***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: UNLABELLED Patients with minimal hepatic encephalopathy ( MHE ) have impaired driving skills , but association of MHE with motor vehicle crashes is unclear . St and ard psychometric tests ( SPT ) or inhibitory control test ( ICT ) can be used to diagnose MHE . The aim was to determine the association of MHE with crashes and traffic violations over the preceding year and on 1-year follow-up . Patients with cirrhosis were diagnosed with MHE by ICT ( MHEICT ) and SPT ( MHESPT ) . Self and department-of-transportation (DOT)-reports were used to determine crashes and violations over the preceding year . Agreement between self and DOT-reports was analyzed . Patients then underwent 1-year follow-up for crash/violation occurrence . Crashes in those with/without MHEICT and MHESPT were compared . 167 patients with cirrhosis had DOT-reports , of which 120 also had self-reports . A significantly higher proportion of MHEICT patients with cirrhosis experienced crashes in the preceding year compared to those without MHE by self-report ( 17 % vs 0.0 % , P = 0.0004 ) and DOT-reports ( 17 % vs 3 % , P = 0.004 , relative risk : 5.77 ) . SPT did not differentiate between those with/without crashes . A significantly higher proportion of patients with crashes had MHEICT compared to MHESPT , both self-reported ( 100 % vs 50 % , P = 0.03 ) and DOT-reported ( 89 % vs 44 % , P = 0.01 ) . There was excellent agreement between self and DOT-reports for crashes and violations ( Kappa 0.90 and 0.80 ) . 109 patients were followed prospect ively . MHEICT patients had a significantly higher future crashes/violations compared to those without ( 22 % vs 7 % , P = 0.03 ) but MHESPT did not . MHEICT ( Odds ratio : 4.51 ) and prior year crash/violation ( Odds ratio : 2.96 ) were significantly associated with future crash/violation occurrence . CONCLUSION Patients with cirrhosis and MHEICT have a significantly higher crash rate over the preceding year and on prospect i ve follow-up compared to patients without MHE . ICT , but not SPT performance is significantly associated with prior and future crashes and violations . There was an excellent agreement between self- and DOT-reports AIM to determine the effect of L-ornithine-L-aspartate ( LOLA ) together with the nutritional improvement and branched chain amino acids ( BCAAs ) substitution , on encephalopathy in liver cirrhosis with malnutrition . METHODS liver cirrhosis patients visited Cipto mangunkusumo Hospital in June-October 2009 were evaluated by critical flicker frequency ( CFF ) test . Encephalopathy is defined when CFF < 39 Hz . Nutritional status is measured by the mid-arm muscle circumference ( MAMC ) and is stated as malnutrition when MAMC < 15 % . All subjects who fulfilled the inclusion criteria received education for adequate calories and protein intake , and then they were be divided into 2 groups by r and omization . One group was given LOLA granules 3 x 6 g/d for 2 weeks , while another group was not . Then their prealbumin and CFF test were measured again . Statistical analysis conducted for this double blind r and omized clinical trial was independent student t test . RESULTS there were 34 liver cirrhosis patients fit the inclusion criteria , and by r and omization 17 subjects were put into group A ( received LOLA ) and 17 subjects into group B ( without LOLA ) . Statistical analysis obtained the statistically significant ( p=0,016 ) of increasing of the mean CFF value in group A ( 2.41 ± 1.6 Hz ) compared to group B ( 0.67 ± 2.3 Hz ) . However , there was not significant increasing of prealbumin level in group A compared to group B ( 1 ± 1.3 mg/dL vs 1.2 ± 1.4 mg/dL , respectively ( p=0,59 ) . Furthermore , after 2 weeks of treatment there was no significant increase of ureum and creatinine level in both groups ( 4 ± 0.5 mg/dL vs 9.3 ± 1.3 mg/dL , ( p=0.4 ) for ureum , -0.1 ( 0.1 ) mg/dL vs 0.1 ± 0.1 mg/dL , ( p=0.3 ) for creatinine . CONCLUSION minimal hepatic encephalopathy with malnutrition can be given a diet of 35 - 40 cal/kgBW and 1.5 g protein/kgBW including BCAA substitution to improve nutritional status , and LOLA granules can be given to improve encephalopathy A representation and interpretation of the area under a receiver operating characteristic ( ROC ) curve obtained by the " rating " method , or by mathematical predictions based on patient characteristics , is presented . It is shown that in such a setting the area represents the probability that a r and omly chosen diseased subject is ( correctly ) rated or ranked with greater suspicion than a r and omly chosen non-diseased subject . Moreover , this probability of a correct ranking is the same quantity that is estimated by the already well-studied nonparametric Wilcoxon statistic . These two relationships are exploited to ( a ) provide rapid closed-form expressions for the approximate magnitude of the sampling variability , i.e. , st and ard error that one uses to accompany the area under a smoothed ROC curve , ( b ) guide in determining the size of the sample required to provide a sufficiently reliable estimate of this area , and ( c ) determine how large sample sizes should be to ensure that one can statistically detect differences in the accuracy of diagnostic techniques BACKGROUND AND AIMS : Minimal hepatic encephalopathy ( MHE ) is associated with poor quality of life and increased work disability in cirrhotic patients . Its prevalence in extrahepatic portal vein obstruction ( EHPVO ) is not known . We studied the prevalence of MHE in EHPVO patients and utility of critical flicker frequency ( CFF ) for diagnosing MHE . PATIENTS AND METHODS : Thirty-four EHPVO patients with a history of variceal bleed ( age 23.2 ± 11.2 yr , M : F 22:12 ) diagnosed by either Doppler US or MR angiography  , which demonstrated portal vein obstruction and /or portal vein cavernoma , were evaluated by psychometry ( number connection tests A , B or figure connection tests A , B ) and P300 auditory event-related potential ( P300ERP ) . CFF was also evaluated . MHE was diagnosed by abnormal psychometry ( > 2 st and ard deviation [ SD ] ) and /or P300ERP ( > 2.5 SD ) . RESULTS : Prevalence of MHE ( N = 12 ) was 35.3 % . Of 34 patients , P300ERP was abnormal ( 380.0 ± 28.9 msec ) in 11 ( 32 % ) , psychometry in 9 ( 26.4 % ) , both P300ERP and psychometry in 8 ( 23.5 % ) , and CFF < 38 Hz in 7 ( 21 % ) patients . Six ( 67 % ) patients with abnormal psychometry and 7 ( 64 % ) with abnormal P300ERP had CFF below 38 Hz . CFF had sensitivity ( 75 % ) , specificity ( 96 % ) , positive predictive value ( 86 % ) , negative predictive value ( 93 % ) , and diagnosis accuracy of 91 % when compared to patients with both abnormal psychometry and P300ERP . The venous ammonia level was higher in patients with MHE ( 83.1 ± 29.7 vs 44.7 ± 16.1 μmol/L , P < 0.001 ) compared to patients without MHE . Spontaneous shunts were present in 67 % of patients with MHE compared to 14 % of non-MHE patients . MHE was more common in patients with spontaneous shunts ( 72.7 % vs 17.4 % , P= 0.001 ) than without spontaneous shunts . CONCLUSIONS : Prevalence of MHE in EHPVO patients is 35.3 % , and CFF alone can reliably diagnose 88 % of MHE patients with both abnormal psychometry and P300ERP . However , in view of the relatively low number of patients with MHE , the usefulness of CFF in this setting awaits confirmatory studies UNLABELLED The diagnosis of hepatic encephalopathy ( HE ) relies on clinical , neurophysiological , psychometric and laboratory variables . The relationships between such tests remain debated . The aim of this study was to determine the laboratory correlates/prognostic value of neurophysiological/psychometric abnormalities in patients with cirrhosis . Seventy-two patients and 14 healthy volunteers underwent EEG and paper- and -pencil psychometry ( PHES ) .  