks for the RIS array as a potential solution for handling mutual coupling. With these networks, the system model reduces to the same structure as when no mutual coupling were present. Including decoupling networks, we can optimize the channel gain of a RIS-aided SISO system in closed-form which allows to analyze the scenario under mutual coupling analytically and to draw connections to the conventional transmit array gain. In particular, a super-quadratic channel gain can be achieved which scales as N^4 where N is the number of RIS elements

Dynamics in Liver Stiffness Measurements Predict Outcomes in Advanced Chronic Liver Disease

Background &amp; Aims:Liver stiffness measurements (LSMs) provide an opportunity to monitor liver disease progression and regression noninvasively. We aimed to determine the prognostic relevance of LSM dynamics over time for liver-related events and death in patients with chronic liver disease. Methods:Patients with chronic liver disease undergoing 2 or more reliable LSMs at least 180 days apart were included in this retrospective cohort study and stratified at baseline (BL) as nonadvanced chronic liver disease (non-ACLD, BL-LSM &lt; 10 kPa), compensated ACLD (cACLD; BL-LSM ≥ 10 kPa), and decompensated ACLD. Data on all consecutive LSMs and clinical outcomes were collected. Results: There were 2508 patients with 8561 reliable LSMs (3 per patient; interquartile range, 2–4) included: 1647 (65.7%) with non-ACLD, 757 (30.2%) with cACLD, and 104 (4.1%) with decompensated ACLD. Seven non-ACLD patients (0.4%) and 83 patients with cACLD (10.9%) developed hepatic decompensation (median follow-up, 71 months). A 20% increase in LSM at any time was associated with an approximately 50% increased risk of hepatic decompensation (hazard ratio, 1.58; 95% CI, 1.41–1.79; P &lt;.001) and liver-related death (hazard ratio, 1.45; 95% CI, 1.28–1.68; P &lt;.001) in patients with cACLD. LSM dynamics yielded a high accuracy to predict hepatic decompensation in the following 12 months (area under the receiver operating characteristics curve = 0.933). The performance of LSM dynamics was numerically better than dynamics in Fibrosis-4 score (0.873), Model for End-Stage Liver Disease (0.835), and single time-point LSM (BL-LSM: 0.846; second LSM: 0.880). Any LSM decrease to &lt;20 kPa identified patients with cACLD with a substantially lower risk of hepatic decompensation (hazard ratio, 0.13; 95% CI, 0.07–0.24). If reliable, LSM also confers prognostic information in decompensated ACLD. Conclusions: Repeating LSM enables an individual and updated risk assessment for decompensation and liver-related mortality in ACLD.</p

Post-treatment LSM rather than change during treatment predicts decompensation in patients with cACLD after HCV cure

Background &amp; Aims: Baveno VII has defined a clinically significant (i.e., prognostically meaningful) decrease in liver stiffness measurement (LSM) in cACLD as a decrease of ≥20% associated with a final LSM &lt;20 kPa or any decrease to &lt;10 kPa. However, these rules have not yet been validated against direct clinical endpoints. Methods: We retrospectively analysed patients with cACLD (LSM ≥10 kPa) with paired liver stiffness measurement (LSM) before (BL) and after (FU) HCV cure by interferon-free therapies from 15 European centres. The cumulative incidence of hepatic decompensation was compared according to these criteria, considering hepatocellular carcinoma and non-liver-related death as competing risks. Results: A total of 2,335 patients followed for a median of 6 years were analysed. Median BL-LSM was 16.6 kPa with 37.1% having ≥20 kPa. After HCV cure, FU-LSM decreased to a median of 10.9 kPa (&lt;10 kPa: 1,002 [42.9%], ≥20 kPa: 465 [19.9%]) translating into a median LSM change of -5.3 (-8.8 to -2.4) kPa corresponding to -33.9 (-48.0 to -15.9) %. Patients achieving a clinically significant decrease (65.4%) had a significantly lower risk of hepatic decompensation (subdistribution hazard ratio: 0.12, 95% CI 0.04-0.35, p &lt;0.001). However, these risk differences were primarily driven by a negligible risk in patients with FU-LSM &lt;10 kPa (5-year cumulative incidence: 0.3%) compared to a high risk in patients with FU-LSM ≥20 kPa (16.6%). Patients with FU-LSM 10-19.9 kPa (37.4%) also had a low risk of hepatic decompensation (5-year cumulative incidence: 1.7%), and importantly, the risk of hepatic decompensation did not differ between those with/without an LSM decrease of ≥20% (p = 0.550). Conclusions: FU-LSM is key for risk stratification after HCV cure and should guide clinical decision making. LSM dynamics do not hold significant prognostic information in patients with FU-LSM 10-19.9 kPa, and thus, their consideration is not of sufficient incremental value in the specific context of HCV cure. Impact and Implications: Liver stiffness measurement (LSM) is increasingly applied as a prognostic biomarker and commonly decreases in patients with compensated advanced chronic liver disease achieving HCV cure. Although Baveno VII proposed criteria for a clinically significant decrease, little is known about the prognostic utility of LSM dynamics (changes through antiviral therapy). Interestingly, in those with a post-treatment LSM of 10-19.9 kPa, LSM dynamics did not provide incremental information, arguing against the consideration of LSM dynamics as prognostic criteria. Thus, post-treatment LSM should guide the management of patients with compensated advanced chronic liver disease achieving HCV cure

Hepatocellular Cancer Surveillance in Patients with Advanced Chronic Liver Disease

BACKGROUND: Patients with advanced chronic liver disease (ACLD) are at high risk of developing hepatocellular carcinoma (HCC). Therefore, biannual surveillance is recommended. This large-scale multicenter study aimed to stratify the risk of HCC development in ACLD.METHODS: From 3016 patients with ACLD screened in 17 European and Chinese centers, 2340 patients with liver stiffness measurement (LSM) determined using different techniques (two-dimensional shear-wave elastography [2D-SWE], transient elastography, and point shear-wave elastography) and with different disease severities were included. Cox regression was used to explore risk factors for HCC. We used these data to create an algorithm, named PLEASE, but referred to in this manuscript as "the algorithm"; the algorithm was validated in internal and two external cohorts across elastography techniques.RESULTS: HCC developed in 127 (5.4%) patients during follow-up. LSM by 2D-SWE (hazard ratio: 2.28) was found to be associated with developing HCC, alongside age, sex, etiology, and platelet count (C-index: 0.8428). We thus established the algorithm with applicable cutoffs, assigning a maximum of six points: platelet count less than 150×10 9/l, LSM greater than or equal to 15 kPa, age greater than or equal to 50 years, male sex, controlled/uncontrolled viral hepatitis, or presence of steatotic liver diseases. Within 2 years, with a median follow-up of 13.7 months, patients in the high-risk group (≥4 points) had an HCC incidence of 15.6% (95% confidence interval [CI], 12.1% to 18.7%) compared with the low-risk group, at 1.7% (95% CI, 0.9% to 2.5%). CONCLUSIONS: Our algorithm stratified patients into two groups: those at higher risk of developing HCC and those at lower risk. Our data provide equipoise to test the prospective utility of the algorithm with respect to clinical decisions about screening patients with ACLD for incident HCC. (Funded by the German Research Foundation and others; ClinicalTrials.gov number, NCT03389152.).</p

Il monachesimo e la riforma ecclesiastica (1049-1122). Atti della quarta Settimana intern. di studio, Mendola, 23-29 agosto 1968

Semmler Josef. Il monachesimo e la riforma ecclesiastica (1049-1122). Atti della quarta Settimana intern. di studio, Mendola, 23-29 agosto 1968. In: Cahiers de civilisation médiévale, 15e année (n°60), Octobre-décembre 1972. pp. 329-334

Adolf Schmitt-Weigand. — Rechtspflegedelikte in der fränkischen Zeit. Münsterische Beiträge zur Rechts-und Staatswissenschaft.

Semmler Josef. Adolf Schmitt-Weigand. — Rechtspflegedelikte in der fränkischen Zeit. Münsterische Beiträge zur Rechts-und Staatswissenschaft.. In: Cahiers de civilisation médiévale, 6e année (n°21), Janvier-mars 1963. pp. 72-74

Adolf Schmitt-Weigand. — Rechtspflegedelikte in der fränkischen Zeit. Münsterische Beiträge zur Rechts-und Staatswissenschaft.

Semmler Josef. Adolf Schmitt-Weigand. — Rechtspflegedelikte in der fränkischen Zeit. Münsterische Beiträge zur Rechts-und Staatswissenschaft.. In: Cahiers de civilisation médiévale, 6e année (n°21), Janvier-mars 1963. pp. 72-74

Harold Willjung, ed. Das Konzil van Aachen 809.

Semmler Josef. Harold Willjung, ed. Das Konzil van Aachen 809.. In: Revue belge de philologie et d'histoire, tome 78, fasc. 2, 2000. Histoire medievale. moderne: et contemporaine - Middeleeuwse, modhrnf en hedendaagse geschiedenis. pp. 570-573