Blood was obtained for C reactive protein ( CRP ) , interleukin 6 ( IL6 ) , tumor necrosis factor (TNF)α , ammonia and indole/oxindole . Patients were followed prospect ively for a median of 22 months in relation to the occurrence of death , transplantation and HE-related hospitalizations . Thirty-three patients had normal PHES and EEG , 6 had abnormal PHES , 18 abnormal EEG and 13 abnormal PHES and EEG . Patients with abnormal PHES had higher CRP ( 17 ± 22 vs 7 ± 6 , P < 0.01 ) , IL6 ( 32 ± 54 vs 12 ± 13 , P < 0.05 ) and TNFα ( 17 ± 8 vs 11 ± 7 , P < 0.001 ) levels than those with normal PHES . Patients with abnormal EEG had higher indole ( 430 ± 270 vs 258 ± 255 , P < 0.01 ) and ammonia ( 66 ± 35 vs 45 ± 27 , P < 0.05 ) levels than those with normal EEG . Psychometric test scores showed significant correlations with CRP , TNFα and IL6 ; EEG indices with ammonia and IL6 . CRP and TNFα concentrations were independent predictors of abnormal PHES , ammonia and indole of abnormal EEG on multivariate analysis . Seven patients were lost to follow-up ; of the remaining 65 , 20 died and 14 underwent transplantation ; 15 developed HE requiring hospitalization . PHES and EEG performance were independent predictors of HE and death ( P < 0.05 ) . CONCLUSION PHES and EEG abnormalities in patients with cirrhosis have partially different biochemical correlates and independently predict outcome OBJECTIVES : Cirrhotics with minimal hepatic encephalopathy ( MHE ) have a poor health-related quality of life ( HRQOL ) . Treatment of MHE is still evolving . The aim of this double-blind r and omized pilot study was to assess the efficacy of rifaximin in improving neuropsychometric ( NP ) test performance and HRQOL in patients with MHE . METHODS : MHE was diagnosed if any two NP tests ( number and figure connection tests , picture completion , digit symbol , and block design tests ) were deranged beyond 2 s.d . of normal . HRQOL was assessed using the sickness impact profile ( SIP ) question naire . RESULTS : A total of 486 patients with cirrhosis were screened and 284 were found eligible . Out of these 115 ( 40.9 % ) had MHE , of which 21 refused consent and 94 were r and omized to receive  placebo ( n=45 ) and rifaximin ( n=49 ; 1200 mg/day ) for 8 weeks . At the end of treatment , significantly more number of patients in rifaximin group showed reversal of MHE ( 75.5 % ( 37/49 ) vs. 20 % ( 9/45 ) in placebo group ; P < 0.0001 ) . Rifaximin group also showed significant reduction in mean number of abnormal NP tests ( baseline , 2.35 ( 95 % confidence interval ( CI ) , 2.17–2.53 ) ; 2 weeks , 1.29 ( 95 % CI , 1.02–1.56 ) , P=0.002 ; 8 weeks , 0.81 ( 95 % CI , 0.61–1.02 ) , P=0.000 ) , compared with placebo group ( baseline , 2.31 ( 95 % CI , 2.03–2.59 ) ; 2 weeks , 2.03 ( 95 % CI , 1.74–2.31 ) ; 8 weeks , 1.97 ( 95 % CI , 1.69–2.25 ) , P>0.05 ) . The mean total SIP score also improved significantly in rifaximin group ( baseline , 11.67 ( 95 % CI , 10.31–13.03 ) ; 8 weeks , 6.45 ( 95 % CI , 5.59–7.30 ) ; P=0.000 ) compared with placebo group ( baseline , 9.86 ( 95 % CI , 8.66–11.06 ) ; 8 weeks , 8.51 ( 95 % CI ,  
    Output:
    
Critical Flicker Frequency has a high specificity and moderate sensitivity for diagnosing minimal hepatic encephalopathy .